For over 30 years, the National Alliance of Healthcare Purchaser Coalitions (National Alliance) has united business healthcare coalitions and their employer/purchaser members to achieve high-value care that improves patient experience, health equity, and outcomes. Its members represent private and public sector, nonprofit, and Taft-Hartley organizations that provide health benefits for more than 45 million Americans and spend over $400 billion on healthcare.
To help employers and other purchasers make informed coverage decisions about comprehensive, holistic approaches to obesity care, the non-profit National Alliance of Healthcare Purchaser Coalitions (National Alliance) has released guidance from its National Obesity Advisory Council made up of employers, business coalitions and medical experts.
Obesity is a complex and multifaceted chronic disease linked to more than 220 conditions, including cardiovascular disease, type II diabetes, and certain cancers. Addressing this epidemic is critical as organizations spend twice as much on healthcare costs for individuals with obesity compared with individuals at a healthy weight.
"Employers and purchasers are struggling to manage the explosive growth in use of transformative, but higher-cost anti-obesity medicines," said Shawn Gremminger, National Alliance president and CEO. "We are trying to bring some sanity to the conversation by helping employers consider reasonable guardrails that are informed by medical evidence and the evolving standard of care."
In support of its commitment to obesity management, the Council encourages:
Adoption of comprehensive guidelines that emphasise the importance of high-quality, interdisciplinary care, including prevention, treatment and maintenance
Plan and programme design that reimburses providers for obesity care consistent with emerging standards of practice
Individualised treatment plans and the establishment of realistic expectations and goals
Inclusion of behaviour modification programmes to support mental and physical health and wellbeing
Traditional approaches to weight management have fallen short with employers continuing to see rising obesity rates. The Council offered a series of recommendations that include:
Promote education on the science of obesity – what happens to the body and why traditional/periodic diets are likely to fail
Use person-first language in communications to reduce the bias, stigma and shame associated with the disease of obesity; ensure the availability of less expensive obesity management options (e.g., lifestyle programs, memberships and generic medications)
Implement clear conditions and qualifications for advance obesity management, targeting the medically eligible and those with the greatest need
Ensure coaching supports each participant's unique demographics (e.g., gender, age, race, and ethnicity) and lifestyle
Work with health plans to make sure primary care physicians are trained and given incentives (i.e., appropriate reimbursement) for the full spectrum of obesity care
Provide coverage that enables physicians to consider appropriate anti-obesity medications where clinically warranted for individuals who are unresponsive to prior therapies and committed to lifestyle changes
Consider environmental influences, mental health, biology, predisposition to metabolic syndrome, medication-induced weight gain, and other co-existing conditions
Consider the long-term cost benefits of preventive obesity management to avoid the much higher costs and complexity of treating advanced obesity and ensuing co-existing conditions
"As the science of obesity evolves, employers will have better resources and tools to address the needs of their employees," said Margaret Rehayem, National Alliance vice president. "Effective obesity care requires that benefits, programs and services meet people where they are and employers and other purchasers must keep their benefits adaptable."
The National Obesity Advisory Council is an experienced group of leaders from National Alliance member coalitions, clinicians and other industry experts deeply involved in assessing and making recommendations about obesity coverage and treatment best practices.
The resource also offers guidance on coverage benefit decision approaches for anti-obesity medications to help employers decide how and when to cover or not cover these drugs. The coverage guidance and full report, Addressing Obesity through Holistic Design for Affordability and Sustainability, can be downloaded here (log-in maybe required).