Presented by: Healthcare Outcomes and Analysis LA Care Health Plan

1. Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Presented by: Healthcare Outcomes and Analysis LA Care Health Plan September 30, 2010

2. Presentation Purpose: • Best Practices for documenting record for the new • measure “Weight Assessment and Counseling • for Nutrition and Physical Activity for • Children and Adolescents (WCC)” • Proper documentation of WCC visit(s) reflect a better • quality of care for patients and a positive feedback for • providers’ participation to encourage children and • adolescent wellness.

3. WCC - Background: • Obesity In Children and Teens • The problem of childhood obesity in the • United States has grown considerably in recent • years. • Statistics/Facts: • Between 16 and 33 percent of children and • adolescents are obese. • Obesity is among the easiest medical conditions to • recognize but most difficult to treat. • Unhealthy weight gain due to poor diet and lack • of exercise is responsible for over 30,000 deaths • each year. • The annual cost to society is estimated at nearly $100 billion. • Overweight children are much more likely to become overweight adults unless • they adopt and maintain healthier patterns of eating and exercise.

4. WCC – Background (contin.): According to a study conducted by CDC in 2004, 16% of children (over 9 million) 6-19 years of age are overweight or “obese.” This number is three times the population in 1980. 1 In addition to the three-fold increase, obesity has “more than doubled” in both children and adolescents from ages 2-5 and also ages 12-19. Similarly, the population more than tripled in children between 6-11 years old in the past three decades (according to this same study). 2References:1. Obesity In Children and Teens, American Academy of Child and Adolescent Psychiatry, May 20082.Prevalence of overweight and obesity among children and adolescents: United States, CDC, 2004

5. WCC – Background (contin.): • Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC): • Is one of the newest HEDIS measures developed by the National Committee for Quality Assurance (NCQA) • The measure consists of three (3) indicators: • Body mass index (BMI) • Counseling for Nutrition • Counseling for Physical Activity

6. WCC - Body Mass Index (BMI) Indicator Documentation: • Body Mass Index – documentation in the medical record should include date and BMI percentile &/or value depending upon the child’s age • BMI norms vary for children between • the ages 3 to 15 years, so the BMI • percentile should be recorded, not • just the value. • For 16-17 years of age, BMI value is • acceptable.

7. WCC - BMI Indicator Calculation:The formula used to calculate BMI is as follows: Weight in PoundsBMI = ( (Height in inches) x (Height in inches) )x703The pediatric height and weight charts can be found on the CDC website at:http://www.cdc.gov/growthcharts/data/set1clinical/set1color.pdf

8. WCC - Counseling for Nutrition Indicator Documentation: 2. Counseling for Nutrition • Documentation must include a note indicating the date and • at least one of the following: • Discussion of current nutrition behaviors • (e.g., eating and dieting behaviors) • Checklist indicating nutrition was assessed • Counseling or referral for nutrition education • Member received educational materials on nutrition • Anticipatory guidance for nutrition

9. WCC - Physical Activity IndicatorDocumentation: • Counseling for Physical Activity • Documentation must include a note indicating the date • and at least one of the following: • Discussion of current physical activity behaviors • (e.g., exercise routine, participation in sports • activities and exam for sports participation) • Checklist indicating physical activity was addressed • Counseling or referral for physical activity • Member received educational materials on physical • activity • Anticipatory guidance for physical activity

10. WCC – Best Practices for Documentation: • BMI Don’ts • No BMI or BMI percentile documented in the medical record or plotted on age-growth chart • Notation of height and weight only • BMI or BMI percentile noted before or after the measurement year • Entries on the BMI growth charts without an affiliated date • Nutrition and Diet Don’ts • No counseling/education on nutrition and diet • Counseling/education before or after the measurement year • Notation of “health education” or “anticipatory guidance” without any specific mention of nutrition

11. WCC – Best Practices for Documentation (contin.): • Physical Activity Don’ts • No counseling/education on physical activity • Notation of “cleared for gym class” alone without any documentation of a discussion • Counseling/education before or after the measurement year • Notation of “health education” or “anticipatory guidance” without any specific mention of physical activity

12. WCC – Best Practices for Documentation (contin.): • Take advantage of any type of member visit, whether it’s for a well-child visit or sick visit to assess and counsel your patient on their BMI, nutrition, and physical activity.

13. For questions, please contact: Carina Yapyuco, RNcyapyuco@lacare.orgTheresa Colom, LVNtcolom@lacare.org