Marty:
Okay, I think we’re gonna get started here, everyone. So Thank you all for taking time out of your busy schedules to join us here today for the engagement health groups webinar.
The rest of the story with GLP-1 drugs. Our goal is to focus on what employers need to understand to help support their members who are prescribed these popular drugs by ensuring that they are both safe and affected.
My name is Marty Solomon. SVP of sales here at Engagement Health Group.
And we are so happy that you could join us here today. Joining me is Jack Curtis.
CEO and co-founder of EHG. Dr. Jennifer Musick is the President and also co-founder of EHG and Jackie Warren, the Director. Of data and reporting. We also have a special guest that we’re going to introduce you to a little bit later on who has benefited greatly from our solutions here at EHG.
But before we get started, a couple of housekeeping items.
Number one, we’re going to keep this webinar to 30 min. We respect and value how important your time is.
2. We’re hoping to keep 5 min open for questions and answers at the end.
If you have any questions. Please submit them through the QnA function and direct them to the host.
And finally, we are recording this. You all get a copy of this later on.
So here is our agenda for today. It starts with a very, very quick introduction to our company that I’ll walk you through right now. So Engagement Health Group was formed earlier this year and it’s the creation of 2 organizations, corporate health partners an engagement and wellness company of 20 years, and Health Solutions, a condition, disease management organization, also with 20 years. We now have 40 years of combined experience.
And we offer virtually every solution available in the Population Health Management Arena.
Our goal and this is very important, is not just to be another one of your vendors.
But instead a value partner. In terms of our differentiators, It really starts with our experience. We are true professionals here at EHG. We know this industry inside and out and we know how to help you solve your problems. In terms of our solutions, again, we offer everything under the sun making it available for one-stop shopping with employers.
Engagement meets so much to us. Heck, it’s the first word in the name of our company.
Because without it, nothing else matters. And when it comes to condition and critical care management. We have we have ROIs that exceed 3 to one and we’re willing to guarantee those for our our clients. With me here, it’s Jack Curtis. CEO and co-founder of EHG.
Jack has a 20-year-long and distinguished career in the wellness industry with corporate health partners.
Also is Dr. Jennifer Musick, Also, who has 20 years of experience in this industry, but in the clinical care management arena, and joining us here for the first time is Jackie Warren. She is our director of, Data Reporting and she has over 16 years of experience with this tier at EHG. In fact, I’m now going to turn it over to Jackie to kind of introduce you all to the problem.
Jackie:
Thank you, Marty. Obesity isn’t just an appearance issue. It’s a progressive and relapsing chronic health condition with serious and expensive implications. Over 42% of the US population has a BMI in the obese category, which is a BMI of 30 or greater, which is about 30 pounds overweight for someone who’s 5 10. And you know when I first started working as a dietician 15 years ago the BMI rate was the obesity rate was 34% so it’s increased just a lot even in the last 15 years. And Obesity is a complex issue and it can lead to many other conditions. You see a lot of those listed here, Type 2 diabetes. High cholesterol, high blood pressure, many other things, and obesity cost the United States a tremendous amount of money, in our health care system. And there’s a big market for weight loss solutions that promise to deliver immediate weight loss results.
One of the things that we’re gonna stress over and over today are the treatment guidelines for chronic obesity, which have been around for more than 10 years now and they all advise behavior modification as a standard of care. It’s such a critical piece of obesity care and it’s a part of all obesity care whether it’s a procedure or a medication. Marty, next slide, please.
So you can see we had there are many options for treating obesity. We’ve got them listed here. One thing I, like I said, that’s really important is that behavior modification is so important. For all of them. So Behavior modification on its own, which includes dietary changes and exercise. Isn’t, hasn’t always been successful by itself. But when it’s been included as a part of a comprehensive program we see really good results like we did with the diabetes prevention program, DPP. We saw that 62% of participants had lost 5% of their body weight and kept it off long-term. As a part of this program when they were working with a health care practitioner such as a registered dietician and they were involved in a comprehensive program that addressed all aspects of lifestyle modification.
