Coverage for Obesity Prevention & Treatment Services: Analysis of Medicaid & State Employee Health Insurance Programs

BACKGROUND Despite the high prevalence of obesity among U.S. adults, coverage for evidence-based obesity treatment modalities is inconsistent across states. The primary objective of this study was to examine changes in coverage for adult obesity prevention and treatment services within Medicaid programs and state employee health plans between 2009 and 2017. METHODS Changes in coverage were assessed by comparing data from plan year (PY) 2016/2017 to baseline data collected during PY 2009/2010. Data were obtained through an extensive review of administrative documents, health plan websites, provider manuals, subscriber handbooks, fee schedules, and drug formularies from Medicaid and state employee health insurance programs in all fifty states and the District of Columbia. Source materials were reviewed for indications of coverage and payment policies specific to evidence-based treatment modalities for adults (≥ 21 years of age) with obesity, including behavioral/nutritional counseling, pharmacotherapy, and bariatric surgery. RESULTS Like 2009, state programs were most likely to cover bariatric surgery and least likely to cover pharmacotherapy for members with obesity. Evidence of coverage for adult obesity treatment modalities increased in both Medicaid and state employee programs between 2009 and 2017, with more changes observed among state employee programs. The proportion of state employee programs indicating coverage increased by 37% for behavioral/nutritional counseling, 20% for pharmacotherapy, and 16% for bariatric surgery. The proportion of Medicaid programs indicating coverage increased by 18% for behavioral/nutritional counseling, 4% for pharmacotherapy, and 8% for bariatric surgery. CONCLUSIONS Our findings suggest that some states have bolstered coverage for evidence-based obesity treatment modalities in recent years. However, many states continued to deny reimbursement for non-surgical obesity treatment options that are supported by clinical consensus recommendations. Unclear guidance on what constitutes appropriate and reimbursable care for obesity-related services within Medicaid and state employee health programs likely prevents providers from referring highly-motivated beneficiaries with obesity to effective care. Where reimbursement for evidence-based obesity treatments has expanded, educating providers and beneficiaries on the availability and proper utilization of these services may improve obesity-related health outcomes

Weighing the costs and benefits of climate change to our children

Our efforts to put the brakes on climate change or adapt to a warming climate present a fundamental tradeoff between costs borne today and benefits that accrue to the children and grandchildren of the current generation. In making investments today that affect future generations’ prospects, we need to think carefully about how we value their welfare compared to our own. A common economic formula recommends giving up only 5 cents today for every dollar of benefits 100 years in the future; we call this discounting the future. Underlying this approach is the assumption that future generations will be much better off than our own, just as we are much wealthier than our ancestors were. Would our descendants’ agree with this approach? Are there reasons to put more value on future benefits? William Pizer, Ben Groom, and Simon Dietz discuss three possible reasons that we might put a higher value on future benefits. First, people disagree considerably about the correct discount rate. Other plausible interpretations of society’s preferences or observed data could increase the weight we place on future benefits by as much as a factor of five. Second, we may have failed to correctly value future climate change impacts, particularly those related to the loss of environmental amenities that have no close monetary substitutes. Third, we may not be properly valuing the risk that a warming climate could cause sudden and catastrophic changes that would drastically alter the size of the population. Ultimately, the authors write, many of the choices about how we value future generations’ welfare come down to ethical questions, and many of the decisions we must make come down to societal preferences—all of which will be difficult to extract from data or theory

Assessment of the Small-scale Food Processing Subsector in Tanzania and Uganda

Assessment of the Small-scale Food Processing Subsector in Tanzania and Ugand

2-(3-Pyrrolin-1-yl)-1,4-naphthoquinones: Photoactivated Alkylating Agents

The preparation of 2-(3-pyrrolin-1-yl)-1,4-naphthoquinones and a study of their use as photoactivated alkylating agents is reported. The title compounds were easily synthesized by conjugate addition of the corresponding 3-pyrrolines to various naphthoquinones. Upon exposure to ambient room light, the compounds undergo an internal redox reaction to form 2-(pyrrol-1-yl)-1,4-hydroquinones, which are activated for nucleophilic addition by an S N 1 azafulvene mechanism. Control experiments demonstrated that the redox reaction is triggered by light and that the nucleophilic addition does not proceed before this activation occurs.(© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2008)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60962/1/4264_ftp.pd

Altitude-wind-tunnel investigation of Westinghouse 19B-2, 19B-8, and 19XB-1 jet-propulsion engines III : performance and windmilling drag characteristics

The performance characteristics of the 19B-8 and 19XB-1 turbojet engines and the windmilling drag characteristics of the 19B-8 engine were determined in the NACA Cleveland altitude wind tunnel. The 19B engine is one of the earliest experimental Westinghouse axial-flow engines. The 19XB-1 engine is an experimental prototype of the Westinghouse 19XB series, having a rated thrust of 1400 pounds. Improvements in performance and operational characteristics have resulted in the 19XB-2B engine with a rated thrust of 1600 pounds. The investigations were conducted on the 19B-8 engine at simulated altitudes from 5000 to 25,000 feet with various free-stream ram-pressure ratios and on the 19XB-1 engine at simulated altitudes from 5000 to 30,000 feet with approximately static free-stream conditions. Data for these two engines are presented to show the effect of altitude, free-stream ram-pressure ratio, and tail-pipe-nozzle area on engine performance