Attendees will learn about:
- Nutrition's role in sustainable weight loss management
- Why employer-provided resources for diet and nutrition are key methods of support
- Nutrition resources can be used for other wellness-based benefits, such as hormonal balance, which appeals to a larger portion of the workforce.
- Various integration styles of GLP-1s
Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.
Lee Hafner (00:12):
Hello and welcome to EB N'S Health and Wellness Benefits Summit Weight Loss GLP ones, and a new era of holistic employee health. As the incorporation of GLP one's into employer benefit offering continues to grow, it is impossible to have a complete conversation without addressing the many ways employees need to be supported when it comes to their weight health. Today's summit addresses many of these things that employers and benefits experts need to consider as they put together an impactful sustainable health and wellness package for their workforce. So without further delay, let's get started with our first panel, which focuses on holistic weight loss care, how integrating medications and nutritional and behavioral support enhances employee wellness. And just to take care of a few very quick housekeeping things, welcome to all the attendees in our first panel today, and thank you very much to our sponsor found.
(01:11):
We are thrilled to have them as part of this. Also for SHRM credits today, S RM recognizes the Health and Wellness Benefits Summit for professional development credits or PDCs, applicable to SH RM CP or S-H-R-M-S-C-P certifications. So attendees, they can earn up to three PDCs for the virtual sessions they attend to receive credit pleases, stay the full hour, participate in audience engagement activities. We will have three poll questions throughout this session. Complete and submit the evaluation form no later than Monday December 16th. The evaluation form is in the attendee hub where you are first logged into the session today, and it will be available after the first session of the summit. If an attendee participates in all three sessions, you only need to complete the form one time. Please participate in our poll questions and as you think of them, as our speakers are going through the information today, please submit poll questions to the or not poll questions.
(02:13):
I'm sorry. Please submit your questions to the chat section and we will do our best to get to as many as possible during our q and a session, which happens at the end. Alright. I could not be more excited to present today's speakers, so let's go ahead and get rolling. I'm Lee Hafner, I'll be your moderator today. I'm an editor at EBN and we have Dr. Reka Kumar, the Chief Medical Officer at found. Stephanie Koch, director of Human Resources at Hendry Marine Industries in Tampa. And Kara Bull population health management consultant with USI Ladies. Welcome. Okay. They're going to introduce themselves a little bit more with details of their backgrounds and then we will get rolling with our session. Dr. Kumar, I'm going to turn that over to you.
Rekha Kumar (03:01):
Sure. Thank you for the introduction and having me here. I'm Dr. Reka Kumar. I'm an endocrinologist and obesity medicine specialist. I'm located in an academic center at Weill Cornell in New York City. And prior to becoming the Chief Medical Officer of found, I was the first medical director of the American Board of Obesity Medicine where my position was really to create the credentialing exam for physicians who choose to become board certified in the field. That was a great experience for me both through that position and my position at found. I've continued to practice general endocrinology and obesity medicine and really try to push forward the science of metabolic health.
Lee Hafner (03:43):
Thank you, Stephanie.
Stephanie Koch (03:46):
Good morning, or actually good afternoon. My name is Stephanie Koch and I'm the director of Human Resources for Hendry Marine Industries and Hendry Marine is a holding company for two shipyard operations and we are in the Tampa, Florida area. Our company has 300 employees. And as far as my background is concerned, I've worked in human resources over 25 years and over the past eight plus years I've taken a very vested interest in healthcare strategy as a foundational information for an organization. It has to be strategy related to healthcare in order to be successful. And this is a really huge interest to us because of the nature of our population. So I'm excited to be here.
Lee Hafner (04:40):
Thank you,
Kara Boley (04:41):
Kara. Hi, my name is Kara Boley and I am a population health management consultant for USI insurance services. I am also a registered dietician. I have a specialty in adult weight management. I've worked in the area of employee wellbeing for a long time, but also I've worked in a clinical setting from bariatric surgery to medically supervised weight loss and cardiac rehab and everywhere in between. So I've been part of a benefits team. I'm now on the consulting side and I've been the feed on the street, the employee wellness person for a large city here in Arizona.
Lee Hafner (05:20):
Thank you. So it is wonderful to have the three of you on this panel today, all of your expertise. I can't wait to hear all of the insight that you have to offer. So I think we're talking about the role of nutrition support as part of this holistic approach to weight management in general and why employers need to keep this in mind if they decide to incorporate GLP ones into their benefits offerings, but also in general, even if they don't. So Dr. Kumar, I'd like to get started with before employers and benefits professionals can create an impactful weight management package, why is it important for them to educate themselves on the challenges that come with long-term weight loss success, such as adhering to a healthy eating routine?