Now with the weight loss medications. Some of the older ones that have been around for a while. Like, that, don’t necessarily have as high a success rate, but today we’re talking about the GLP-1. So those are the ones that are bolded here. So we mostly know them as Ozempic. That’s the most common one and they do have a very high success rate, that’s the most common one. And they do have a very high success rate, 15 to 20% weight loss. But keep in mind that that was part of the clinical research study that did include behavior modification also. So it wasn’t the medication by itself. It was the medication in combination with behavior modification. With the devices and, procedures like the bariatric surgery. They have had success rates too, but with those lifestyle modification is often a requirement to get the procedure. They have to meet with a registered dietitian and Adapt that modification before they can even have that procedure.
It’s such an important piece when it comes to obesity. Whether it’s medication or procedures.
Behavior modification is the key to successful weight loss. So the GLP-1 drugs are the newest option and people are very excited about them, but it’s not a cure.
It’s a tool. And they may need to be used long term and they’re very expensive over a thousand dollars a month. So what we’re saying is yes, chronic obesity is very prevalent and the GLP-1s work.
Okay.
But covering these medications without a plan will negatively impact your health plan and not help your members long term. So I’m gonna turn it over to Jen to talk about this some more.
Jennifer:
Wonderful. Wonderful. Thank you, Jackie. Now that we’ve kind of leveled the plane field on chronic obesity as a disease and our available treatment options. You know, and knowing that all medications and medical interventions were studied with behavior change. Let’s go into GLP-1s a little bit further. What you can see on the slide here team is, you know, all of the concerns. Listed. For GLP-1s, we’ll go through them and then hopefully make them really actionable for you. The high prevalence of obesity with the high price point of GLP-1s are really the issue, right?
That makes High utilization, right? Cause they work. Many patients want to use these are impacting access. For patients who need it the most, especially those that are trying to use these medications for diabetes. So those are issues. We are still unsure about the duration of treatment. As Jackie mentioned, GLP-1s are also not a cure like any of the other treatment options that we have. And they’ll need to be used long-term. To prevent weight gain. And with that being said team. These medications are for weight loss. We have been studying GLP-1s for many years, almost 20 years now in the treatment of diabetes.
With, you know, good success and good long-term tolerance. But I will note team that we are using these at higher doses. So these are being used at higher doses and we don’t know what the long-term safety data is as a result of that.
There are many GI side effects associated with GLP-1s that actually are the primary reason for patients discontinuing treatment up to 68% of patients do stop GLP-1 treatment within a year, mostly nausea and vomiting. The high price point does make access and equity a concern. If we don’t cover these medications and, you know, our populations try to access these on their own, you know, obviously at this high price point, will GLP-1, for example, I think has an estimated annual net price of over $13,000. Obviously leaves those covered members with those members on the health plan that don’t have the means to afford them, you know, without good coverage there.
So with all of these concerns, outside, let’s really talk about what not to do, right? Our, number one goal today is to really help you address these concerns and give you some takeaways on things that are actionable for you. So we’ll start with what not to do. Refusing to cover GLP-1s. According to the 2023 Mercer survey about 64% of employers cover or plan to cover GLP-1s in the upcoming year. Considering obesity a chronic disease as Jackie started Obesity is complicated. A chronic condition that’s often relapsing. So we just need to address that. It’s a diagnosable condition with standards of care, much like any other chronic condition like diabetes and or hypertension, or hyperlipidemia.
Not having a plan for how to best cover GLP-1s will leave you exposed and your members.
Not cared for, offering a one-size-fits-all approach to diabetes or to obesity treatment.
Is also not a plan for success, obesity as again Jackie mentioned is a complicated recurring condition that requires a very individualized approach. Relying on your carrier to manage the risk and cost of the health plan. You all know if you’re self-funded, you’re covering these medications anyways.
If you’re fully insured and we, you know, act, to increase access to these medications for your covered population it raises the cost of your health plan. Those increases are passed on to you, right? So not taking matters into your own hands is a real recipe for failure and then relying on your members and their providers to appropriately and successfully use GLP-1s as an obesity treatment option.
We need to ensure that relying on your members and providers to appropriately and successfully use GLP-1s. As an obesity treatment option, you know, we need to ensure that a behavior modification plan is in place. That’ll really, ensure that you don’t have these varying impacts and results to the health plan and your members. Yep. So next slide.
