At a presentation at the 2021 Fall Managed Care Forum, Ken Fujioka, MD, director of Nutrition and Metabolic Research at the Scripps Clinic Department of Diabetes and Endocrine in San Diego, discussed the long-term treatment of obesity, including the economic burden and implications for managed care.
Dr. Fujioka began with a description of the costs associated with treating patients with obesity, noting that research has shown these patients incur costs that are 42% higher than healthy-weight peers. “Costs for patients with obesity are going up due to increasing prevalence of obesity, not costs of medical care,” he added. The higher costs are also tied to comorbid diseases of obesity such as depression and diabetes.
Diabetes care metrics, including HbA1c tests, LDL levels, and management of nephropathy, were a focus of Dr. Fujioka’s talk. He noted that “metrics that can be and are done through virtual care now dictate ‘good’ and ‘bad’ care, as well as determining the reimbursement for services.”
With bundle packages, providers need to fulfill all metrics to collect a lump sum at the end of the year, which he stated is an unrealistic goal. The question then shifts to weight management and how much weight loss is needed to improve glycemic control, blood pressure, and lipids.
Hormonal changes and metabolic adaptation affect a patient’s weight loss journey, leading researchers to explore targeted replacement of these hormones to support long-term weight loss. Also, given the availability of weight loss medications, Dr. Fujioka noted that providers can reach a metric of patients losing 5% to 10% of their body weight, which could increase to an average of 10% if providers follow responder criteria.
Given these response rates, Dr. Fujioka predicted that more patients will be on a combination of anti-obesity agents and hormone replacement strategies in the future, but questions remain about who will pay for these approaches.
Insurance coverage of anti-obesity agents is improving, with great variation from state to state, and is largely driven by employers. He noted that many anti-obesity agents have cash discount cards ($15-135 per month) to reduce patients cost. Also, “now that the diagnosis of obesity is established, providers will begin to see change,” Dr. Fujioka stated. These improvements include changes to healthcare metrics and a push toward payment of anti-obesity agents that treat the multiple comorbid problems of obesity.”