Rekha Kumar (06:09):
So from learning about what matters to employers and benefits managers, of course we want people to be healthier. We want our employees to manage their metabolic health, but it also has to make sense from a cost perspective. And one of the big challenges I have heard from that population is adherence to these medicines and the concern that when people don't adhere, the cost doesn't make sense. So one thing I want to emphasize is the need for comprehensive long-term care. That doesn't necessarily mean just the cost being on medicine forever, but kind of explaining to a patient or employee that they will require medicine plus lifestyle or behavioral change in order for the medicine to work. The medicine is just one tool and if there aren't associated lifestyle intervention support with nutrition, fitness, sleep, stress management, all of the lifestyle side of managing your weight and metabolic health, that the medicine isn't going to work for the longterm. So the medicine really is a tool and a companion to good lifestyle intervention. People are able to adhere to the lifestyle intervention better when they have the biology help from the medicine. So I think we really want strong lifestyle intervention plus the use of medicine and if there's any chance of people coming off medicine, it's going to be the people that adhere most and have the most support on the lifestyle side.
Lee Hafner (07:46):
Yeah, okay. And so that brings us to our first poll actually for the audience. Okay. So first question, does your employer or company cover or plan to cover GLP ones in their healthcare benefits offerings? And the choices are yes for everybody, yes. But on a limited basis, no. Or last one is I'm not sure. And so take a few seconds to go ahead and answer that. And while people are doing that, Kara, I'm curious as to what you have seen as far as the trends with GLP one offerings and are you getting a ton of interest in questions about this? I would have to imagine that you are.
Kara Boley (08:39):
Yeah, we were talking earlier, it has not died down, that's for sure. Definitely a lot of questions, and I think most of the groups that I have worked with are really trying to figure out the best options. They're sort of trying to navigate all of the information, the cost of course, weighing that against what their budgets look like, what their renewals have looked like, and then all the other stuff. Does it work? Do people stick with it? The things that Dr. Kumar mentioned as well, it is definitely a hot topic and I certainly don't see it going away anytime soon anyway.
Lee Hafner (09:15):
Yeah. Okay, perfect. All right, so I think we just have maybe one or two more seconds, so if everybody could get their answers in. Okay. All right. We'll come back to results in a second. Dr. Kamar, I'm going to go ahead and keep the conversation going with you. What are some important education points? You've written a ton about this, so for everybody who is attending today, I would encourage you to seek out some of Dr. Kumar's informative pieces on this topic. But you've highlighted some very specific things. Can you talk a little bit about some of the ones you just feel are most important for the people who are attending here today to keep in mind?
Rekha Kumar (10:08):
Yeah, I would say one of the most important things for long-term weight management and metabolic care are probably personalized care. And that's something that's very difficult to do at scale, but even with these very effective, potentially miracle drugs that people are calling them, there are still people that don't respond or respond sub-optimally. And when I learned that data of a huge percentage of people stopping after a few months, I thought, well, I've been in this field for 15 years and my patients rarely stop their medicine. And why is that? And I think it's that not the standard perfect as per packaging dosing isn't perfect for everyone, so you really need an expert prescribing the medicine. And I think because of the demand, what we're seeing and what I'm seeing in my practice is that people will get the medicine from almost anywhere these days. Hopefully it's the PCP, somebody that is really caring for the patient, knows the patient, but even the PCP when they write the prescription, they don't have the education time resources to deal with all of the other pieces of managing all of the things I said that come along with the metabolic health journey.
(11:29):
The number of phone calls my office gets on, like, can I eat this? Can I eat that? I think I accidentally shot the medicine into my thumb instead of my tummy. The number of phone calls is incredible, and you have to respond in order to keep these patients on their journey. And so they may get that first prescription from anywhere. I've heard MediSpa, primary care doc, dermatologist, plastic surgeon. And then the scariest is I got it online without seeing a doctor. All I did was send a text. People are getting their hands on these prescriptions and then they don't know what to do either if it's written by a reliable person, that actual person doesn't know what to do if the patient has a side effect, or even if the patient does well, I've seen the textbook scenario, which is a good thing, which somebody loses 2040 pounds and then the prescriber says, oh, you've lost the weight.
(12:23):
I'm going to discontinue the prescription. And nobody wants to hear that patients need to be on medicine forever. And I think we don't, although the research is showing that when people abruptly stop the medicine, they regain two thirds of the weight within a year. What the sophisticated prescribers are doing is that they are finding ways to deescalate space out the medicine, create a more personalized regimen that involves prescribing less medicine over time, reducing the cost while pairing that with lifestyle support. And so I think that one of the essential things is personalization. And that's been one of the hardest things in metabolic health to do at scale because there isn't, although that there's standard recommended dosages, people need a personalized approach not only to their medication regimen, but to their nutritional recommendations, their exercise recommendations. So it's not a one size fits all thing. And I would almost equate it to how personalized we are with cancer treatment. We really target chemotherapy these days. The difference with this is that potentially 70% of the US population has some version of this disease, whereas a small number of people have cancer. And so how do you personalize care to a condition that affects so much of the population? And I think it's choosing a partner or a platform that really has the right experts, has the right wraparound care. Those are things that I'd say are important.
