As of 2024, 12% of adults in the United States have now tried a GLP-1 medication, with 6% currently taking one. Despite the popular conception of GLP-1 agonists as the long-sought weight loss “miracle pill,” 62% of the 22 million people currently on the medication are taking it because of heart disease and diabetes.
At the same time, the medication remains expensive and often difficult to administer, with oral versions only recently making a strong entrance to the market. The expense of the new medications means they also face an uphill battle with payers, one that will still need to be fought for every possible population, from value-based care to private payers.
Still, the pressure to leverage the medication is on. Of the “big hitters” of chronic conditions either treated outright by GLP-1s or by reducing obesity:
21.7 million Medicare Advantage beneficiaries have heart disease, 9 million Medicaid members have diabetes, and 45 million commercial insurance beneficiaries are living with obesity, all of which together cost the US healthcare system 1.3 trillion dollars a year, a full 26% of the total healthcare expenditures.
There’s no question about the medical benefits of addressing obesity or the costs of care. The question is how to do it best at scale.
For now, the consensus among payers seems to follow the guidance of studies like this, that identify the magnitude of impact for weight loss by percentages and aligning to the 10% threshold to maximize impact while controlling costs. Typically, once a patient crosses that threshold, coverage concludes.
There’s an obvious logic to it: do the most good based on costs and impacts.
However, early proponents like Dr. Spenser Nadolsky, one of the first obesity specialists in the country to advocate for the use of GLP-1s, has long pushed for providers and payers alike to treat GLP-1 as a long-term, chronic management tool. His concern? Any lost adiposity will return, with initial markers of health returning to their prior state. Unfortunately, a study at Cambridge found that’s precisely the case.
There is hope, though: lifestyle change. And while this has been the clinical advice for well over a century, there’s a new opportunity with the head start GLP-1s can provide. This is where social risk data comes into play because, fundamentally, lifestyle is a non-clinical factor of health. Factors like health literacy (do they fully grasp how they can continue to see benefits after the medication term is complete?) food insecurity (do they have good access to more nutrient dense foods?) transportation insecurity (can someone get to a gym or park?) are often hidden from providers and payers alike. Each of these negatively affecting outcomes, increasing avoidable utilization, and driving costs through the roof. (Or at least, they were before we got here).
The ability to understand the immediate social risk factors affecting someone directly changes what that 10% reduction in bodyweight does long term. It’s the opportunity to see the relevant factors in every individual’s life, like living in a food desert, financial status, or health literacy barriers, and provide direct assistance. It doesn’t matter how much someone may want to change their lifestyle if there are barriers outside of their control.
Real, actionable social risk data is still new in healthcare, especially when it’s directly tied to outcomes and cost avoidance. It’s not surprising if you’re saying, “So now what? How would this actually work?” Well, if you’ll indulge us, we’re going to get into precisely how partners across the US are already seeing success from partnering with us.
You don’t know what challenges someone is even facing? Benefit Matching combines social risk factors with suggested interventions, taking the guesswork out of lifestyle improvement, tailoring results to their individual challenges.
Are you looking for a bigger picture view that helps you understand the correlations between social risk and documented conditions? Population Pulse combines both datasets, helping you identify the overlap and strategize on solutions and monitoring.
Do your care managers need better insight into their patients? Individual Spotlight, much like Benefit Matching, can identify specific interventions through Socially Determined partners like FindHelp.
Are you a life sciences company, payer, or provider that already has an existing, robust data infrastructure? We provide a straightforward data package updated at a regular cadence, putting social risk data into your own systems.
Looking for that unique, next generation opportunity? You can share your existing patient data with us and we’ll run it ourselves, delivering outputs directly to you in any configuration.
GLP-1s are a revolutionary medication that can address a common, and critical challenge to lives across the US. In its current typical payment strategy, it is unfortunately a temporary fix. However, with real, focused support, organizations can provide direct patient and member support that ends blanket-programs with low engagement and poor targeting and enables precise strategies that deliver results and radically reduce overhead.