Austin Barrington, FSA, MAAA, Principal and Consulting Agency, Milliman
Seth Friedman, National Pharmacy and Health Plan Services Practice Leader, Gallagher Benefit Services
Jennifer Layne, PhD, Director, Medical Affairs, Dexcom
Jessica Vilani, Director of Product Management, Blue Cross Blue Shield of Michigan
Tejaswi Kompala, MD, Senior Director, Clinical Strategy, Teladoc Health (Moderator)
As our understanding of cardiometabolic health progresses, so too does the need for benefit strategies to progress. What should that evolution look like? From the role of lifestyle programs, expanded uses for medical devices, and new ways of evaluating success, industry leaders across healthcare shared interesting perspectives for employers and health plans to consider during a session at Forum 2024.
Jessica Vilani said that the portfolio of cardiometabolic health solutions at Blue Cross Blue Shield of Michigan has evolved from traditional disease management to a more integrated approach. “Our members don’t have just one condition that they’re dealing with,” Vilani said. “It’s not just the diabetes. It might be the diabetes and the heart condition.”
Tejaswi Kompala said, “They’re all connected,” about the spectrum of cardiometabolic diseases. “Let’s make sure we support people with those conditions using a connected approach.”
A key aspect of this is supporting foundational lifestyle behaviors—diet, activity, sleep and stress management—that help across the spectrum. This is something that technologies like continuous glucose monitors (CGMs), a wearable device that helps people track blood sugar levels, support.
Once specifically used to help people with type 1 diabetes, Jennifer Layne shared that they are increasingly used in treatment plans for other conditions because of the power of data to drive behavior change.
“Having information and technology is so empowering for people to make change and can help how they feel about their self-efficacy and their success,” Layne said.
Demonstrating the impact beyond diabetes, Layne said Dexcom has found that people using a CGM device have seen improvements not only in blood sugar levels but also in blood pressure, cholesterol and weight.
Technology has played a big role in innovative cardiometabolic health programs for years. More recently, opportunities for innovation have come from how these programs can support people considering or on GLP-1 medications for weight loss.
Seth Friedman said Gallagher’s employer clients initially took a variety of approaches to covering GLP-1s for weight loss. According to Friedman, about half elected not to cover. A smaller percentage prioritized broader access, and he said they saw skyrocketing costs with little clinical results.
Friedman said people were coming on and off the medication, and the lack of consistency with the therapy affected outcomes. Because of this, he said more groups are mandating lifestyle management programs that support medication adherence and behavior change.
“If you want access to therapy, you need to engage in these programs because there’s a lot more to it than just injecting yourself,” Freidman said of the approach employers are taking with employees to maximize their investment in medication coverage.
Vilani said Blue Cross Blue Shield of Michigan has also begun requiring participating in a lifestyle management program. “We want to make sure members are having the best care,” she said. “It’s not just treating obesity through medications, but also looking at lifestyle habits so that members are living their best and healthiest lives.”
Kompala said it highlights the importance of patient education. “We must help members move from, ‘OK, I get this shot, I’m better,’ to it’s a lifestyle,” she said. “But the education is hard for providers because they only see a patient once or twice a year. That’s where programs like what we’re doing at Teladoc Health are pivotal.”
As cardiometabolic health programs have evolved, so have how they’re evaluated.
Traditionally, return on investment (ROI) based on direct claims savings was the focus. Now, as more plan sponsors see the added benefit of innovative virtual care solutions, they are considering value on investment (VOI). VOI looks at direct claims savings plus indirect savings based on increased productivity, improved retention, reduced absenteeism and more.
“We know that our employers are thinking about VOI,” Kompala said. In a recent survey, 89% of Teladoc Health employer clients are using or considering using VOI when evaluating virtual care—not just ROI. Teladoc Health created the Cardiometabolic Health Value Model to help plan sponsors understand the full value of its chronic care solutions.
This model uses client-specific inputs, such as occupation, and Teladoc Health results to project overall clinical improvement. Clinical improvement is then translated to financial impact and multi-year ROI and VOI projections based on assumptions from peer-reviewed research.
Teladoc Health engaged Milliman, the world’s largest actuarial consulting firm, to validate this approach. “The model is probably one of the more robust, more flexible models that I’ve seen,” Austin Barrington said.
“Many of the same techniques that can be used to evaluate the financial outcomes can also be used to evaluate satisfaction, presenteeism, absenteeism and workforce retention,” Barrington said. “All of these things can be measured, and I think it’s critical to do that if that’s the goal of the program.”
With VOI, groups take a broader look at their solutions. “It reminds us that we can be thinking about financial outcomes,” Kompala said. “But we should think about it alongside the clinical outcomes and the qualitative aspects too.”