Lee Hafner (13:55):
Yeah, no, thank you. And so I think it speaks to also the importance of what we're talking about today, which is this holistic approach versus maybe piecing things together without being completely informed. And I know, Stephanie, you have done so much research when putting together the benefits that you guys offer your workforce. And so first I'd like to recognize that Henry Marine Industries was named the most engaged employer in healthcare in the entire state of Florida, which is just awesome. And so that's a huge achievement. But in speaking to you in previous times and at events, I know exactly why this is, you guys have done a tremendous job. So you've personally played a huge role in designing innovative health and wellness offerings for your workforce. Can you share the specific way that your company decided to go about offering the GLP ones to your employee population and some of the benefits you've brought in to help all of your workers when it comes to their health and wellness in the area of weight management?
Stephanie Koch (15:01):
Sure. So thank you so much for that nice introduction. We're really proud of all the accomplishments that we've made over the past few years, and going from a fully funded to self-funded healthcare program was probably the biggest milestone. The company, a private company like ours and our size that we achieved over the past few years, we went self-funded in 2019. And when you're self-funded, it really gives you an opportunity to create and curate a healthcare plan design that is really necessary to help support the needs of your employees and their covered family members. And that has been our focus for all the time. I've been at Hendry since 2019, and what happened was when we became self-funded, we started seeing a lot of data. We had transparency and a lot of it was showing. And one of the big points showed back in 2021 that we had only 15% of our population even participating in the preventative wellness programs, which as we all know are covered at a hundred percent.
(16:16):
So given the fact that we have 300 employees and 80% of them are men in late forties, early fifties, that was definitely a showstopper for us. And it gave us a reason to pause and decide at that moment. We wanted to have an immediate intervention of availability of primary care. Now we know that primary care services are difficult to come by. They almost are less primary care providers. When someone does see a provider, it's a short visit even if you can get in. So one of the things we did, and this was a huge accomplishment as well, was we partnered with a company to provide onsite primary care for our organization. And we brought them onsite in January of 2022. And what was so great about that partnership and still is to this day, is they've allowed us to customize the type of primary care and relationship model that we wanted our employees to have with their nurse practitioners and the medical assistant that are on site.
(17:32):
So that was really the catalyst for a lot of the work that we've been doing. And while we don't use GLP ones for everybody, and I commend companies that are doing that, we do approve them for people that are diabetic and do need the help with the GLP ones to control those metrics so they can be healthier and be more productive. But having the onsite primary care was our way to get things from the root of the cause and work with the employees at the base and foundation of any issues go from the prevention side rather than what happens after the fact. Now, those employees are certainly treated at the clinic. We allow our employees to go to the clinic at no cost. They're open two days a week, they go on company time. And what we've actually done is we've curated a system where we can send our, we call 'em ghost claims or $0 claims to our TPA, so we can, in essence track what's happening so we know what we can continue to treat and how we can help our employees live and their family members live better and more productive and healthier lives.
(18:49):
So our mission is preventative based, and we don't cover GLP ones for everybody. It is something that eventually we may do, but unless we see a program that we'll speak to our entire population, we're going to put that aside for right now.
Lee Hafner (19:09):
Yeah. Okay. Thank you. Kara, could you jump in for just a second with what Stephanie was talking about, the importance of tracking this type of information so that you can keep track of what is working and what is not. I know you do this with folks, but why is it important for employers, regardless of who they're working with to help them out? Why is it important they get something that can help track and manage whatever it is they're doing for their employees regarding nutrition?
Kara Boley (19:40):
Yeah, absolutely. Stephanie stole a little bit of my sunder, but that's fine. I definitely think the more data any employer group can get, the more data the HR team or the decision makers can get. Obviously this is de-identified data, it's aggregated, but the more data that's available, the better informed decisions. If you're a fully insured group, I realize depending on the carrier, the amount of data you can even get or claims information is somewhat limited. So I think even going back to the basics, I think our HR teams, especially the benefits leaders and the feet on the street, they hear questions. So to me it's anecdotally, what are people asking for? What are other companies doing that kind of maybe are similar to you? I think geographic location makes a difference as well, where companies are located, there's different kind hot topics. Nationwide varies here and there.
(20:40):
So I think any data and then even anecdotal data is meaningful in how you start to form your strategy. And part of the strategy can be we're looking at it and we're considering it, but we're just going to wait and see another year. That's an okay strategy too, but just opening your eyes to the data, what people are asking for, what's going on in the marketplace, finding a partner that will provide reporting for you that is meaningful to your group and to your leadership. I realize sometimes our HR teams are answering to people that have different perspectives in those higher level roles. And finances certainly play a role. So making sure that all of your partners can report what you need and what's meaningful to support your program and your decisions.
Lee Hafner (21:31):
And Stephanie, I'm going to pivot right back to you for that. That was a perfect tea. Thanks, Kara. So when you're able to do more of this, it goes from being this wonderful thing that you're doing for your employees to also really being able to see the impact on the employer's bottom line. And so how have you guys really worked to shape a very, very well constructed program to where you have both sides of the coin?
