Obesity is a complex, multifaceted, chronic disease. Environmental, metabolic, behavioral, and genetic factors can all affect obesity. A study by the Robert Wood Johnson Foundation found that obesity contributes to nearly 1 in 5 deaths in the United States.1 The ranges are determined by using the “body mass index” (BMI) since BMI provides the most useful population-level measure of overweight and obesity.1 Careful monitoring of BMI will help health care providers identify adults who are at risk and provide focused advice and services to help them reach and maintain a healthier weight. It also ties to NCQA ratings and is a HEDIS measure.


What is the HEDIS measure?

The percentage of members 18 – 74 years of age who had an outpatient visit and whose body mass index was documented during the measurement year or the year prior to the measurement year. To get HEDIS credit a patient’s medical record needs to include height, weight, calculated BMI, and date of service.2 BMI documentation is commonly overlooked, which prevents the documentation from meeting criteria for this measure.


Continued management and diverse pathways to care are essential in controlling BMI. While it is extremely beneficial for the patient to have continuous management, it also benefits our providers. As HEDIS rates increase, there is potential for the provider to earn maximum or additional revenue through Pay for Quality, Value Based Services, and other pay-for-performance models.3


Tips for talking with patients4

  • Reinforce importance of lifestyle changes such as being active or making dietary choices that lead to weight loss and improve overall health
  • Encourage patient to set goals regarding his or her weight
  • Discuss weight loss medications for people with health problems related to excess weight
  • Consider bariatric surgery for patients who:
    • Continue to have severe obesity (BMI greater than 40 kg) after trying lifestyle changes to lose weight
    • Have a BMI greater than 35 kg and have one or more chronic conditions linked to obesity


1 https://www.ncqa.org/hedis/measures/adult-bmi-assessment/


3 https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/value-based-programs.html

4 https://www.niddk.nih.gov/health-information/weight-management/talking-adult-patients-tips-primary-care-clinicians


Featured In:
June 2019 Anthem Connecticut Provider Newsletter