Comparative Effectiveness, 2009

Iowa Medicaid Enterprise

March 2009

When the Iowa Medicaid Enterprise revised its bariatric surgery policy, it used research from AHRQ's Evidence Report No. 103, Pharmacological and Surgical Treatment of Obesity.

Thomas Kline, D.O., Medical Director, Iowa Medicaid Enterprise, and member of the AHRQ-sponsored Medicaid Medical Directors' Learning Network, notes that reviewing the successful outcomes from the AHRQ literature review on bariatric surgery helped re-affirm the importance of coverage for this procedure. In addition, the evidence report helped guide a policy revision to better prepare patients both before and after the surgery for improved long-term outcomes.

The AHRQ-sponsored Medicaid Medical Directors' Learning Network meeting held in November 2005 featured a session on bariatric surgery. The presentation highlighted selected key findings from the AHRQ evidence report, including the impact of dietary interventions on post-surgery weight maintenance and a discussion of the clinical outcomes for bariatric surgery.

As a result of this presentation on bariatric surgery coverage policies and the experiences of other States, Iowa initiated a policy change that requires patients to have a six-month period of dietary counseling in primary care before becoming eligible for bariatric surgery. Although the previous Iowa policy required two years of conservative treatment with numerous dietary attempts—diaries, charts, and supplements—prior to bariatric surgery, the policy was not well implemented, nor necessarily effective.

Iowa Medicaid Enterprise records demonstrate how inefficient the pre-surgery requirements were prior to the policy change. The records showed numerous requests for surgical revisions and even second revisions. Patients reported the requirements were time-consuming, and Kline said that the requirements were not well received by providers.

With support from the AHRQ resources, the Iowa Medicaid Enterprise decided to shorten the time frame for pre-surgery preparations by focusing on post-operative dietary requirements and behavioral changes. Kline states, "If we supported, promoted, and required this conservative dietary period, patients would have a better understanding of the post-operative dietary requirements needed and therefore would be less likely to revert back or 'eat through' their surgery and need to have it revised."

Following implementation of the new policy in 2006, the need for surgical revisions has essentially been eliminated. Kline notes, "In the last three years, we haven't had a request for a revision of any surgery we approved."

Kline reports that he feels fortunate to have had access to AHRQ resources as the Iowa Medicaid Enterprise continually strives to better manage patient health care. He notes, "We're further ahead than [we would be] had we not participated in the AHRQ Learning Networks and had access to the AHRQ resources. The combination of the latest research, in concert with opportunities to discuss its applications with State peers, has been invaluable."

Impact Case Study Identifier: KT-COE-05
AHRQ Product(s): Medicaid Medical Directors' Learning Network, Evidence Report
Topic(s): Obesity, Policy, Medicaid
Scope: Iowa

Pharmacological and Surgical Treatment of Obesity, Summary. Evidence Report/Technology Assessment Number 103. July 2004. AHRQ Publication No. 04-E028-1. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcsums/obesphsum.htm

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