Stephanie Koch (22:01):
With respect to our onsite primary care, we work in tandem with them along with our healthcare plan, and it's always about the data. So we make decisions like Kara was saying, a company has the response. Well, we're fiduciaries as plan sponsors, we are fiduciaries of our healthcare plan. So we have an obligation and duty to our employees to be prudent in how we spend the company's money and spend the employee's money with respect to healthcare. So we're always going to be investing time in our data and evaluating where we see hotspots like we did in 2021 where we saw the preventative care being an issue, and we also have a 10% diabetic population. And in a group of 300 people, that's significant. And we continue to look for data that points to problems within our population so we can help facilitate programs that will help support them. And again, they work in tandem together. So our onsite medical clinic works with our healthcare plan, works with our local network of physicians. So everybody is part of our healthcare ecosystem and they understand the assignment and they deliver it very well.
Lee Hafner (23:26):
Yeah, thank you. So let's go ahead and do our second poll question. So this one is, does your company offer any kind of nutrition diet or weight loss management support or resources? And the options are yes, for everybody, yes. On a limited basis. No, they do not. Or you are not sure. Let's take a couple seconds to answer. And so quick question I'm going to ask Dr. Kamar, while people are taking a second to get their responses in. When it comes to employer sponsored focus of any kind, resources, support programs, policies, anything that helps their workforce manage their health and wellness, what is the trickle down effect also when it comes to employee families? Where is the broader picture in this when it isn't just I'm simply helping people get their weight under control? Why is it actually so much bigger than that when employers step in and take this role on?
Rekha Kumar (24:36):
Yeah, that's a really good question and a good topic. Metabolic health really has to be a family intervention. When you look at the literature from pediatric obesity, almost all of the interventions are really based on the family and the home and the setting. And really we should extrapolate that to adulthood. For me and my practice, I actually sometimes see multiple generations and multiple members of the same family because it's very difficult to have one person change their habits and lifestyle in isolation from their family. And likely it's not going to be sustainable if the other people don't have the tools. And so people are more likely to develop healthy routines, comply with their medicine if they're in an environment where everyone's doing it and everyone's supportive.
Lee Hafner (25:31):
Okay. Yeah. Thank you so much. And so the poll results actually look really great. I think so people said yes, 40% said yes for everybody. My company does offer some of these resources, so I think there's room to grow, obviously, but it doesn't sound like a bad start at all. Another 30%, yes. On a limited basis. So 23% said no, and 8% said not sure. So that's fantastic. And so Kara, I'm excited to get your thoughts on the next section of this. You have experience as a registered dietician as well as a counselor and consultant. And so how has your unique expertise really helped you to communicate to employers as well as individuals about the importance of the behavioral changes that Dr. Kumar was just talking about eating better and developing a healthier relationship with food? Why is this so pivotal?
Kara Boley (26:30):
Sure. I mean, as Dr. Kumar mentioned, every piece of research out there says it's not going to work with medication alone. And even my days spent working with our bariatric surgery patients, and I mean this was a long time ago, not to date myself, but there was really only one or two great options for those patients for types of surgeries. And that there's still a huge lifestyle piece of that. There's still, I think we forget about the mental health piece. There's still a lot around the mental health side of things. And also just what am my protein foods? Why am I eating the emotional side of it? It's not ever just going to be, I magically get to take this pill and I have to do nothing else. I mean, I guess maybe way down in the future that could be a possibility. I don't know.
(27:18):
But I know right now that's not the case for anything. So that behavioral piece is pivotal, and the medications that we're talking about with these GLP ones are really not meant for the member that's just trying to lose 20 pounds. That's really not what they're meant for. And so again, having a partner and having programs available that meet everybody where they're at, because it's not to discount people that do have 10, 20 pounds that they want to lose to feel better. Those are people that need some support also. So having programs that cover, Hey, I need to lose a little. And the programs that are really working with these medications where we're looking at BMIs of 30, 35 and above, and there is a behavioral piece and a mental health piece and an emotional health piece and an exercise piece to every single part of the puzzle, for sure. I could talk a long time, so I'll stop myself there on that one.
Lee Hafner (28:13):
No, I think that's fantastic. So maybe pick it up in just a second too, because Stephanie, you're in the trenches basically with your employees trying to figure out what they need. And this is an evolving conversation. Obviously lots of changes, lots of new research is coming in. So as that's happening and as people's needs change within their employee experience with the company, what are some ways you stay up to speed with your employees so you understand their evolving needs and wants in regard to this topic?
Stephanie Koch (28:49):
It's interesting you asked that question because one of the things we were talking about doing in the first quarter of 25, because remember I was saying, we have been shaping our healthcare plan, our healthcare strategy. When we went self-fund, and this has been for the past six, seven years, and we were doing it based on the data that was trending where we were identifying critical needs and critical areas. But in the first quarter of next year, our goal is to reach out to our employee workforce and really identify things that they may want to incorporate into our healthcare plan that maybe we don't know that they want. So I always think it's important to really engage them because we want them to be part of the process. And I think also it helps the company culture and it helps you get better buy-in when you want to roll out a new, and I was also going to add, because I love all the comments that Kara and Dr.
