With Weight Management, One Thing Leads to Another

Paul E. Terry, PhD

John Muir, the famous naturalist, wrote: “When one tugs at a single thing in nature, he finds it attached to the rest of the world.”  It’s a concept that’s long overdue but now fully ensconced in the field of population health management.  Employee health management (EHM) practitioners, in particular, are coming to understand that the environments in which health promotion interventions occur are a primary determinant of the effectiveness of the interventions.  What’s more, many now fully acknowledge that the sustainability of healthy lifestyle improvements in diet, exercise, or tobacco use is fundamentally linked to our surroundings.  Indeed, in last week’s “HEROForum12”, a conference featuring EHM solutions, a third of the session titles included references to culture.  Moreover, no matter what the topic, the phrase “building a culture of health” was stated at nearly every session.

Given this inexorable trend in EHM, there are two recently published articles that deserve to be read side by side.  First, dig into Thomas Reinke’s article from Managed Care: “Employers, Others Not Sold on New Anti-Obesity Drugs.”  Reinke, a contributing editor, offers thoughtful contrasts between the weight loss and co-morbidity improvements that the two recently approved weight loss drugs have produced and the recommendations of the American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF). Bottom line: both science-driven, consensus-based bodies conclude that nature’s favored approach to weight loss works.  That’s 12–26 intervention sessions per year focused on diet and exercise, according to the USPSTF. The ADA recommends a 7 percent reduction in weight and 150 minutes of activity per week to manage diabetes. Weight loss drugs are not recommended by Mother Nature, the ADA, or the USPSTF.

But don’t stop with Reinke’s concrete exposition if you’re among those awaiting a pill to solve obesity.   In a letter this month in the New England Journal of Medicine, a Four Year Follow up after Two Year Dietary Interventions, Schwarzfuchs and colleagues report significant weight loss and “overall persistent and significant reductions from baseline” in LDL, triglycerides, and total cholesterol levels.   This is a follow up on a 2008 weight loss study that I’ve cited more often than any other research since.  I reference it first, because it offers an edifying contrast between three different diets; second, because it’s among very few weight loss studies with long-term monitoring (six years!) and impressive results to share, but, third and foremost, I cite Shai and colleagues because of the context in which the study occurs.  Though the authors underplay this attribute of the intervention, the diets occur at a worksite that is as close as a researcher can find to a captive audience: live-in workers at a power plant in Dimona, Israel.  The authors seem downright coy (usually forbidden in the turgid NEJM) when they conclude that their findings “may be difficult to generalize to other free-living populations.”

Still, even in free-living populations, weight loss has been shown to be possible and sustainable.  Weight loss research at StayWell, underscores how vital program completion is relative to sustainable weight loss.  In support of this, new approaches to employee engagement are proving effective in improving consumer activation for better use of health care resources and improved health outcomes.  Mother Nature continues to offer the best medicine and that includes a healthy dose of culture change.

Paul E. Terry, PhD, is CEO of StayWell Health Management

 

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.