4.19.2023 Board Book

Conclusion Demand for obesity treatment and support seems likely to increase in coming months and years if, as expected, the prevalence of obesity continues to rise. The increasing number of obesity treatment options, from new anti-obesity medications to specialty obesity treatment and support delivered in-person or virtually, will heighten demand as well. However, continued reliance on fee-for-service reimbursement for obesity treatment and support could still lock in current inequities in which the stigmatization of obesi ty inhibits both patients and clinicians from initiating treatment, and in which limited insurance coverage and patient responsibility for cost-sharing limit access and skew uptake away from patients with lower incomes, limited or no insurance coverage, and away from patients from historically marginalized communities. Moreover, obesity-related health risks are among the most significant drivers of poor patient health and health care spending in the U.S. health care system --- easily as sig nificant as conditions (such as hypertension, hypercholesterolemia, and cardiovascular conditions) that are at the center of value-based payment innovation today. While obe sity presents challenges for value-based payment, the challenge seems unavoidable. Insurance coverage of anti-obesity medications took a notable step forward in 2023 when mandatory coverage of AOMs will be required in health insurance plans serving over nine million federal employees and dependents under the Federal Employees Health Benefits (FEHB) program. The new FEHB coverage will not as of now be linked to parallel development of value-based payment for providers that might enable obesity treatment and obesity support to be offered to federal employees at greater scale. The federal government and other large employers are in a particularly good position to experiment with the design and implementation of value-based provider payment for obesity treatment and support. Self-insured employers underwrite benefits for naturally defined patient populations --- their employees. Employers have flexibility in designing employee health benefits, employee assistance programs, and other benefits that allow for experimentation with outcomes-based and quality-based reimburse ment. Many large employers are demonstrating this flexibility today by offering employ-

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Envisioning Value-based Provider Payment for Obesity Treatment and Support