(29:46):
Kumar are making, and it really is about structuring a program around support. And it came to mind that over the past few months, even though our onsite primary care clinic, we have nurse practitioners and we have a medical assistant, but they are so engaged with our workforce and the people that see them every week. We did have a couple of employees that went there and they were struggling with their weight. And that started with some blood work, which prompted a conversation of, can you help me lose weight? And we had two success stories over the past few months where employees didn't use GLP ones. They had conversations with the primary care doctor who helped assist them just go on a more natural journey. So it was nice to see as an option, but that was also managed care.
Lee Hafner (30:45):
Yeah, okay. And I think too, going back to what Dr. Kumar was just saying as well about this being a very just all encompassing journey, and everybody from every angle who's involved needs to be on board. So Dr. Kumar, can you expand upon that for a second about the need for someone's care team to be in communication? So if you, for instance, are communicating with someone's general practitioner and so on and so forth, and why all of these things need to meet with maybe an employer is using a weight loss platform in addition to the GLP one offerings, for example, to enhance people's nutrition and education and habits, why do all of these pieces need to connect so that the employee is really getting the best comprehensive level of care possible?
Rekha Kumar (31:39):
So it's really hard to separate weight and metabolic care from other aspects of your health. It's connected to your primary care, your cardiac care, your reproductive health, and it really can't sit in isolation first for obvious medical reasons. So medication interactions, that's the most important. Is the metabolic health specialist prescribing something that is contraindicated, has an interaction with or requires a dose adjustment of something else. I'd say the most common would be insulin. If somebody has diabetes type one diabetes or type two and is on insulin and we're adding medicine that helps with weight loss, that likely requires a reduction in insulin. So you really want to be doing that in collaboration with whomever is using or prescribing the insulin. I also think that there's still not a ton of knowledge about these medicines, their mechanism of action, their duration of therapy by all providers.
(32:41):
And so what I saw years ago when I occasionally did function in isolation, and I shouldn't do that, is I would start a medicine and then it would be discontinued by a primary care doctor, for example, off-label Metformin, which is a great medicine for insulin resistance to help with weight loss. And someone else would discontinue it and say, patient doesn't have diabetes. And then the patient would come back to me and said, my primary care doctor said I can't be on this because I don't have diabetes, and now I regained the weight. And so I think there's an element of educating our colleagues on the science of metabolic health and what medicines are appropriate to use. And occasionally things are used off label and that can be misunderstood. So I think for the reason of medication interactions, education and just collaborative approach, I know that patients always do better when they feel like there's a team taking care of them and that everyone is supportive of what their goal is.
(33:40):
The other is actually weight stigma. There's this, sometimes patients will feel embarrassed with one doctor or feel like they're cheating on a doctor or say the PCP says you just need to eat less and exercise more. Then they come see someone like me and they feel a little bad. They're like, my PCP is going to be mad at me because now I'm asking for medicine or want to try medicine. And it's not for the patient to have to deal with that kind of pressure or guilt. I think it's my job to go to the PCP and say, Hey, this is a really appropriate candidate for a GLP one for reasons X, Y, and Z. The patient shouldn't feel bad to go back to their PCP and feel like they're cheating because of the way another doctor made them feel. And I see this all the time.
(34:24):
People end up not going back to their PCP or to whatever doctor they felt judged by. So I think if people could communicate and help the patient stay inside the healthcare system, this was, I think one of the problems with covid when the data came out that obesity was a risk factor for severity of disease for ICU admission. And the question came up of, well, is this because patients with obesity aren't seeking out care early? They've already had bad experiences with the healthcare system. They come in later and these are patients we want to take care of. We want them to get healthy. And I think part of our job is keeping them inside the system and letting their doctors communicate.
Lee Hafner (35:06):
Yeah, absolutely. Thank you.
Kara Boley (35:07):
Can I jump in for just a hot second?
Lee Hafner (35:09):
Sorry. Of
Kara Boley (35:10):
Course. Thank you. I just wanted to piggyback on what Dr. Kumar was saying from a claims perspective. So for my larger groups or self-insured groups, we can look at the claims data and we know statistically speaking, the CDC tells us there's about 40% of Americans are overweight or obese. When I look at a diagnosis code of obesity, overweight, the actual claims, the codes, when I look at US book of business, it's over 2 million lives, 2% not adding up. How are we saying that in the US 40% have an issue, a condition, and we're only seeing claims related to a diagnosis code of obesity or wait for 2% or less? That's pretty extreme. So I think to Dr. Kumar's point, there is still a ton of stigma and discrimination that leads people to not seek out care or wait until there's literally no choice. I think I always like to remind you, when I'm sitting in meetings with our HR leaders, these are things I like to remind them about.
