Latest / Becker’s Payer Issues Podcast / Reframing GLP-1 Strategy Through Clinical Outcomes, Behavior Change, & True ROI

Transcript

Reframing GLP-1 Strategy Through Clinical Outcomes, Behavior Change, & True ROI · Becker’s Payer Issues Podcast

• 0:00
  Hello, and welcome to the Becker's Healthcare Podcast.
• 0:02
  My name is Chanel Banger. Today, I'm excited
• 0:04
  to welcome back Jennifer Jones to the podcast
• 0:06
  for a conversation on reframing GLP ones and
• 0:09
  ROI.
• 0:10
  Jennifer is a healthcare leader with more than
• 0:12
  twenty years of experience across clinical dietetics,
• 0:15
  wellness programming, and employer health. After working directly
• 0:18
  with patients and employees, she now focuses on
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  population health as director of clinical solutions at
• 0:23
  Noom Health. Jennifer, welcome to the podcast. Great.
• 0:26
  Thanks so much. Happy to be here. Happy
• 0:27
  to be back. Of course. Well,
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  to get us started, at a high level,
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  can you tell me what has changed at
• 0:33
  Noom Health in the past year?
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  I've had a lot of changes. It's been
• 0:36
  exciting, though.
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  Obviously,
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  GOP ones are still a really hot topic
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  for the industry, and we have evolved with
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  that process as well.
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  So we still work really closely with payers
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  and with employers on supporting the behavior change
• 0:52
  component.
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  But as we think about GLP ones, what's
• 0:56
  changed significantly is how we partner with payers
• 0:59
  and plans on how to offer that to
• 1:02
  their members.
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  So while we still have, like, a fully
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  embedded kind of integration with the PBM, we
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  also now have carve out solutions, and then
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  we also offer direct to consumer options as
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  well. So a lot's happened, a lot of
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  big changes, but we've seen a lot of
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  adoption and a lot of success with the
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  new programs as well. Got it. Got it.
• 1:19
  And now that we're all caught up, in
• 1:21
  your Becker's
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  presentation, you shared real world cost savings data
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  from NOOM's Metabolic Health Program. For payers who
• 1:28
  remain skeptical of r o one claims, what
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  differentiates
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  programs that deliver measurable value from those that
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  simply add support on top of already high
• 1:35
  med spend?
• 1:37
  Yeah. I think the the one key thing
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  that we tried to emphasize
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  in our presentation
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  was
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  obesity is not a pharmacy problem. And I
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  think a lot of the times when we
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  look at programs that are trying to solve
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  ROI around GLP ones,
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  They're trying to solve a pharmacy problem, but
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  the bigger problem is the conditions that GLP
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  ones treat. So diabetes, obesity, those are truly
• 1:59
  chronic conditions that drive up medical cost.
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  So looking at a program like Noom and
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  those types of programs that offer support in
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  conjunction
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  with the medications,
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  we're seeing outcomes for ROI. We're seeing outcomes
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  on downstream medical cost impact. So
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  it's more than just support in that perspective.
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  Plans that who are skeptical, I think it's
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  because they're only looking at it from the
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  lens of this is a pharmacy problem.
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  And when you broaden that perspective and look
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  at it as a true chronic condition medical
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  plan
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  issue as well, that's when you can start
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  to
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  utilize
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  different types of framework, different programs that can
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  truly have a broader impact on ROI.
• 2:43
  Absolutely. Thank you so much for walking us
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  through that. And now benefit design for GLP
• 2:48
  ones is still evolving in real time. How
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  can payers adjust eligibility duration and reauthorization
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  requirements without creating confusion or disruption for members?
• 2:58
  That's a really tough question because we traditionally
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  have
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  always looked at solving the GLP one spend
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  problem with these acute cost containment measures that
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  have worked really well in other pharmacy challenges
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  that we've had, but that works for more
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  acute episodic type of conditions. And when we're
• 3:15
  dealing with GLP one conditions
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  or conditions that that those medications treat, those
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  are chronic conditions.
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  So we have to look at those levers
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  like eligibility, like prior auth, like reauthorization,
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  all of those with a little bit of
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  a different lens and understand
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  we may need to have some give and
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  take on how much we wanna push one
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  versus the other because those can be good
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  for cost containment,
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  but we have to understand how that then
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  could
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  result in changes or challenges to the overall
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  clinical outcomes as well.
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  So
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  what we have set up and what we
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  have found effective is you still have obviously
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  certain eligibility criteria that every plan is going
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  to have, but then we also employ a
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  step therapy approach. So we do utilize some
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  oral anti obesity medications, non GOP ones, to
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  treat people that are maybe a little bit
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  lower risk or intermediate risk. So they may
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  not necessarily have the high risk of cardiovascular
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  disease or as much weight to lose as
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  other individuals. So we can probably get a
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  good benefit from an oral medication
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  with behavior change instead of just going directly
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  to a GLP one. So that's that's one
