We all know the sobering statistics: approximately 42% of adults in the U.S. currently have obesity1 and that number is expected to rise to 1 in 2 adults by 20302.
Obesity is among the top 10 most expensive chronic diseases for payers, costing the healthcare system nearly $173 billion a year3.
Members with obesity are at risk for poor health outcomes, acute care visits, hospital admissions, and high costs. In fact, those with an obesity diagnosis have an average of $1,487 in out-of-pocket costs compared to $698 for those without a diagnosis, according to the Peterson-KFF Health System Tracker4.
While obesity was previously considered a lifestyle disease, perhaps the result of epigenetic factors, we now know the condition is a unique, complex, chronic disease5 just like type-2 diabetes or hypertension.
Treatment options have historically mirrored how we have diagnosed obesity. For example, diet and exercise interventions were the primary treatment options for obesity when it was diagnosed as a lifestyle disease. Although diet and exercise remain undeniably important, they may not be sufficient for obesity management in some individuals. And while surgery may be indicated for others, procedures are invasive, carry risks, and are expensive.
In addition to evolving science and diagnostic definitions, the advent of glucagon-like peptide-1 (GLP-1) agonists like Ozempic and Wegovy has ushered in a renewed focus on how best to address obesity.
Although they have existed in the market for some time as FDA-approved diabetes medications6, GLP-1s have become another option to treat obesity, with some studies reporting a 15%+ reduction in initial body weight7. Recognizing the benefits of these medications in individuals with obesity makes them viable treatment options.
Despite the promises of GLP-1 medications for obesity management, patients need support and coaching for medication adherence and side effect monitoring and management for optimal outcomes. According to a 2021 study8 in the journal Diabetes Spectrum, among people who discontinued GLP-1s with at least one month of treatment, 55% cited side effects while nearly the same (50%) cited high cost.
While the weight can return once treatment ends, when used with a lifestyle change program, patients can begin to taper off the medications and may still see weight loss sustained through their healthy lifestyle changes.
Implications for Cost
As demand for GLP-1s continues to soar, health plans and employers are growing increasingly concerned about how to manage and treat their populations, address the high costs9 of these weight loss drugs, and project what the financial impact will be on their bottom line.
According to a recent report10 by Pharmaceutical Strategies Group, among the reasons to exclude weight loss drugs from coverage, 46% of health plans said they’re too expensive to cover for all members for whom the medication would be prescribed, versus 34% of employers who said the same.
This year, health plans and employers must rethink their strategies and strike a balance between effectively treating obesity and improving outcomes, without driving up costs.
Rethinking GLP-1s: A Roadmap
As health plans and employers continue to look at ways to manage their obese populations and curb costs, identifying each member’s unique needs, utilizing the full spectrum of treatment approaches, and personalizing treatment is vital. Based on our experience, here is an effective strategy we recommend for our clients.
Consider a Digital-First Approach
Solutions that offer various options including 24/7 AI-driven lifestyle coaching, real-time feedback, remote patient monitoring (RPM) and clinician-guided, telehealth management effectively engage members throughout their healthcare journeys. Look for solutions that have outcomes tied to program engagement13 and that reach, engage14, and have proven outcomes15 in hard-to-reach populations or those experiencing barriers to care.
Start withResponsible prescribing
GLP-1s are appropriate for certain members, particularly for those who are at risk for obesity-related acute care visits and hospital admissions. Risk stratification should be used to identify those who would benefit most from the weight loss drugs. Members must be risk-stratified to ensure each individual receives the right treatment for their weight, health metrics, comorbidities, etc.
For example, members who are overweight but not obese and do not qualify for GLP-1s may benefit from a healthy lifestyle program, which has been shown to reduce incident disease and disease progression risk11. These members will likely be able to make meaningful changes that lead to improved health markers and weight loss.
Utilize evidence-based digital health programs for those at risk
At-risk members should be enrolled in an accessible digital healthy weight management program, whether they’re taking GLP-1s or not. Programs should offer various tiers with different levels of support customized for member needs, offer evidence-based care, be scalable to your population, and be clinically proven12.
Simple and streamlined program offerings
Point solution fatigue is a challenge for many employers, with 50% of organizations managing 4 to 9 digital vendors16. Organizations should look for partners that offer an end-to-end solution to solve point solution fatigue and ensure continuity of care and a simple, streamlined experience.
Want to learn more about how Lark Health partners with health plans and 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.