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In what is being touted as a unique and groundbreaking initiative, the state of Tennessee is partnering with Weight Watchers to provide weight loss services to TennCare enrollees — adults and children — who are obese.

"We are not aware of any other Medicaid program that is doing a partnership like this with a commercial weight loss program," said TennCare's Marilyn Elam.

TennCare provides insurance coverage for 1.2 million people, and the bureau had reached a point of stability, after a rather unstable year, where it could begin to look at improving the quality of life for its enrollees. Since Tennessee ranks fifth in the U.S. in the rate of adult obesity, weight loss seems to be a good starting point.

"We wanted to not only provide that access to insurance, but also find ways to improve the quality of care and quality of life in general for the enrollees in our program," Elam said. "Obesity contributes to a number of disease states, some of which are ones we added to our medication short list such as asthma, heart disease and diabetes. All of these are complicated or brought on by obesity. The idea is that if we could attack that underlying cause or factor in those three high disease states, we could lower dependence on medications and improve overall health."

Weight Watchers was more than willing to come on board, according to Carolyn Kalil, vice president of Weight Watchers of Middle and East Tennessee.

"It has always been a dream of ours to work with people who are financially challenged and can't afford our fees. In a lot of the cases, this is not about losing vanity weight. It's not about losing 20 to 30 pounds for a class reunion. The people I'm talking to, it's now or never. It's exciting to go where we haven't gone before. It is a dream come true."

The partnership works fairly simply. TennCare enrollees who are technically considered obese can walk into any Weight Watchers office in the state and sign up for a 12-week program. They pay $1 per meeting and agree to attend at least 10 of the 12 meetings and to meet the initial minimum weight loss goal of four pounds. TennCare, in return, pays the $10 per meeting co-payment. Weight Watchers provides TennCare with a $1 per meeting discount and waives the $35 enrollment fee. If the enrollees meet these criteria, they can reenroll for another 12 weeks.

"From TennCare's perspective, for one 12-week program it's costing us $120 per enrollee, a minimal investment for proven results," Elam said. "If an enrollee sustains some modest weight loss, it will actually reduce an overweight person's lifetime medical costs up to $5,300 and that's by lowering the cost of treatment for things like hypertension, diabetes and heart disease."

Elam said she does not know how many people will take advantage of the program since TennCare does not track how many of its enrollees are obese, but Kalil said she has at least 100 people on the waiting list for the program, which gets started in January.

"What we do know, at $120 per enrollee we can easily absorb that into our current $8 billion budget," Elam said.

The Weight Watchers program is open to all TennCare enrollees with a BMI of 30 or more or who have a referral from their physician for a serious weight-related condition. Children must have a note of referral from their physician. Elam and Kalil say that while both TennCare and Weight Watchers stand to save money and make money respectively from the program, the quality of life issues of the enrollees are at the heart of the partnership.

"We see the fact if an enrollee can improve his health, that can save the state and TennCare dollars. More importantly, as a public healthcare insurance program, it is about improving quality of health and quality of life of the people we serve," Elam said.

Kalil concurs. "Our whole mission is to help people achieve better health. We do that on such a grand scale. We will see increased business, of course, but the ability to further help change people's lives is most important."

Across the state Weight Watchers holds about 1,000 meetings a week with three combined franchises. In Middle and East Tennessee, it runs about 500 meetings a week. Weight Watchers offers two food plans and relies heavily on weekly meetings and peer support. Kalil said she will be creating brochures and guidelines to help financially challenged individuals develop meal plans that work within budget constraints.

"All of the practical information is wonderful, but you can't beat the support," she said.

There are six main centers and hundreds of other locations that hold meetings. For the TennCare program, Weight Watchers hopes to hold meetings in neighborhoods currently without a Weight Watchers presence.

"The state has been so smart about how they have set this up in terms of incentives," Kalil said. "The people I've talked to who have inquired about the program have a substantial amount of weight to lose and are very motivated to do it."

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