With a passion for making healthcare work better for everyone, Anita has dedicated over 29 years helping organizations bring data, insights and innovation to key stakeholders to improve care. Prior to joining Lark, she led Payer & Provider Strategy at IBM Watson Health after their 2016 acquisition of Truven Health where she was Senior Vice President of Strategy and Business Operations. Earlier in her career, she also worked at Medecision, Aetna and Watson Wyatt. Anita earned a Master of Health Administration and a Bachelor of Science in Biology from The Pennsylvania State University.
There’s no doubt that 2024 will be a challenging year for employers. Healthcare costs in the U.S. continue to rise, with some estimates showing they could increase by 7%1. Traditional levers like deeper provider discounts and cost-shifting to employees to manage cost trends are no longer viable. In fact, 45% of employers say they will avoid increasing cost-sharing next year2. Plus, provider shortages and greater costs of goods and services are preventing providers from increasing their discounts for volume.
In addition to these challenges, employers are trying to figure out how to manage the demand for GLP-1 drugs—and they’re growing concerned. According to a recent survey by Business Group on Health, 92% of large employers say they are concerned about high drug costs as a larger driver of healthcare cost trends. Additionally, there are newer GLP-1 drugs coming including oral form. Employers are looking closely at ways to manage the demand for these drugs.
The High Cost of Obesity and GLP-1s
With nearly 42% of Americans3 who have obesity, employers have been grappling with the high costs of managing this population for quite some time.
A 2021 study4 in the Journal of Occupational and Environmental Medicine found that annual productivity loss due to obesity-related issues can be as high as $542 per employee. Higher medical spending, more sick days, short-term disability, workers’ compensation claims, and absenteeism are all contributing factors for lost productivity from obese employees.
While GLP-1s for weight loss are effective, striking a balance between addressing their chronic disease populations and managing the high cost of these drugs will be critical to their bottom line. Here are 3 ways for employers to manage the demand.
1. Provide support for employees who are already taking GLP-1s
Provider shortages have resulted in shorter doctor visits with less opportunity for your employees to get the guidance and support they need to manage GLP-1 drugs. Employees who take GLP-1s for diabetes or weight loss, or those who will qualify for the drugs in the future will need help with medication adherence and managing side effects.
A personalized digital care program that focuses on behavior and lifestyle interventions through remote patient monitoring and connected devices, and includes nutrition counseling and personalized coaching for weight loss and medication adherence can complement traditional, in-person care. Coaching can also help people manage side effects such as GI distress by making diet modifications5 like reducing meal size and avoiding high-fat and spicy foods.
2. Offer the entire employee population access to a healthy weight program
The decision to cover GLP-1s only for those with diabetes, or for those with obesity as well, is a challenge. Your team must consider costs, outcomes, ROI, and work with your PBM and payers to adjust your strategy. In the meantime, your employees, regardless of their health status, need support.
By offering your entire employee population a scalable digital healthy weight program, all employees can get the care they need to support their health goals. If you decide to cover GLP-1s in the future, your employees will be equipped to start treatment and achieve long-term, sustained weight loss.
A holistic solution that provides support for employees whether or not they are taking GLP-1s also provides a consistent experience, streamlines benefits, and prevents point solution fatigue.
3. Add clinician-guided step therapy for expanded GLP-1 coverage
Providers in your network lack transparency into coverage policies and criteria for these new weight loss drugs. With only about 18 minutes6 to spend with their patients, determining coverage is impossible.
If your organization covers GLP-1s, a virtual clinician step therapy program can ensure coverage policies are adhered to and employees and dependents get the support they need without overwhelming your provider network.
When looking to identify a solution, look for a partner that is focused on responsible management of GLP-1s, including ensuring that the drugs are provided to the medically-necessary populations and your coverage policies guarantee costs are controlled.
Want to learn more about how Lark Health partners with employers to develop a weight management strategy that balances clinical outcomes and cost-effectiveness? Learn more.
Lark helps you eat better, move more, stress less, and improve your overall wellness. Lark’s digital coach is available 24/7 on your smartphone to give you personalized tips, recommendations, and motivation to lose weight and prevent chronic conditions like diabetes.