The good news is that there is a lot that you can do to responsibly manage this new obesity.
We’ll start with what’s good. You know, cost containment strategies like prior authorization and step therapy, a prior authorization, an example of that would be only covering these medications for patients or members that have a BMI over 40 when the FDA-approved VMI is 30. That would be a prior, you know, prior authorization. Step therapy, an example of that might be, you know, requiring patients to fail an older weight loss treatment first or another option like behavior modification. Only first would be a way to control some costs. Limiting off-label prescriptions of GLP-1s, although the pharmaceutical industry is beating you to that.
They’re making sure that they’re creating GLP-1s that are specifically approved for obesity.
But that was that would also be a strategy for some cost containment. A better approach is adding the following strategies on to those cost containment strategies.
Your authorization and step-by-step therapy alone are good, but there are loopholes that will leave you exposed. And then your members, you know, not well cared for. So adding these following initiatives on to those cost-containment strategies is important. Making data-driven decisions using your claims information and health risk assessment data to understand the prevalence of obesity and its possible impact. Of obesity on your population and your plan costs. Flames are good, but they will underestimate the prevalence of obesity, HRA data through health screenings is much better, right? So using all of the data available about your population to estimate prevalence and cost is an important first step.
Doing that will really allow you to do that next step, which is to provide coverage for the most at-risk population based on your population and your budget, kind of regardless of the FDA-approved population. So you’re using that data to better target the most at-risk population, within your members is will be an important step.
Including a defined process or program for pre-treatment during and post-treatment to ensure that we’re prescribing correctly and maximizing outcomes.
So again, if you are covering these medications without a plan. You know, a defined plan pre-during and post, you know, you’ll have unforeseen consequences.
And potentially many organizations are having to unravel. They’re, reversing the coverage for GLP-1s because they went into these decisions without a real consistent plan for pre and post-treatment.
Requiring intensive behavior modification as we mentioned per the published guidelines. These medications were studied with behavior modification. For the success rate that they’re publishing. So making sure that we’re covering them in the same way, right?
So requiring intensive MoD, creator modification to address key obesity risk factors that will really help them optimize and maintain weight loss. And then honestly, As I mentioned, if you know we don’t want to use these medications or cover them long-term, then not having a behavior modification plan is really a risk. So if we don’t want to cover these medications long term, then supporting behavior change really is essential as your long-term solution.
Jackie mentioned the DPP study, that study had long-term weight loss results. So again, you can cover GLP-1s as a first step and then really rely on behavior modification as a long-term solution. So the takeaway of this side is really the best approach is to use all of the above strategies together to reduce risk to the health plan and ensure your members benefit most from GL. Next slide, Marty.
So ultimately, employers need to really weigh the clinical and financial issues, to ensure that your benefit design really reflects your organizational philosophy. Your program objectives and your budget. The following decisions are really going to help ensure that you have a good plan going into covering GLP-1s. You know, will you allow coverage for GLP-1s using the standards of care and prescribing recommendations? Advising the use of intensive behavior modification. What data will you use to understand your population and prevalence of obesity in a necessity and estimate the impact on your health plan? Will you limit coverage to a higher-risk population to reduce the cost of the health plan to those that really need it the most? Will you require intensive behavior modification sponsored you know as an employer-sponsored benefit? Before covering anti-obesity medications, you know, will this be part of that pre-treatment plan is to have behavior modification on board before covering GLP-1s?
Then how will you manage during treatment and post-treatment those program requirements? Will you work with a partner to help you do that? Will you provide an employer-sponsored behavior modification program to make it easy for your members to access? A good quality program ensures quality and results from your investment.
And then lastly, will you cover anti-obesity medications long-term like GLP-1s?
The next slide is really a takeaway slide. It’s a sample plan that addresses all of the dues and the don’ts and the decisions that we just reviewed. Please feel free to use this as a tool to really help you get started with your GLP-1 coverage approach. Next slide.
Okay, so GLP-1s as we’ve covered are very promising. Again, they are not a cure.
They are not meant to be used as standalone solutions, just like all the other anti-obesity medications, they do serve as valuable tools and a broader approach as Jackie mentioned a comprehensive approach is best pairing medications and medical Interventions with behavior modification is truly necessary for successfully addressing obesity.
