The three videos in this section are designed to provide an overview of the Fit Family Challenge pilot project and the preparation needed to facilitate FFC group visits at your primary care practice. Narrated by Bonnie Jortberg, PhD, these videos provide healthcare providers and practices with valuable information that will help to transform the way they deliver pediatric obesity care.

Dr. Bonnie Jortberg served as the Principle Investigator for the Fit Family Challenge Pilot project. Ms. Jortberg holds a PhD and Master’s degree in Human Nutrition, is a Registered Dietitian, a Certified Diabetes Educator. She has devoted her professional career to doing translational research in disease prevention, specifically, diabetes, obesity, and cardiovascular disease.

Fit Family Challenge Pilot Project Overview

Fit Family Challenge Results Summary

Fit Family Challenge Group Visit Facilitation

Like all practice transformation efforts, the Fit Family Challenge program requires a sustained effort that is guided by a larger vision and commitment. Identifying change champions – at the project and organizational level – will critically support your efforts to implement the Fit Family Challenge. For clinicians and staff, the Fit Family Challenge can be a personal venture. Identify a champion to conduct an initial staff meeting to express the importance of pediatric obesity at your practice and the desire to implement the Fit Family Challenge as a team. The champion should emphasize the importance of Fit Family Challenge, demonstrate leadership, and work to increase buy-in. Make it a collaborative process. Your practice may want to form a committee to assist the champion in developing and implementing the project. Read more about the importance of a project champion.

HealthTeamWorks was founded as the Colorado Clinical Guidelines Collaborative (CCGC) to convene stakeholders to create evidence-based clinical guidelines for Colorado providers. HealthTeamWorks continues to develop new and revised guidelines as the foundation of quality care. When incorporated into practice using tracking forms, registries, electronic health records and work-flow redesign to maximize the abilities of the healthcare team, clinical guidelines support efficient, quality care.

Overview of the HealthTeamWorks Pediatric Obesity Guidelines

Download the HealthTeamWorks Pediatric Obesity Guidelines

Find supporting information for the HealthTeamWorks Pediatric Obesity Guideline

Why Screen?

The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to intensive counseling and behavioral interventions to promote improvements in weight status (grade B recommendation). Pediatrics 2010;125:361–367 Establishing routine screening for pediatric obesity risk factors in your practice will greatly benefit your Fit Family Challenge program. Not only will routine screening introduce and familiarize all families, regardless of weight status, on the importance of 5-2-1-0; but also, robust screening efforts will begin to build your referral base for your Fit Family Challenge program.

Screening Tools

All of the FFC pilot practices utilized the HeartSmartKids system to recruit and track their FFC participants. The HeartSmartKids system addresses three difficulties in confronting childhood cardiovascular risk (CVR) factors: acquiring timely patient data, efficient data presentation, and patient counseling on modifying unhealthy behaviors.

Contact the HeartSmartKids team to find out more about bringing this innovative tool to your practice.

This Enduring Material activity, Fit Family Challenge Motivational Interviewing eModules, has been reviewed and is acceptable for up to 2.50 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 10/01/2014. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity

Open Ended Questions Activity

Evaluation

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Kaiser Permanente

Change Talk – Pediatric Obesity

Fit Family Challenge is now a reimbursable benefit for Colorado HealthOP members.

