1. Comorbidities, Health Care Use, Health Care Costs, and Health Behaviors by BMI Suzanne M. Goodwin Doctoral Candidate Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health sgoodwin@jhsph.edu AcademyHealth Annual Research Meeting June 10, 2008

2. 2 Obesity in the U.S. 34% of adults in U.S. are obese (BMI30 kg/m 2 ) Obese persons generally have more comorbidities and higher health care costs and utilization than nonobese

3. 3 JHU-BCBS Patterns of Obesity Care Study Partnership with Johns Hopkins University, Blue Cross Blue Shield Association, and 7 BCBS plans Evaluate health care utilization, cost and obesity treatment outcomes among 7 BCBS plans 2002-5 claims data on selected plan enrollees –Health Risk Assessment data from 3 plans

4. 4 Study Purpose To assess the association between BMI and comorbidities, health care utilization, health care costs and health behaviors among a large cohort of individuals enrolled in 3 BCBS plans *** Preliminary results – work in progress ***

5. 5 Study Sample 71,058 unique HRA respondents –56% female –Mean age: 48.8 years Exclusions –Missing height or weight –10<BMI<70 –Age <18 –Pregnancy within 1 year of HRA completion year –<6 months plan enrollment in HRA completion year –Extra HRA records for same person –Bariatric surgery patients

6. 6 Study Data Members HRA data combined with their claims data for same year HRA data –Height and weight to calculate BMI –Self-reported health behaviors (e.g., smoking, alcohol use, exercise) Claims data –ICD and CPT codes –Paid costs

7. 7 BMI Distribution Mean BMI = 26.7

8. 8 Comorbidities by BMI Prevalence Odds Ratio Ref: normal adjusted for sex, age, plan site, and plan type * p<0.05 * * * * * * * * *

9. 9 Comorbidities by BMI Prevalence Odds Ratio Ref: normal adjusted for sex, age, plan site, and plan type * p<0.05 * * * * * * * * *

10. 10 Hospital Stay by BMI Odds Ratio Ref: normal adjusted for sex, age, plan site, plan type, and 6 comorbidities * p<0.05 * * *

11. 11 Health Care Costs by BMI Standardized Mean Costs based on RVUs

12. 12 Health Behaviors by BMI

13. 13 Health Behaviors by BMI Ref: normal Adjusted for sex, age, plan site, and plan type * p<.05 * * * * * * * Odds Ratio Exercise Smoking Alcohol

14. 14 Strengths and Limitations Largest and most current database that has been used for this type of study HRA data –Self-reported height, weight and health behaviors –Survey instruments Claims data –Unreported comorbidities and health care services Single BMI measurement, one year of claims data

15. 15 Conclusions Obese more likely to have comorbidity, be hospitalized, have higher health care costs, and engage in unhealthy behaviors Findings will help: –Health plans better understand how obesity is affecting their members' health and use of health care resources as well as the impact of obesity on their costs –Providers, health plans, and employers identify which conditions to focus on for disease prevention and management programs

16. 16 Acknowledgements Johns Hopkins University – Jonathan Weiner, Jeanne Clark, Hsien-Yen Chang, Tom Richards, Andrew Shore, Shari Bolen BCBS Association – John Newman, Greg Wozniak, Nadine Caputo, Mary Madison BCBS plans – BCBS of Tennessee, BCBS of Hawaii, BCBS of North Carolina, BCBS of Michigan, Independence Blue Cross, Highmark, Wellmark Funders – J&J Ethicon Endo-Surgery, Pfizer, GlaxoSmithKline