(36:18):
Obesity has so often been thought of as just pull yourself up by the bootstraps and just work a little harder. And we don't say that to people with cancer. We don't say that to people with cardiovascular disease or high blood pressure, those types of things. So I just think kind of helping our HR team to be able to also explain to their leadership, we're trying to treat a condition here. We're not treating someone's willpower. That's not what we're in the business of doing. We're really trying to treat a condition that, and sorry if I'm kind of all over the place, but it's impacting so many other things. We mentioned sleep earlier. Sleep apnea is a significant problem, especially if you've got drivers, right? It's impacting your rates of diabetes, it's impacting the mental health of your workforce. It's impacting all those other types of claims, workers' comp claims, missed days off work, leaves of absence, all of those types of things. So it's such a bigger thing, and there's just still so much stigma. I think hopefully tides are changing, right? We've seen quite a good change with mental health and the stigma related to that. So hopefully this is another one, but I think it's a tough conversation to have with your leadership sometimes is like, Hey, it's not just willpower. It's not just the simple move more, eat less. If that was the case, we wouldn't just be creeping up every single year in our percentages.
Stephanie Koch (37:47):
Yeah. Going to jump in a second too. I mean, I couldn't agree with all of those comments more because I myself struggled with having extra weight almost my whole life. And it is something that if you as an employer are putting a program in, you really want to have, like Dr. Kumar said, and Kara said, you have to have the support that you need. I always say on the front end, and I'm certainly not a clinical person, but the way I think about it is someone on the front end that's going to do a really deep dive, like a psychological or behavioral analysis to identify the root issue related to the eating. And then when you have someone monitoring, it's not going to be a carte blanche where you're going to be on medication and bounce around as long as you want to. There have to be bookends or guardrails that are in place to help manage the program. So you have your beginning, your middle, where you're on your weight loss journey, but you're getting coaching and you're developing your life skills and you're changing. And then on the back end of it, you continue those habits. But if you as an employer are covering these, I think it is really important to have a structure in place to help support it. So you're managing the cost without it becoming too excessive unnecessarily.
Lee Hafner (39:15):
Yeah, I think that was an excellent point. And Kara, I mean, I think you jump in with something incredibly important. And actually I want to ask you based on what Stephanie was just talking about, I think a lot of employers these days feel really intimidated by one, all of the different options out there. Because on the one hand, it's wonderful to have so many choices, but on the other hand, it's overwhelming. So it helps to have someone like you, for example, to kind of narrow down what their population specifically can benefit from. But also why is it really important that employers take a step back and when they're looking at trying to play a role in employees, long-term health, their nutrition, their weight management, their wellness, it's important to start somewhere. It doesn't have to be perfect. Why is that something they need to keep in mind instead of trying to knock it all out at one time?
Kara Boley (40:10):
Yeah, absolutely. I think you're totally right. Small steps are steps, right? No decision is a decision. So I think that all kind of goes into play. So we talked earlier about having a program or a partner that can support your employees throughout, whether it's 10 pounds to 110 pounds, everywhere in between, and helping to manage the conditions that come along with that. But I've worked with some partners I've worked with found, I've worked with some partners in the marketplace where you really want to choose someone who can help customize what the employer group wants. So instead of saying, I have groups that it's kind of a free for all, and the GLP ones for weight loss are covered on the plan, there's no program in place, just go get it from your doctor. That's fine. No behavioral support, no nothing. I have that. I don't love that, but I have that.
(41:01):
And then I have the other end where I have no, not covering it at all. And then a great middle road of we're going to offer the GLP ones all along with a program, behavior change therapy, and not just the GLP ones. And this is Dr. Kumar's area more than mine, but there are plenty of medications. She mentioned metformin earlier. There are plenty of medications available that are generics that are 30 bucks a month that can really help people. So I think I'm employer groups helping our benefits partners to understand saying, yes, we'll cover GLP ones for the appropriate candidates. There's FDA recommendations or certain guidelines, certain criteria, all that has to be followed. But also saying we have other options. It's not just a GLP one. So maybe we start by having a partner who helps with the behavioral lifestyle changes and can prescribe some of those generic medications for the appropriate people.
(41:59):
And then maybe phase two of that will be add the GLP ones later on, maybe in year two, year three. So a phased approach. Absolutely works. Medications available, sorry. And then even back to what Stephanie was mentioning earlier about can we start with what are even just some nutritional, Hey, here are some healthy eating basic education to get people started and little steps in that direction. That's also a great first step, especially for a company that is just trying to figure out and get through it. I do think one thing I'll call out, if you have employees that are working in a work location and you're really trying to make cultural change, like Stephanie, you've talked about, if we're saying, Hey, we want you to eat healthier, move more. Here are some tools. We really have to be mindful of not having donuts at every meeting and pizza for every lunch. We have to, I can't tell you the number of times I've gone to do a nutrition education class and I've literally been in the elevator with the ice cream guy, the pizza guy, whatever. So not that we have to control everything because I'm all about moderation for sure. But I just think culturally, if you're sending a message, you want it to be consistent
(43:17):
Over time.
