Five solutions to challenges health systems face in operating weight management programs | Viewpoint

Health systems across the U.S. are modifying how they approach chronic diseases such as diabetes and hypertension with an “obesity first approach.”

Yige Cao and Amanuel Kehasse

Obesity had long been treated by addressing underlying conditions associated with the disease such as diabetes, hypertension and heart disease because there were previously limited treatments available. With the emergence of GLP-1 medications, providers have more effective treatment options for patients with obesity. These new medications target the key and common risk factor to these conditions, obesity itself.

Although obesity has been steadily rising in the U.S. with a prevalence of 41.9% in adults between 2017 and 2020, it has long been under-diagnosed and under-treated and has not been recognized as a chronic disease by many providers.

A recent study in The American Diabetes Association’s Diabetes Care reviewed 47 published pieces of research and found that GLP-1 medications resulted in significant weight, BMI and circumference reduction versus placebos. These medications work by helping to reduce blood sugar levels, quell appetite and lower calorie intake by slowing gastric emptying.

While healthcare providers are best positioned to treat patients with obesity with these medications because they can oversee the long-term care of the patients, they often face several challenges when launching or managing a weight management program.

Those challenges include an overwhelming number of patients in the population, lack of a programmatic approach, limited staffing capacity (especially among physicians) to screen and treat obese patients, variable coverage criteria and a high denial rate when obtaining prior authorization (especially in primary care settings).

Here are five solutions to common challenges health system leaders may face when launching or managing a weight loss program.

1. Design a system-wide, data-driven screening approach and care pathway to identify and triage eligible patients.

Health system leaders should leverage their electronic medical record data to identify patients who can benefit most from GLP-1 therapy.

With nearly 42% of American adults potentially eligible for these therapies, leveraging existing data to narrow the GLP-1 patient population to a smaller group of patients is a key step towards developing a health system’s screening and triage pathway.

Once the program is established, expanding the patient population will be more manageable. Patients’ disease state, comorbidity characteristics and payor requirements are examples of criteria that should be assessed to determine a patient’s acceptance into the program. Data can be used to inform the program approach and to monitor progress and measure outcomes after program launch.

Health system leaders should be mindful to create an equitable weight management care delivery model for all patients.

2. Running a successful weight management program is dependent on aligned leadership support and additional resources.

All stakeholders, including the health system medical and operational leadership teams, need to be on board with the strategy to launch a weight management program.

Forming a clinical steering committee is an effective way to engage the key stakeholders, create alignment and organize the effort. A physician champion, often in the endocrinology or primary care setting, is needed to lead the design of an optimal workflow or referral pathway within the system, and advocate for the program.

In addition, the leadership team should assess if additional resources such as dietitians and nutritionists, or diabetic educators are available to support patient engagement and education.

3. Identifying patients with comorbidities can help to secure a pathway to payor coverage.

While insurance coverage for GLP-1 medications is expected to improve with time, health systems are currently facing a challenging payor landscape and variable reimbursement policies.

One way to help secure a pathway to payor coverage in the coming year, is to identify current obese patients with comorbidities. The Food and Drug Administration recently expanded the approval of certain GLP-1 obesity medications for patients with comorbidities who could also benefit from the medication’s potential ability to prevent these conditions, such as cardiovascular disease, heart attack and stroke.

4. Clinical pharmacist and pharmacy liaison dyad model provides support in treating and managing patients long term.

Launching and managing a weight management program can be a daunting task for health systems that are already experiencing limited staffing capacity (especially among physicians) to screen and treat patients diagnosed with obesity.

Additional resources such as a clinical pharmacist and pharmacy patient liaison dyad model are uniquely equipped to fill this void for health systems. These teams screen patients, manage treatment plans and secure prior authorizations.

They also improve the patients’ comfort level with GLP-1 medication through education, helping to start treatment, adjusting dosage, managing side effects and follow up.

Primary care physicians are increasingly receiving requests to treat and manage obese patients. However, given the large patient panel size, they often have limited bandwidth to address weight management concerns, which also leads to lack of diagnosis and documentation that is required for insurance approval.

For those patients who encounter additional requirements from their health insurance plans, providing patient-centered support to navigate and process PAs can improve the success rate.

5. Improve patient experience and adherence rates.

Although 90% of patients in GLP-1 clinical trials were shown to adhere to their medications, an updated study in The Journal of Managed Care and Specialty Pharmacy found that real-world adherence for commercially insured patients is much lower.

The study followed more than 4,000 adults and found less than one in three participants took their medication persistently or adhered to their medication routine. While the reasons for non-adherence are still being further researched, probable causes include the previous drug supply shortage, out-of-pocket-expense, side-effects management (such as GI-related issues), and dosing schedule (weekly vs. daily doses).

Health systems can work to improve the patient experience and proactively address barriers for patients on GLP-1 medications by implementing the clinical pharmacist and pharmacy patient liaison dyad model to streamline medication delivery to patients and provide a comprehensive medication management support team that can provide closer supervision in helping to reduce or diminish side effects, make necessary dosage adjustments and improve overall adherence to GLP-1 treatments.

Over time, the barriers for patients prescribed GLP-1 medications will be reduced. This will strengthen clinical weight loss programs’ ability to treat and manage obesity and associated comorbidities.

In the meantime, leveraging data to identify patient cohorts most in need of these medications is an effective approach to evaluate a health system’s market approach.

Many patients, however, are demonstrating they want to lose weight, and they do not want to wait for other indications to access GLP-1 medications, indicating that obesity as a disease state is worthy of being a health system led program.

Time is limited, though, and competing competition from weight management vendors outside of health systems, although not ideal for patients, is fierce. These competing vendors do not have an infrastructure in place to closely monitor patients, prevent adverse events and provide follow-up patient care for these GLP-1 medications.

The treatment of obesity goes hand in hand with the clinical team that treats the conditions it causes, such as high blood pressure and diabetes. Patients would not use vendors to treat any of those more severe health conditions, and the same clinical oversight should be used for the treatment of obesity.

The opportunity for health systems to implement a weight management program to best serve their patients is here. Health systems taking steps to implement a weight management clinical program within their walls will also have an advantage to accessing GLP-1 medications now and later down the road for their patients. Once a program design is finalized, hiring clinical pharmacy resources to support the program and its patients will increase the likelihood of success and limit burdens on the clinical team.

Health systems that leverage the five solutions to successfully launch and manage a weight management program will be early adopters to address obesity as one of the most important risk factors for a wide range of diseases and to promote an “obesity first approach” for patients seeking care.

Yige Cao is director of health system strategy at Clearway Health. Amanuel Kehasse is director of clinical programs and drug information at Clearway Health