So what about EHG, we have 3 programs to support our clients and their members with weight loss. Our good approach is really a group, a coaching weight loss program.
It is lower cost, but it isn’t personalized. So a better approach is using our EHG behavioral health coaching program, which does include personalized support, member to health coach, but doesn’t include a registered dietitian’s advice and or curriculum.
And our best approach team really does align with the guidelines. Given by the National Institute of Health for a safe and successful weight loss program.
We’re really a really is 14 or more weight loss counseling sessions conducted over a period of time with an eating plan based on the calories and nutrients individualized to a member’s needs.
At least a hundred 50 minutes of activity per week. Tracking nutrition and activity, and then regular feedback and support from specialists like health coaches and dieticians.
So our best approach is really our EHG-targeted weight loss coaching program. It is a 15-session program. It does include a registered dietician providing advice and a nutrition plan to enroll members. It is curriculum-based and those members are supported throughout the program by their behavioral health coach. So with that, I’m going to introduce our guest speaker, Tracy, who has been successfully working with one of our health coaches to help her on her personal journey to better health. I am excited for her to share her story with all of you today. And welcome Tracy.
Tracy:
Thanks, Jen, for the warm welcome. I’m excited to be here and share my health journey.
It all started when my employer provided a financial incentive to participate in the engagement health group and free money is always good to me. So I was like, well, let’s do this. So, at the time the Pillar system was a little cumbersome, so the option of meeting with the health coach once a month. Just seemed a lot easier for me. What I didn’t realize is how impactful the health coaching would turn out to be for me. The 30 min each month helped me to make basically take difficult situations and turn them into personal growth opportunities.
I’ve grown in multiple aspects of my life that have positively affected me personally. And with the relationships that I have at work as well as outside of work.
I have learned techniques that help me set healthy boundaries and responses. In doing so, I realized that putting others first wasn’t leaving me any time or energy for my own needs.
Since accepting my own self-love and the new mindset. And then turning 50 this year I decided it was time that I was ready to make a significant lifestyle change. And I didn’t realize at the time that all of this work, like behind-the-scenes work, was really my mental state. But once I was there, with the knowledge and the guidance of my health coach, the challenging changes that I had ahead of me were so much easier.
The monthly meetings and the support of the health coach has helped me and holding me accountable for my action plans. Because honestly, change is really hard. However, the rewards have been amazing and the lifestyle choices I’m now making are much easier which means for me that there’s less temptation to go back to my old habits, which was drinking a lot of soda instead of water or opting for fast food instead of meal planning. And even on the days that I don’t want to work out, I do it anyway, knowing that there’s something better. That’s gonna happen for me. And then it feels better. My help coach. Not only helped me get to a better place mentally, but she also assisted me in finding multiple different.
Tracking methods, recipes, and exercise options all worked for me. Some didn’t, but we worked through it and figured out the ones that did. After committing to 9 grueling months of working out and eating healthier I’ve gone from being chronically or I’m sorry considered medically obese to having my weight and my BMI in the normal range. Which is a celebration because I don’t have to go to those doctors anymore. I don’t have to worry about Geez, and I’m borderline diabetic and going into diabetes, I’m not there anymore.
So, it’s left me more time to concentrate on me. And the best part is that I just feel better and I feel stronger.
I’m no longer intimidated about challenges with my goals. I embrace the failures as opportunities rather than setbacks. And no matter what I refuse to give up because I love how being stronger and healthier feels. Everyone’s journey starts somewhere and for me, mine was working through things mentally so that the changes I needed and wanted to make physically didn’t seem so overwhelming. The bottom line is that life in general is hard. So we all have to choose our hard. It’s hard to change. It’s hard to make healthy choices. It’s hard to work out, but it’s also really hard to feel down and feel unhealthy. So the difference is that there’s a reward. When you put the hard work in because it changes your life and you feel so much better. Reaching my goals and hopefully anybody else who participates in the program. Reaching the goals makes things The difficult changes so much easier when you have, an engagement health coach group in your corner that’s tearing you on and helping you all along the way.