Lee Hafner (43:19):
Yeah, no, that's such a good point. And so let's do, we've got one last poll question. Let's do that. And then Stephanie, I want to ask you about the impact of what Kara was just talking about on the workforce overall. So this last question for the audience is, what best describes your company's workplace population? A very interested in employer sponsored nutrition and weight management resources and support. B, somewhat interested C, not interested at all or very, very little. And d really don't know. Don't have a good read on it at this point. So while you guys take a couple minutes, Stephanie, the things that Carrie was just mentioning, creating this culture, which you have done at Hendry, how does opening up the communication about these issues, but also not in a way that is forceful or putting people on the spot, it's sort of organic.
(44:21):
When you guys introduced your primary care mobile clinic, people were enticed to go and excited and their families were included in this benefit as well. So this wasn't just only the people working there, it became very inclusive. How does shaping a more open conversation about these topics that have been stigmatized for so long, help in things like employee retention, engagement, their productivity at work, basically really feeling good about showing up on a daily basis because my coworkers are, a lot of 'em are in the same boat I am, and I know who they are and we're talking and it's great. I steam line at the clinic, but they know their employer is taking this to heart more so than just, we offer these prescriptions for you, which are very helpful. But why is this other stuff so crucial to this being a success?
Stephanie Koch (45:20):
Well, I mean that's a really great point and a great question. But everybody is struggling to find and retain top talent and we're no exception. And what we're hearing is that when people come on site for an interview and we point out the fact that we have primary care on site and we are open, they're open two days a week and we take care of our employees. And it's interesting that employees will make choices or candidates will make choices to go work at a company that has something that they're personally interested in. So whether it's GLP ones or that we're going to talk about later or something else, those things are very meaningful to people. So we have found that it really has helped with employee engagement and the employees are also encouraging each other to go. So when someone's not feeling well, it also keeps them at work. So they know we're taking care of them. They don't have to leave for four hours or eight hours. They're just able to either go while the doctors are on site or they do a telemed call with them. So I mean, like I said, in this competitive market for candidates, these things to are very important to consider. So a cookie cutter healthcare plan that's been around forever and doing the same thing again and again, may not be the best resources to try to attract and retain employees.
Lee Hafner (46:56):
Absolutely. So the answers responses are into the poll question. And again, I think really positive. So 36% said very interested in employer-sponsored nutrition and weight management resources and support, and 47% said somewhat interested, which is understandable based on a population, only 5% said not interested, and 12% weren't sure. So that's good. Okay. So I think we talked about this a little bit earlier, but going back to why it's so important to offer employees resources that help them avoid the mass amounts of misinformation about these products that are out there. Dr. Kumar, can you speak to this for just another second, just to drive home the point of when employees understand more about nutrition as a whole, weight management as a whole, not are just grabbing at what seems to be the most popular thing. Why is this such an important opportunity for employers to be involved in?
Rekha Kumar (48:03):
This is a big problem right now where people are getting their information and who they're trusting. The number of patients that are getting their information from influencers and not medical professionals is tremendous. And I feel fortunate to have good relationships with my patients and they'll send me what they're looking at and ask me if it's true. But if you don't have that relationship, people are going to do not evidence-based things and potentially end up getting sicker because they're following the advice of non-experts. And so I think to keep a patient population and employee population healthy, you want them to be getting their information from a truly vetted place of experts that can teach the employee and the patient what is evidence-based and what isn't is just internet gossip. I think we're seeing it in not only metabolic health these days, but I think in women's health and perimenopause and menopause, the number of patients coming to me with all these theories of things that they've seen on the internet, and I actually sometimes wonder, I'm referring back to the pandemic, but with all of the misinformation during covid and the vaccines and vaccine hesitancy, I think if people had really solid relationships or places to get their information or really good relationships with their PCP, maybe things like that wouldn't have happened.
(49:32):
Maybe they would've called someone that they knew was reliable and said, I heard this on the internet. Is this true or not? But people didn't have anywhere to go. We never realized how important it was to provide that good information from a reliable source.
Lee Hafner (49:48):
Yeah, yeah, absolutely. Okay, so before we get into our q and a session, I just wanted to make sure that we've covered the things that the three of you would like to cover today. We've talked about a lot and it's all been wonderful, but I don't want to leave anything on the table before we jump in because we've got some really good questions. But Kara or Dr. Kimara or Stephanie, is there anything that you'd like to add before we shift over into that section today? Okay. So Dr. Kumar, this first question from the audience is going to be directed to you. Medical carriers are promoting wegovy for new uses like reducing cardiovascular disease. However, the select trial shows only a 1.5% absolute reduction with 70% white male participants and high dropout rates. Are these drugs being pushed too quickly?
Rekha Kumar (50:49):
That's a good question. I thought the select trial was pretty convincing, and it was a 20% reduction in the composite outcome of heart attack, stroke and cardiovascular death. I agree the number needed to treat. Did it really make sense? How many people do you need to treat to prevent one heart attack? And I know that that was what was looking a little questionable to people. What I thought was interesting in the select trial was that I think the initial criticism was, well, are these people not having heart attacks just because they're losing weight? Why can't people eat less and exercise more then they won't have a heart attack? But when they looked at the data more closely, even people that didn't lose a lot of weight had the cardiac benefit. So I do believe that there's benefits of these medicines beyond weight loss likely related to something.
