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The Alliance convened a workgroup of large public and private employers, and union trusts over four months to identify and act upon opportunities for improvement in their health and wellness offerings to improve care for their workforce of people living with obesity.
The Alliance included clinical research as a model, including Prevention and Screening, Behavior Therapy, Pharmacotherapy, Surgery, and Weight Maintenance.
The Alliance shared other publicly available clinical pathways and provided information to educate members should they decide to develop treatment pathways for patients with obesity.
With our partners at Midwest Business Group on Health, an Obesity Management Toolkit was created, full of employer-focused resources from addressing obesity through employee benefits to business cases and economics.
Employer #1:
Employer Facts
• Industry: Public Sector Benefit Trust
• Number of Medical Covered Lives in WA: Over 30,000
• Scope of Coverage: HMO and PPO plan options
Challenges
“We are an Association coordinating benefits for 270 employer groups/locations state-wide. Our employees have two medical carriers to choose from and we’ve found that while there is higher enrollment in one plan than the other, the plan with the lower enrollment has a higher percentage of enrollees with obesity. Getting desired claims data from health plans has been challenging – coding rates for obesity are generally low, as it’s not a diagnosis that is often used, which is further complicated in that we are unable to pull claims data for more than one diagnosis at a time to capture any of the conditions identified as common comorbidities and occurring with a diagnosis of obesity. Another challenge we acknowledge is our current lack of coverage for any weight loss medications.”
Employer #2:
Employer Facts
• Industry: Public
• Number of Covered Lives in WA: 15,000
• Scope of Coverage: HMO and PPO plan options
Challenges
“We’ve found claims data from one of our plans to be less transparent and less readily available and our current data may be inflating patient counts when a patient has multiple diagnoses. The data needs more analysis. We need to review current lifestyle modification programs for more condition specific and culturally competent. We’ve seen poor program utilization and an employee focus group has expressed resistance for one vendor due to perceived obesity bias and lack of cultural representation. Our members have requested more coverage for weight management, and we have also seen escalating cost of GLP-1 prescriptions for off-label use without a diabetes diagnosis.”
Employer #3:
Employer Facts
• Industry: Public
• Number of Covered Lives in WA: Over 30,000
• Scope of Coverage: HMO and PPO plan options
Challenges
“Obesity is under-reported in our data: .058% of enrolled members had a claim with a principal diagnosis of overweight or obesity. Meanwhile, 14% have related diagnoses of dyslipidemia, diabetes type 2, hypertension or metabolic syndrome.”
“Although weight loss drugs are currently excluded from coverage, 27% of members in the PPO plan who received Ozempic did not have a diagnosis of diabetes. Ozempic ranks 7th highest in drug spend over the last 12 months, at a trend of 118%.”
Employer #4:
Employer Facts
• Industry: Public Union Trust
• Number of Covered Lives in WA: 22,000
• Scope of Coverage: HMO and PPO plan options
Challenges
“Although 54% of our population have a chronic condition with a comorbidity of obesity, we have challenges with engagement. Coverage of pharmacotherapy is currently strictly for diabetes management, but members have requested coverage for weight management as well. We also recognize the need to offer coverage for minors.”
Overweight and Obesity – Labels & Language
According to the Centers for Disease Control and Prevention (CDC), overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. We are using the CDC’s recommendations for the use of people-first language. For example, “adults with obesity” and “individuals who are overweight or have obesity” are used rather than “obese adults” and “individuals who are overweight or are obese”. For more information on people-first language for obesity, click here.