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  of our approaches as well. But a lot
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  of times what we're seeing now in conversations
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  is we have groups that are looking to
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  try to set, like, limits on how long
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  they can use GLP ones or put spending
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  caps on that, which, again, from a cost
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  containment perspective,
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  that can work, but
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  your trade off is a huge loss as
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  far as from a clinical perspective. And there's
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  there's not, you know, any clinical efficacy to
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  a program that would be set up like
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  that as well. So a lot of different
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  levers, a lot of different opportunity, but it's
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  finding that nice balance of where you can
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  help control some cost, but also
• 5:00
  seek the broader clinical outcome.
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  Got it. Got it. And as a follow-up
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  to that, what should leaders prioritize to maintain
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  that balance you were just talking about? Yeah.
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  I think, you know, what we have seen
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  is
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  when we work with groups that have offered
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  pretty much, like, unfettered access to GOP ones.
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  Now there there's obviously the clinical eligibility and
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  there may be a PA in process, but
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  that's usually about it. When they convert to
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  a Noom clinical program, so Noom's prescribing the
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  medications,
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  and we're following that alongside with our behavior
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  change program.
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  We will see a natural dropout
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  anywhere from probably, like, twenty five to thirty
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  percent of people that were on GLP ones
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  because they don't wanna convert to the Noom
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  program, because they don't wanna put in the
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  effort
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  to really put in the behavior change and
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  meet with the clinician every three months and
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  have a health coach and kind of go
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  through that process. So there's some natural selection
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  that's there.
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  So I think, again, the the balance here
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  from a leadership standpoint is understanding there will
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  be some friction that is going to come
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  with change.
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  But, ultimately, you wanna be able to support
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  those members that are in it for the
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  long haul that want to see the best
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  outcomes for themselves from a health perspective.
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  Now looking ahead a bit, as longer term
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  outcomes data continues to mature, how do you
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  see GLP one coverage strategies evolving over the
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  next years? And what should payers be preparing
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  for now?
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  I think we'll continue to see a lot
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  of change because, you know, we've already had
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  two orals that have come to market this
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  year for for GLP ones. We're likely to
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  see retrotide come to market probably late this
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  year, early next year. So we are gonna
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  have more and more medications, which are going
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  to have more and more demand from our
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  members and from the population.
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  So I think the biggest challenge as far
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  as with outcomes data is if you don't
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  have a structured plan in place today,
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  you are gonna be really pressed to see
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  any type of positive outcomes over the next
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  year or two years.
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  So building your framework now, as far as,
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  again, what are all the levers you're pulling
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  to help with some cost containment, but also
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  optimize the clinical
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  investment in the medications
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  is where you need to be now to
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  be able to see that ROI in one
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  to three years as well. Ultimately, first, you're
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  likely to see the benefit as far as
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  from a pharmacy reduction, most likely, but that
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  is not where the core of your ROI
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  is going to come from as far as
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  from pharmacy claims savings.
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  Again, it's the clinical investment and the behavior
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  change that will really help with that downstream
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  impact and effect from an ROI perspective.
• 7:26
  That makes a lot of sense. Well, Jennifer,
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  I wanna thank you for your time today.
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  But before I let you go, is there
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  anything else that listeners should know?
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  Oh, gosh.
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  I think again, I can't underscore enough just
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  really evaluating your population and those key levers
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  and and reframing how you think about the
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  use of GLP ones today, not as a
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  pharmacy problem, but really understanding the conditions they're
• 7:48
  treating
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  to where you can optimize the medications
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  with behavior change and get sustained results post
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  medication or even just long term medication use
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  to ensure that people will optimize the clinical
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  outcomes.
• 8:00
  Absolutely. Well, Jennifer, I wanna thank you once
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  again for your time and for sharing insights
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  today on the Becker's Healthcare podcast.
• 8:06
  Thanks so much for having me. We also
• 8:08
  wanna thank our podcast sponsor, Noom. You can
• 8:10
  tune into more podcasts from Becker's Healthcare by
• 8:13
  visiting our podcast page at beckershospitalreview.com.