Ripple effects of scenario one

In scenario one, the status quo of fragmented care and restrictive financing persists as few providers and purchasers make changes. This reduces the potential benefit of weight management drugs and fails to transform obesity care.

Spending stays high, despite restricted coverage

Despite restrictions on use of GLP-1s for obesity, purchasers still see an increase in drug costs for patients with diabetes. They may also see a surge in spending for surgical options or medical appointments related to weight management for patients paying for these medications out-of-pocket.  

Patient demand ebbs amid continued access challenges 

Heightened demand for weight management medications sparks an initial increase in patient interest for obesity services across the board. However, a lack of integrated obesity offerings and poor wrap around care reduces demand, as those who can access the drug have minimal support and poor outcomes while those who can’t access medications are also unable to find alternative options for obesity care. Demand reverts to the status quo prior to GLP-1s, with patients steered to bariatric surgery programs when medications aren’t available. 

Quality of obesity care remains poor

Health systems and providers struggle to integrate their obesity offerings due to a lack of investment and limited reimbursement for their services. As a result, most patients receive fragmented care with limited wrap-around support that makes it difficult to achieve their health goals, leading to high discontinuation rates and weight cycling. 

Health equity concerns continue, unaddressed  

Only those who can pay out-of-pocket will have access to comprehensive obesity care services — but even then, patients will likely have to cobble care together across multiple providers, making it difficult to sustain weight loss long-term and contributing to an overall decrease in demand. Today’s inequities in obesity care persist, driving poorer outcomes among uninsured and underinsured patients who are more likely to be people of color. This fuels even more race-based clinician bias on obesity. 

Our take: There are no winners here.  

Scenario one is the result of healthcare leaders taking a prolonged “wait and see” approach that relies on today’s care delivery and coverage mechanisms. There are no winners here: purchasers spend more money, clinicians struggle to provide care, and patients do not have the support they need to manage chronic obesity in the long term. Medicare in particular bears the greatest burden as preventative measures are overlooked, resulting in poorer health for Medicare members.

Ripple effects of scenario two

In scenario two, many providers start to build out comprehensive obesity care services, but coverage falls short. As a result, access to quality care is varied, exacerbating health disparities to a new level. 

Spending stabilizes but plan switching increases

Many patients access treatment out of pocket, which helps keeps purchasers’ costs stable. Those who do cover the drug see spending increase but slow the growth through utilization management strategies.  Purchasers who opt out of coverage experience the fall out of individuals switching employers to access obesity care coverage. 

Demand remains high for those who can afford it

Patient demand for obesity services, especially for those who are willing and able to pay out-of-pocket, will persist over the next few years. However, access remains a challenge due to high cost and limited coverage. People who can’t afford the costs of treatment, eventually give up. 

Quality of obesity care varies widely

Quality of obesity care becomes more variable with only some provider obesity programs succeeding in delivering integrated, comprehensive care. Other providers hesitate to invest in programs given the low reimbursement from payers. Out-of-pocket programs, especially telehealth wellness companies, provide support to those who can afford it. The result is high variability in quality of care. 

Health disparities are exacerbated

Individuals with broader insurance coverage or the ability to pay out-of-pocket reap the benefits of new comprehensive models. This will compound disparities as those without coverage or access, including more people of color, will not have the same access. Programs catering to a wealthier patient population may lack the resources or will to offer effective care to populations with social barriers. The result could exacerbate race-based obesity biases among health leaders as they see some patients flourishing with treatments, while others don’t.

Our take: Health organizations manage risk, but patients lose.  

In scenario two providers may capture some additional revenue, and purchasers can somewhat manage costs. The real risk here is to the patients. This future highlights the difference between the “haves” and the “have nots.” Some patients who have better coverage or can afford higher upfront costs can access integrated obesity care that provides them with long term supports. Those who are unable to do so receive poorer quality care and therefore have poorer health outcomes. This scenario not only stands in contrast to stakeholder’s health equity pledges, but their business interests. 

Ripple effects of stakeholder actions

In scenario three, purchasers and providers invest in chronic obesity care, improving outcomes for patients overall. 

Spending balloons in the short term, with hope of long-term offsets 

Expanded coverage combined with high demand will increase spend for purchasers. In the long term, drug spend will offset other pharmacy and inpatient costs through the prevention of cardiovascular events, surgeries, and medications that would have been required for obesity-related conditions. Purchasers may see some future cost reductions as obesity management limits expensive cardiometabolic treatments, especially if treatment is widespread.  

Patient demand grows as access to comprehensive obesity care increases 

A positive reinforcement cycle between demand and access fuels interest in chronic obesity care. As new medications emerge from the pipeline, demand for medical weight management bolsters volumes for other forms of obesity care. Bariatric surgery, lifestyle interventions, food as medicine, and other treatment approaches grow in popularity as patients encounter integrated obesity care programs. 

Quality of obesity care transforms  

Investment in centers of excellence and specialized telehealth models improve the quality of obesity care and its delivery through greater care integration. A team-based approach to care integrating multiple specialties becomes the status quo and is offered in convenient locations, including telehealth, home health, and local retail clinics. These new models will undergo growing pains and quality is likely to vary in the beginning, though the system as a whole will move several steps forward from the status quo.

Health equity concerns begin to get addressed 

Broad coverage and growing expertise in providing comprehensive, non-biased obesity care helps to minimize disparities. For many patients, access to obesity centers of excellence and comprehensive care models means more patient-centered programs and access to both weight loss and weight maintenance support, ensuring longevity of improved outcomes. Some patients are still unable to access high quality obesity care, but this disparity gap shrinks as coverage becomes broader. 

Our take: Investment is the only option. 

In scenario three, all stakeholders invest to build a better model for managing chronic obesity. Purchaser spending does increase, but that is likely in all scenarios. This scenario offers the best chance at seeing cost savings from primary prevention of obesity-related health conditions. Provider investment pays off as they rise to meet demand and receive adequate reimbursement. While this scenario requires the most investment, it also promises the greatest reward — widespread improvement in health outcomes.