- Key insight: Find out how employers are balancing metabolic support and GLP-1 medication access with strict healthcare cost controls.
- What's at stake: Employers face soaring budgets and massive productivity losses if metabolic health planning fails.
- Supporting data: An expected 54% increase in productivity losses.
Source: Bullets generated by AI with editorial review
Metabolic conditions negatively impact other health areas from head to toe — heart, sleep, brain, hormones — so coming up with a
The price of avoidance or poor planning will hurt budgets and output: For example, by 2050, costs related to heart conditions are projected to almost quadruple from what they were in 2020 ($393 billion to $1.49 trillion), and productivity losses are expected to increase by 54%, according to research from the American Heart Association.
Still, benefit leaders are facing big challenges as they figure out how to put impactful,
"They're grappling with healthcare costs vis-a-vis total cost of care, but also GLP-1 costs specifically," she said. "They're grappling with health outcomes — how to get their population healthier [while] controlling costs, and GLP-1s could be a part of gaining those outcomes — then thirdly, they're grappling with employee value proposition — how do I continue to compete in what is still a competitive employer market?"
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Most benefit leaders see these concerns as being at odds with each other, Walmsley said, but they don't have to be. When employers provide access to interventive resources like clinician-led guidance, personalized nutrition support, and ongoing coaching in partnership with medication, they stand a better chance of "controlling healthcare costs inclusive of GLP-1s … and providing a benefit that people love and [see as an] investment by their employer in themselves and their health."
Walmsley sat down with EBN to share how benefit leaders can determine the best offering options for their workforce. This interview has been edited for length and clarity.
What are the first things to consider when planning a metabolic support program?
When we talk to a customer, the first question we ask is, "What are important outcomes to you?" This decisioning really sits on a continuum, and there is a continuum between high utilization and access of GLP-1s and overall weight-loss care and cost control. You can go all the way down to hypercost control; you can go all the way up to tons of access where all appropriate employees are on GLP-1s. Most employers sit somewhere in the middle, where they would love to be delivering the right care that their employees are seeking with the option of GLP-1s, but want to see that done in a way that feels balanced with an overall budget and healthcare spend.
So the first conversation we have is where you sit on this continuum. Once we've determined that, there's really three decisions that an employer needs to make: How they want to get their population healthier, and whether that is going to be inclusive of GLP-1s or not. If the answer is no, there's still great nutritional care from providers like Virta that they can offer. If the answer is yes, the real question behind that is what are going to be your tools to get your population healthier?
The second question you have to ask is how are you going to provide access to this care to make the best of that investment? What's happened over the last three years is there's been a lot of, hey, GLP-1s … [are the] next miracle medication. The reality is, GLP-1 [leads to] a significant metabolic change and requires significant lifestyle support both to maintain success on the medication vis-a-vis side effects, etc., and then also to get maximum impact of the medication. The clinical trials for these medications were not medication standalone; they included nutritional and exercise care as well. So the second choice is, do I want to provide care support for GLP-1-access or not?
Then the third one is, how do I want to give access to GLP-1s or the fulfillment of this medication, and this is also a very novel decision for benefits buyers to be making. Where traditionally every pharmaceutical that you're going to cover sits on your PBM formulary and is accessed through your PBM at local pharmacies, GLP-1s have behaved differently in lots of ways, and this is certainly one of them, where there is cash-pay availability, access, and more.
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What pitfalls do benefit leaders need to avoid when planning out their metabolic health strategy?
When we look at optimization of a GLP-1 budget, but also your overall weight health or metabolic health budget, we see a number of areas of waste being ignored. One is people who start a GLP-1, but for a number of reasons, whether it's affordability or side effects, don't continue it. So now you've paid for several months of a medication that has zero outcome. The second piece of waste is when GLP-1s are used as a standalone intervention. The health impact is lower than when it's coupled with nutritional care.
Thirdly … we believe there's a lot of waste in assuming you have to stay on a GLP-1 permanently. This is an area that everyone in this ecosystem, including providers, has strong opinions on, but we have 11 years of data prescribing GLP-1s, many of those years in a type 2 diabetes care context and now two years in a weight-loss context, and we have a ton of evidence that shows we can get most patients — not all — to sustain their weight loss post a GLP-1 utilization when they adopt nutritional changes alongside of that as well. That's part of the strategy — identifying do you really understand where these three areas of waste are and making sure that your ultimate solution addresses all of them.
What are the different ways employees can engage with Virta?
When people come to Virta seeking a GLP-1, we provide the option for starting weight loss as a nutrition-only focus first. If you want to start a medication but still make some meaningful nutrition changes to both optimize the outcome of that medication, and have an independent offboarding path in the future, we can do that too. And then of course we have some members who say, "I'm not ready for significant behavior change yet, but I'd like to start a GLP-1," and we can still support the access and symptom control. I think it surprises a lot of people to hear that the segment of our enrollment is actually less than 10% who say I only want the medication.
It's important to provide choices for people — having an option for people that is nutrition only as well as across that spectrum is really delivering great outcomes. Employees want to be able to engage with one platform where they're able to get access to great care, fulfillment of, and clarity on the medication, and nutritional support, and then continue that life cycle through to success and ultimately independence.
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Why are benefit leaders ideal for leading real change in the area of metabolic health?
The greatest mechanism of health outcomes sits in trust. Why do we look to our employers for the best support? It's because we trust them. There's a great deal of trust put into employee benefits leaders to be bringing some of the best health solutions to their people today. And whether or not that's a fair ask, it is the ask of them, and I see so many of them rising to that occasion in such impressive ways. The resourcing and experience that they provide, and the outcome rigor they require to make sure the benefits and solutions they're offering are worthwhile of their people's time and their company's investment — it is a big burden to make those decisions. But they know it's an important job, and they're doing it really well.
