2017 EHP Weight Management Requirements Please be aware of the following requirements for the Nonsurgical Weight Management Coordinated Care Program. This information is important and should be read very carefully. The following Hurdles to Self Management Success apply for ALL Wt Mgmt enrollees:
· Cholesterol – LDL target ­ at or below 130mg/dL; (below 100mg/dl for individuals with diabetes and/or Coronary Artery Disease) o Under age 40, at least one screening; however repeat annually if elevated or on medication o Age 40 or over, one screening every 3 years; repeat annually if elevated or on medication
· Blood pressure at or below 140/90.
· In addition, the weight loss goals are based on your starting BMI: BMI 27 to 29.99
· Weight loss goal is 1 BMI point (approximately 7.5 pounds)
· Telephonic assessments are quarterly.
· 2 options available: a. Meet weight loss goal on your own or with one of the Tier 1 weight loss options OR b. Participate in the Physical fitness activity and meet physical fitness requirement for healthy individual ­ however you must not gain any weight. BMI 30 to 34.99
· Weight loss goal is 2 BMI points (approximately 15 pounds)
· Telephonic assessments are quarterly.
· All enrollees must participate in one of the following options a. Participate in EHP endorsed weight loss program – Any Tier 1 Program offered through Cleveland Clinic or may join Weight Watchers, Curves Complete or Curves Jenny ** OR b. Participate in the Physical fitness activity and meet physical fitness requirement for Weight Management
· A Nutrition consult* is encouraged during the plan year, but not mandatory. BMI 35 to 39.99
· Weight loss goal is 3 BMI points (approximately 22.5 pounds)
· Telephonic assessments are every six weeks.
· A Nutrition consult* is strongly encouraged during the plan year, but not mandatory.
· All enrollees must participate in one of the following options a. Participate in EHP endorsed weight loss program –Tier 1 Program offered through Cleveland Clinic or may join Weight Watchers, Curves Complete or Curves Jenny** OR b. Participate in the Physical fitness activity and meet physical fitness requirement for Weight Management BMI 40 or more
· Weight loss goal is 4 BMI points (approximately 30 pounds)
· Telephonic assessments are every month.
· All enrollees must participate in one of the following options a. Participate in EHP endorsed weight loss program –Tier 1 Program offered through Cleveland Clinic or may join Weight Watchers, Curves Complete or Curves Jenny OR b. Participate in the Physical fitness activity and meet physical fitness requirement for Weight Management
· New starts or participating members who have never had one in the past require a Nutrition consult* during the plan year. Nutrition visit is required once every two years.
Tier 1 Weight Management Programs: Any Cleveland Clinic Weight loss program including
· Shared Medical appointments for Weight loss, Registered Dietitian
· E­Coaching
· Eat Well program for individuals with BMI over 30
· Trim Life Weight loss program: NOTE Only Trim Life physician or Allied Health are covered. There is no coverage for hypnosis, acupuncture or yoga
· Functional Medicine Shared Nutrition Visits: Pilot program—Limited Availability **Weight Watchers and Curves Complete­­Cleveland Clinic will cover 50% of cost of program Physical Fitness Requirement Physical Fitness Options and Requirements for Healthy individuals or individuals with BMI<29.99 and in the Weight Management Program. 6 month participation and reaching requirements is required 1. Device must be linked to the Healthy Choice Portal to track physical activity. Per Month required 150,000 steps or 900 minutes of activity OR 2. Cleveland Clinic Fitness Center minimum of 10 times per month OR 3. Curves Fitness Center Minimum of 10 times per month*** Physical Fitness Options and Requirements for Members in Weight Management Program with a BMI 30 or greater. Minimum of 3 months participation and reaching requirements is required 1. Device must be linked to the Healthy Choice Portal to track physical activity. Per Month required 100,000 steps or 600 minutes of activity OR 2. Cleveland Clinic Fitness Center minimum of 10 times per month OR 3. Curves Fitness Center Minimum of 10 times per month*** *** Curves Fitness Center—Cleveland Clinic EHP will only cover 50% of cost of program Program for Pregnant Moms: Eat Well Moms (Should only be referred to the program during first trimester of pregnancy or must start program during the first trimester of pregnancy). NIH Guidelines for Weight Gain During Pregnancy
· Normal weight (BMI 18.5 – 24.9) single = 25­35lbs, twins = 37­54lbs
· Overweight (BMI 25­29.9) single = 15­25lbs, twins = 31­50lbs
· Obese (BMI 30+) single = 11­20lbs, twins = 25­42lbs 1. 2. More information on EHP programs and new programs added during the year can be found at www.clevelandclinic.org/healthplan Eat Well Moms Eat Well program is available for women in their first trimester of pregnancy. Contact your Care Coordinator to discuss and find out information regarding this. EHP/PZ, December 2016