for providing nonsurgical obesity interventions. Many primary care offices, there- fore, have added allied health providers, such as RDNs, exercise specialists, and behavioral health providers to their clinical staff in order to adhere to current CMS reimbursement requirements. Although primary care faces many challenges in terms of staffing and providing adequate patient support, studies have shown that primary care offices can be ideal locations for weight management care.36-38 Resources are available for primary care providers to better integrate weight man- agement services into their practice and to develop forward-thinking models of weight management care.39


Methods of integration include adding systems for


screening and diagnosis, providing a built environment that is weight inclusive, and establishing training and policies for staff regarding obesity and weight bias.40


Service Line Models


A service line model is an approach to care in which the provision of health services is organized by the type of disease. In this model, all the clinicians who serve as a part of the patient care team are housed within the same administrative system or department according to the disease being treated. This type of care is most com- monly seen in fields such as oncology, transplantation, or orthopedics. Service line approaches center the patient experience in one place, unlike traditional health care models that require patients to visit multiple providers in different locations (each with their own administrative support).41


With the recognition of obesity as


a complex metabolic disease, more health care systems are shifting to this model for obesity care, thus allowing all members of the care team to work and com- municate in the same space and eliminating many of the administrative hurdles of siloed interprofessional care. In comprehensive, dedicated weight management centers, multiple services (nutrition, physical activity, behavioral health, surgery, pharmacotherapy) are offered to patients in one system or location. This model can be extended to create similar systems within private practice groups, by having complementary health care providers partner with each other within the practice. This can take the form of shared partnership or ownership of the practice, shared physical space, or even coordinated locations and referral systems.


Shared Medical Appointments


In a shared medical appointment, an individual patient sees more than one health care practitioner during a single encounter. This may include any mix of members of the health care team. Shared appointments are most commonly employed in the bariatric-surgery setting, where patients may often see an RDN, a behavioral health provider, and an exercise specialist all during their scheduled appointment with their surgeon or surgical advanced practice provider. This model promotes improved com- munication, greater patient satisfaction, and greater weight loss.42


A study comparing


2-year weight loss outcomes of patients who attended individual obesity-treatment visits vs shared visits (involving multiple providers and group visits) at an academic medical center found that patients attending shared visits experienced 1.5% to 1.6% greater total weight loss compared to patients who saw care team members individu- ally.42


However, practitioners should be aware of the increased complexity of shared


visits and be able to adjust their approach to align with care being provided simul- taneously by other team members. In addition, clinicians should work with their administrative teams to optimize billing practices, as many payers do not reimburse for multiple visits in the same practice on the same day.


342 SECTION 4: Models and Insurance Coverage for the Treatment of Obesity


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