Billing and Coding with Other Providers

Group visits are not specifically covered by most private health insurance plans because billing codes for group visits are not established. It has been recommended that group visits be billed as individual office visits, using existing CPT codes (e.g., 99212 to 99214, depending on the level of care provided). CPT codes should be chosen based on the level of complexity of the individual visit and not on length of time spent with the patient in the group education session; time can be used as a controlling factor when counseling dominates individual visits but not when it is shared in a group context. Physicians should inquire whether their health plans have group visit billing policies. Completing forms and reviewing charts prior to the group visits facilitates the documentation of complexity levels after the encounters. Physicians might also be able to obtain reimbursement for time spent outside of the individual visits in group education and behavioral change coaching. Group sessions are time-intensive and often require preparation and updates. They could be billed with modifier -25 in addition to the E/M code for the individual visit. The additional code would be either for preventive medicine group counseling, such as 99411 or 99412, or for physician educational services in a group visit setting, such as 99078. However, managed care companies that provide reimbursement for this code do so mostly for diabetes-related education. Using these codes may require patients to pay out-of-pocket for these services, in addition to paying the co-pay required at each visit. Therefore, some practices refrain from using them, but we remain hopeful that insurance companies will cover these codes in the future. If your group visits include the services of nutritionists or a behavioral health specialist, contact payers to determine if that portion of the group visit can be directly billed by the non-physician provider. This typically would include codes for medical nutrition therapy (97804) or health and behavior intervention (96153). Other codes that may be applicable are the codes for education and training for patient self-management involving a standardized curriculum (98961-98962). Neither these codes nor medical nutrition or behavioral health therapy are billed by physicians. Physicians must use evaluation and management codes to report these services. Code 99078 describes physician educational services in a group. Again, it is necessary to contact the payer to verify that coverage of this service is a payable benefit. As with many services, coding for group visits requires that billing and coding staff do preliminary work with payers to identify desired coding applications.

More Coding Resources 

Group visits offer staff a new and more satisfying way to interact with patients that makes efficient use of resources, improves access, and uses group process to help motivate behavior change and improve outcomes. The slide deck provides an outline of FFC Group Visit as well as an an overview of the skill set needed to facilitate FFC Group Visits.

Fit Family Challenge Care Manager Guide to Weekly Contact

As part of the Fit Family Challenge, the designated Care Manager (CM) contacts each child/parent on a weekly basis to follow up on action plan goal progress, and any questions or concerns about the program. The CM and the child-parent will determine the method of contact (phone, email, or text message) at the baseline visit. The method can be adjusted as needed.

Phone Contact

Please note the following recommendations with phone contact:

• Use your clinic phone number (avoid using personal phone)
• If the patient/child asks you a medical question, please follow your clinic’s policy on setting up an appointment. This is not meant to be a mechanism to answer other medical questions.
• Starting the conversation can be difficult – and the guide below is intended to give the CM some language to use for communication with the child/parent.
• Recommendations for Dialogue
• Hello (child/parent name). It is nice to speak with you today. I want to check in to see how things are going with your goal of increasing/decreasing (how many fruits and vegetables you eat every day; how much physical activity; screen time; sugar sweetened beverages).
• Tell me about how things are going.
• What do you think is going well with your goal? <
• What are some challenges? What are some things that you can do to help overcome these challenges?
• It has been great to touch base with you today.
• Reset action plan goal: It sounds like you are doing well trying a new vegetable each week and increasing your vegetable intake by a serving each day. How do you feel about increasing by another serving?
• If not meeting goal: It sounds like there have been the following challenges to meeting your goal of increasing your vegetable intake (reflect back challenges). What are your thoughts about your action plan goal? Do you want to keep it the same, change it, or change to another goal? As a reminder, we will be talking again next week (day/time). Does this still work for you? Please remember that you can call me at any time if you have other questions. Have a great week and talk to you soon.

Email Contact

Please note the following recommendations with email contact:

• Use your clinic email account (avoid using personal email addresses)
• If the patient/child emails you with a medical question, please follow your clinic’s policy on setting up an appointment. This is not meant to be a mechanism to answer other medical questions.<
• Put something the child/parent will recognize in the Subject line:
• Fit Family Challenge Weekly Update
• (Clinic Name) Weekly Update
• Fit Family Challenge/Clinic Name Action Plan
• Recommendations for Email Content
• Hi (insert child/parent name)-
• I’m so excited to have you participate in the Fit Family Challenge! You seemed motivated to make some changes to (insert fruit/vegetable; physical activity; etc) when we met last week. I’m checking in to see how things are going. Can you please reply back and answer some questions for me? This will help me to see if we need to make any adjustments to your action plan.
• What do you think is going well with your goal?
• What are some challenges?
• What are some things that you can do to help overcome these challenges?
• Do you want to change your goal (increase/decrease or change to another goal)? If yes, please tell me why.
• As a reminder, I appreciate a response by tomorrow (insert date) so that I can do my best to help you with anything you need to be successful with this program. We will also correspond by email next week as well.
• Healthy regards,
• (insert name)

