Obesity programs fight to enter disease management

Physician groups entice payers with savings

Despite the hoopla over such new drugs as Redux and "phen-fen," weight loss therapies remain unacceptably poor in the treatment of obese patients, experts say. Add to that the poor public image of weight loss clinics and lack of established cost savings to managed care organizations, and it’s no wonder MCOs have resisted funding efforts to treat obesity as a disease state.

But things may be changing for the better, says Fred McCall Perez, PhD, president and senior consultant for Miami-based Group Practice Consultants, a group that has just begun wading into the waters of obesity disease management.

Two new clients, a physician group in Texas and another in California, are interested in pitching obesity programs to payers "in order to have obesity and weight problems covered across the whole continuum."

McCall Perez concedes he doesn’t know of any payer yet willing to fund obesity disease management, but he’s willing to test the market. "When I pitch disease management programs all over the country, obesity is still not on the list for me," he says. "However, we’re going to work with these two groups and see whether it can, in fact, turn into something. It’s a real interesting area, but I don’t think the answer is in yet."

He says that the problem with pitching an obesity program to MCOs is that "they want to be sure that the savings are there. In particular, they want to be sure that the savings are generated while the patient is still a member with them."

F. Xavier Pi-Sunyer, MD, director of the Obesity Research Center at St. Luke’s Roosevelt Hospital Center in New York City says that it isn’t difficult getting MCOs to recognize the damaging effects of obesity. Indeed, researchers have long understood the link between obesity and a host of ailments, including type II diabetes and heart disease. Affecting about one-third of all Americans, clinical obesity (defined as a body mass index of 27.5 or greater) is among the most important predictors of poor health. The problem, says Pi-Sunyer, comes down to money.

"Most managed care companies aren’t in the business long enough to care what is going to happen to their patients five years down the road," Pi-Sunyer says. "So their eyes glaze over when you say ‘If you work on this now, then they’re not going to get diabetes or a heart attack five years from now, and you’ll save money.’"

Although McCall Perez and his clients haven’t settled on a final strategy for enticing payers to fund their obesity management programs, it’s likely they will offer to guarantee savings. "If either of these groups demonstrates a real ability in this area —and we think they both can — then we’re going to suggest they put it in writing as part of the contract so the cost will be lower," he says. "They’ll be very much at risk for being able to do that, but it will make for a much easier sell."

Accepting risk might become necessary for other obesity programs as well, given concerns regarding obesity’s high rate of recidivism. "If we had the armamentarium that the hypertension experts have to treat blood pressure, we’d be in good shape, but we don’t," he says. "The drugs we have are fair to poor and don’t have an enormous impact. They haven’t been tried out for a long enough time for us to know whether they really sustain weight loss. But there’s some suggestion that you get regain of weight even with the drugs after a period of 12 months or so."

Indeed, a study of 76 obese women conducted by researchers at the University of Pennsylvania School of Medicine in Philadelphia showed 64% regained all the weight they had lost after five years. Only 4% were able to keep off all the weight. The remaining 32% regained some but not all of the weight they had lost.

The only obesity treatment that has achieved significant results so far in lowering recidivism is surgery, says Thomas Wadden, PhD, professor of psychology at the University of Pennsylvania School of Medicine and lead author of the study. "Patients treated with the gastric bypass or with gastroplasty usually lose about 100 pounds," Wadden says. "At five years, patients on average maintain their full weight loss. A minority of patients regain to baseline, but others continue to lose."

At the moment, obesity is in the same boat as epilepsy and a number of other high-cost but relatively low-volume disease states, McCall Perez says. "There’s a lot that can be done with epilepsy, but first of all, you have to have the numbers of people to make it worthwhile as a true disease state," he says. "At least in the initial stages you do. And it’s a difficult pitch for payers who may be focusing on other areas first. The question becomes how many things can you carve out? How many things can you really offer as a specific disease state?"

[For more information on obesity disease management, contact the following sources: Fred McCall Perez, chairman and CEO of Group Practice Consultants in Miami. Telephone: (305) 374-9122.

Xavier Pi-Sunyer, MD, director of the division of endocrinology at St. Luke’s Roosevelt Hospital in New York City. Telephone: (212) 523-4161.]