Cara Orfield

Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community-Based Recommendations and Interventions

Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.

CHIP and Medicaid: Evolving to Meet the Needs of Children.

OBJECTIVE To examine the evolution of Childrens Health Insurance Program (CHIP) and Medicaid programs after passage of the Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA), focusing on policies affecting eligibility, enrollment, renewal, benefits, access to care, cost sharing, and preparation for health care reform. METHODS Case studies were conducted in 10 states during 2012-which included key informant interviews and consumer focus groups-and a national survey of state CHIP program administrators was conducted in early 2013. RESULTS Despite the recession that persisted during much of the study period, many states expanded childrens coverage by raising upper income eligibility limits or by covering new groups made eligible by CHIPRA. Simplifying rules and procedures for enrollment and renewal continued to be a major priority for CHIP and Medicaid, and CHIPRA played a direct role in spurring innovation. CHIPRAs outreach grants played an important role in supporting and supplementing state outreach efforts. Important legacies of CHIPRA are the laws mandatory requirements for comprehensive dental benefits coverage and mental health parity for all types of CHIP programs. Although most states already offered generous coverage of these benefits, the mandate may have protected them from cuts during the economic downturn. Federal Maintenance of Effort rules were a crucial protection for CHIP, especially during the recession when state budget shortfalls could have led to program cuts. CONCLUSIONS Passage of the Affordable Care Act has raised questions surrounding the future role of CHIP in a reformed health care system. A growing number of stakeholders have recommended a 2-year extension of federal CHIP funding to allow complex transition issues to be resolved.

The Affordable Care Act and Access to Care for People Changing Coverage Sources.

OBJECTIVES We investigated how access to and continuity of care might be affected by transitions between health insurance coverage sources, including the Marketplace (also called the Exchange), Medicaid, and the Childrens Health Insurance Program (CHIP). METHODS From January to February 2014 and from August to September 2014, we searched provider directories for networks of primary care physicians and selected pediatric specialists participating in Marketplace, Medicaid, and CHIP in 6 market areas of the United States and calculated the degree to which networks overlapped. RESULTS Networks of physicians in Medicaid and CHIP were nearly identical, meaning transitions between those programs may not result in much physician disruption. This was not the case for Marketplace and Medicaid and CHIP networks. CONCLUSIONS Transitions from the Marketplace to Medicaid or CHIP may result in different degrees of physician disruption for consumers depending on where they live and what type of Marketplace product they purchase.

The Healthy Weight Collaborative: Using Learning Collaboratives to Enhance Community-based Prevention Initiatives Addressing Childhood Obesity

This report from the field describes the design, implementation, and early evaluation results of the Healthy Weight Collaborative, a federally-supported learning collaborative to develop, test, and disseminate an integrated change package of six promising, evidence-based clinical and community-based strategies to prevent and treat obesity for children and families.

Addressing Childhood Obesity Through Multisector Collaborations: Evaluation of a National Quality Improvement Effort

The Healthy Weight Collaborative (HWC) represents a national quality improvement effort to increase uptake of evidence-based community-based interventions to address obesity among children. Implemented from 2011 to 2013, the HWC built the capacity of 49 community-based multisector teams (10 teams in the Phase 1 pilot, 39 teams in Phase 2), delivered services to support health behavior changes in children and families, and implemented sustainable social and environmental policy change at the organizational and community levels. Phase 2 teams participated in three virtual collaborative learning sessions interspersed with three “action periods” during which teams implemented the HWC “change package” while receiving tailored coaching and peer-support. All of the teams participating in Phase 2 adopted a healthy weight message, 59% implemented community-wide healthy weight assessments and healthy weight plans, and 31% made progress toward developing and implementing policies to promote healthy weight. By the end of the project, one-third of teams had developed sustainability plans to continue working with this approach. The HWC offers a collaborative team model with the potential to effectively address other public health challenges.