Text Message Contact

Please note the following recommendations with text message contact:

• Use your clinic email account to text message participants (avoid using personal cell phone)
• If the patient/child text messages you with a medical question, please follow your clinic’s policy on setting up an appointment. This is not meant to be a mechanism to answer other medical questions.
• Put something the child/parent will recognize in the Subject line:
• Fit Family Challenge Weekly Update\
• (Clinic Name) Weekly Update
• Fit Family Challenge/Clinic Name Action Plan
• Recommendations for Text Message Content
• Hi (insert child/parent name)! How are you this week? Please let me know how you’re doing with you’re action plan goal this week. Thx! (insert your name)

Instructions for sending SMS test through Gmail:

• http://www.google.com/mobile/sms/mail/
• http://www.google.com/mobile/sms/mail/

FAQs

What do I do if the child/parent does not respond to my contacts?

• Try using another method. If they chose email but are not responding, send them a text message or give them a call. If they still don’t respond, note this on your data sheet and try again the following week.

As the designated Care Manager for the FFC, am I the only one in the office who can contact the child/parent?

• For continuity and relationship-building, it is recommended that the CM is the main contact for the child/family. However, if the CM is on vacation or out-of-the office, then another designated person in the office can contact the child/family

Compile a community resource list that will help your families achieve the 5-2-1-0 model.

Having a simple list – even of the obvious resources- on one page can help facilitate discussions by all types of staff with families. It can be a great task for a front desk staff person who often enjoys the idea of helping to connect families to programs and opportunities.

Types of community resources to include:

• LiveWell Colorado
• Farmers markets
• Rec center programs
• Healthy restaurant deals in the community<
• National and state parks in the region that may have special deals for families
• Community Gardens
• Churches
• Chamber of Commerce
• Rotary/Lions/Elks
• Food pantries
• YMCA
• Open Gym times at schools
• Local sports leagues
• Things sponsored by libraries (e.g., cooking classes)
• Things sponsored by businesses (e.g., some healthy stores offer free or low cost cooking classes)
• Activities sponsored by families in the FFC project perhaps – for example a mom who modifies favorite family recipes offers to lead a cooking class at the clinic or another community location)
• Reduced cost programs for kids and families (sports, swim lessons, bike rentals, rec center memberships, etc.)
• Books at the library (e.g. cookbooks FOR kids, fun cookbooks for families)

Be a community advocate—You and your practice staff can be an effective advocates in your community for improving your healthy active living environment. For example you could join existing coalitions or start new ones, participate in parent teacher organizations, and/or write letters to your local and state elected officials. You can even be an advocate for what seem like small issues e.g. what foods a food bank offers, free or low-cost sports and activity programs for families, etc.

Family physicians and their practice teams play a vital role in encouraging patients to lead healthy lives through physical activity, healthy eating and emotional well being — that is, through fitness. Your practice has taken a major step toward improving your patients’ fitness by participating in Fit Family Challenge. Raising awareness among clinicians and office staff regarding their own personal physical activity, healthy eating, and emotional well-being, and encouraging everyone to make changes for better health will help create an office environment that is conducive to integrating Fit Family Challenge concepts in everyday office routines. There are numerous ways to develop and establish a fitness culture in your practice. The important part is getting the entire staff thinking and talking about fitness among themselves and with patients.

Examples of how to demonstrate your fitness culture include:

• Wearing identity items (t-shirts, pedometers, buttons) that promote fitness and elicit questions from patients.
• Placing visual cues, such as posters, placards and table tents, that show fitness is a priority for the practice.