(51:44):
But I also see the other side, is there a group of people or the industry pushing these meds for reasons that they haven't actually been proven for? Probably that's happening too, but that's the other reason that supports really having an expert and learning or having people care for patients that know the whole spectrum of options. There are still people that can achieve good metabolic health with only diet and exercise depending on their age, their family history, the amount of weight they need to lose. And there are patients that we see that should go right to bariatric surgery that for many reasons, again, where they're starting their age, their family history, their comorbidities. Does it make sense to do a GLP one? So I think it's understanding the whole spectrum when you're offering an intervention and not overly promising or pushing meds that we don't have evidence for.
(52:44):
I do think that they're probably being pushed for things that we don't yet have proven reasons to treat. And I see occasionally a very thin person coming to me asking for a GLP one for a reason that they read about or heard from an influencer, and I am not willing to prescribe it for that. And I also think you need doctors that are really confident in their knowledge and a platform that you partner with where the experts know to say, to push back a little in a nice way and educate the patient. I think that there's a lot of just giving the patient what they want, which is I think a very american thing to do If you see how medicines in other countries, it's a little bit different of a relationship. But I think that if you have a good relationship and you're confident in your expertise that you can redirect a patient appropriately without upsetting them hopefully.
Lee Hafner (53:40):
Yeah, absolutely. Okay, so Stephanie, this one is to you. Does the onsite primary care also focus on mental and emotional health as those work in conjunction with overall physical health and how one copes with stress and everyday lived experiences?
Stephanie Koch (53:59):
So they will do some baseline evaluations to their level of expertise, but we are in the process of evaluating a true mental health program that we want to bring in and help that will help facilitate the connection points because that one piece is really missing in our whole healthcare plan. However, we also have connection to a local network of physicians that are part of our ecosystem currently. So if there is a need, they can get referred out in the meantime.
Lee Hafner (54:38):
Okay. Kara, this one is for you. What do you envision employee lifestyle support to look like? IE wellness programming, onsite health coaches, et cetera, as we move forward into the next year and beyond?
Kara Boley (54:53):
Yeah, I think I've definitely had a lot of my groups talking about, and to just piggyback on what Stephanie has talked about with not every group can do an onsite primary care and onsite clinic. That's not realistic for a lot of groups, but I've had a lot moving to looking into virtual primary care, near site partnerships to help with those relationships, help establish relationship. I know there's a primary care provider shortage, and so how do you get that relationship? How do you have a trusted person to go to if we know it's frustrating to try to find even when you move, to try to find a new doctor close to you? So I think virtual primary care, those things I've been seeing a lot of, if onsite's not an option onsite. Again, same types of things. Onsite health coaching works for some groups where you've got a lot of people in one or two main locations.
(55:43):
I have a lot of clients that are spread out nationwide with smaller sites, so it's not always reasonable for them. So virtual, certainly virtual support is still really popular. And I hope you lean on your benefits consultant because that's what they're there for, is to help you figure out what's out there, what might make sense. I know that my HR teams get bombarded with different calls from different vendors, but lean on your broker co consultants to help you navigate through some of that so you're not so overloaded. Because keeping up with trends, I mean, this is my full-time job. I work with a team of about six in the southwest here, and it takes a lot of our time to learn about what's in the marketplace. So I can imagine for a single benefits team, it's really hard to do that. I definitely think we're still seeing more virtual, but all the rules apply.
(56:31):
It's still that level of support, accountability. I mean, I've been a dietician for a long time, worked with a lot of areas in weight management, and no one likes this, but monitoring food in some way has to be done. I don't like doing it. It's not my favorite thing to do in the world, but it's some of that really basic stuff. Can we eat at home more? Can we check our portion size? I mean, some of it's really basic stuff and no one likes to, no one likes to hear that. It's not new and shiny at all. That piece is old tried and true. So I think any of your programming or education around those types of things is meaningful. I do think people are really eager to learn, and sometimes it's just taking it back to the basics and sometimes it is more what's customizable, what's more personalized. I'm hearing a lot of talk about functional medicine and more personalized solutions like Dr. Kamar mentioned earlier. I think that's also really important and I think we'll be learning a lot more about that in the next year or two or more.
Lee Hafner (57:32):
Yeah, absolutely. And I think with those predictions and what we're seeing as far as the trends, what you mentioned about someone as simple as moving is so important because if they lose access to GLP ones through their employer, let's say, or they can no longer afford them, when employers have offered all these other wonderful supplemental ways to get people educated and informed and making those behavioral changes for long-term that sticks with them versus being stuck in a very scary situation if they're reliant on only one thing. So I cannot thank the three of you enough. This was absolutely amazing. So as we come up to one o'clock, I just want to say a thank you to Dr. Kumar, to Stephanie, to Kara thank you to all of our attendees. Please, as you leave the session room, return to the attendee hub to access your CPE form. And there is also the next session link available there as well, ladies. Absolutely. My pleasure. So thank you again, and I hope everybody has a wonderful rest of the afternoon.