Jack:
Thank you, Tracy. That’s an amazing story. I really, I love that, yeah choose your heart. I’m gonna remember that. I’ll quote you on that. But thank you so much for being with us today and sharing your story. I know it’s not easy, but you chose that hard and you chose to share it and I think you’ll inspire a lot of other people with it. Thank you. So. Very appreciative of that. So, to summarize. Today, obviously, you know, obesity is prevalent and it’s very costly. That’s probably why you’re here. GLP-1s look very promising. A lot of a lot of encouragement, but we’re getting a lot of pressure from members to carry this. There’s low adherence. There’s a lack of long-term data. There are issues. So we have to be smart and careful about doing it. So the solution then is to be Very thoughtful and planful in how to approach it. Look at utilization and cost management.
If you’ve got the money, might want to carry it. If you do, you might wanna start with just dipping your toes in the water and start with a BMI of 40 or better or 35 or more.
But if you didn’t pick up anything else from today. If you do that and decide to go forward with it, it’s not gonna work if you don’t have behavior modification as a part of it.
And it’s not just one part of it. They need to do it upfront. To show they can do the work that they can do behavior change it’s going to be required to be successful they need it during treatment with the drugs and then hopefully they graduate from that and they need it.
Some, help to carry on those new healthy choices afterward. To sustain the weight that they’ve lost. So obviously we’re advocating for behavioral health coaching. It’s no big, surprise about that, but we just wanna say, you know, health coaching alone has had its issues, but with GLP-1, we feel like, hey, there’s there’s an opportunity here, but let’s be smart about it.
Their plan is planning to fail so. Hopefully, you’ll take a look at that. You’ll try it, dip your toes in the water, and learn from your own. Basically, try clinical trials and continue to watch the clinical trials that are going on. To see what’s happening in the market what do we learn more about adherence and about side effects and about results and how the best optimize this? So. Look at the inside and outside continuously improve monitor results and tweak your plan. What’s next for us? We’ve got another session coming up in January where we’ll tackle condition management and how a lot of that is missing the mark.
Followed by how your sickest members at 5% that drive 60% of health plan costs how they’re not getting the care they need.
And then the missing ingredient in population health management. So we hope that you’ll continue with us on our journey as we tackle some of the big challenges in the market.
So thanks again to all of you. Marty, I’ll turn it back to you.
Marty:
Wow, that was fantastic. Tracy, that was really inspirational. Thank you so much.
We’re really getting down to the nitty-gritty here in terms of time, but I think we can offer up one question. I’m just gonna pick this one here. Jack or Jen or Jackie, how should a member PCP factor into this plan?
Jack:
Jen, you wanna take that?
Jennifer:
Let me take that. Sure, sure. So Again, I think as in a part of an employer-sponsored program. Having, you know, a very consistent behavior modification strategy to cover as part of covering GLP-1s is going to be extremely important. Obviously, we always advise patients to work with their preferred personal physicians. So it can be a very individualized conversation on the appropriateness of GLP-1s but again not just leaving that up to the covered member. And their provider and rather ensuring that if they’re if you’re going to approve, you know, GLP-1 coverage, it gets prescribed to them that they’re following the pre, during, and post-treatment requirements that you’ve set forth as part of your plan.
We obviously want to make sure that, you know, if someone, you know, receives a GLP-1 from maybe someone that isn’t their primary care provider, we notify their primary care provider that they do not they now are taking this medication.
For weight loss but again having them work with their personal position to assess the appropriateness of GLP-1 fair peep is a great first step and we always encourage that patient-provider relationship. What you could be controlling on your side of the house is the pre-, during, and post-treatment. Requirements include those behavior modification programs to ensure that you know patients aren’t experiencing side effects they can they can continue the treatment plan as appropriate but more importantly that they’re following the behavior modification needed. I’m as you all know personal physicians today don’t get paid or reimbursed to provide behavioral counseling and nutrition advice to their to their patients so you doing that as an employer as part of your employer sponsor GLP-1 benefit will be crucial to generating impact and a return on that investment.
Marty:
Well, it’s half past the hour and I’m gonna keep my promise and we’re gonna end right with a here. I just want to say thank you so much for joining us. We will soon be sending you a recording of this and my name is here at the bottom. Feel free to contact me anytime if we could help you. Thanks, everyone. Thank you so much. Have a great holiday and have a great day too. Thank you again.