The Do’s and Don’ts of Navigating the Health System when you Need It: My First-Hand Experience - Paul Keckley (2024)

I fell down a flight of stairs at 4 a.m. last Wednesday.

It was totally my fault.

Since then, I have used hospital emergency departments in 2 states, a freestanding imaging center and a large orthopedic clinic and I’m just getting started. Six days in, I’m lucky to be alive but I still don’t know the extent of my injuries, my chances of playing golf again nor what I will end up spending on this ordeal. But nonetheless, it could have been worse. I’m alive.

Surprises in all aspects of life are never anticipated fully and always disruptive. This one, for me, is no exception. I am frustrated by my accident and uncomfortable with sudden dependence on others to help navigate my recovery.

But this is also a teachable moment., As I am navigating through this ordeal, I find myself reflecting on the system—how it works or doesn’t—based on what I am experiencing as a patient. Here’s my top three observations thus far:

The patient experience is defined by the support team: The heroes in every setting I’ve used are the clerks, technicians, nurses and support staff who’ve made the experiences tolerable and/or reassuring. Patients like me are scared. Emotional support is key: some of that is defined by standard operating procedures and checklists but, in other settings, it’s cultural. Genuineness, empathy and personal attention is easy to gauge when pain is a factor. By the time physicians are on the scene, reassurance or fear is already in play. Care teams include not just those who provide hands-on care, but the administrative clerks and processes that either heighten patient anxiety or lessen fear. The health and well-being of the entire workforce—not just those who deliver hands-on care—matters. And it’s easy to see distinctions between organizations that embrace that notion and those that don’t.

Navigation is no-man’s land: The provider organizations I’ve used thus far have 3 different owners and 3 different EHR systems. Each offers written counsel about ‘patient responsibility’ and each provides a list of do’s and don’ts for each phase of the process. Sharing test results across the 3 provider organizations is near impossible and coordination of care management is problematic unless all parties agree and protocols facilitating sharing in place. Perhaps because it was a holiday weekend, perhaps because staffing levels were less than usual, or perhaps because the organizations are fierce competitors, navigating the system has been unusually difficult. Navigating the system in an emergency is essential to optimal outcomes: processes to facilitate patient navigation are not in place. What’s clear is hospitals, clinics and imaging facilities on different EHR systems don’t exchange data willingly or proactively. And, at every step, getting approvals from insurers a major step in the processes of care.

Price transparency is a non-issue in emergency care: The services I am receiving include some that are “shoppable” and many that aren’t. I have no idea what I will end up spending, my out-of-pocket obligations nor what’s to come. I know among the mandatory forms I signed in advance of treatment in all 3 sites were consent forms for treatment and my obligation for payment. But in an emergency, it’s moot: there’s no way to know what my costs will be or my out-of-pocket responsibility. So, the hospital and insurer price transparency rules (2021, 2022) might elevate awareness of price distinctions across settings of care but their potential to bend the cost curve is still suspect.

Patients, like me, have to fend for ourselves. I am a number. Last Wednesday, waiting 85 minutes to be seen was frightening and frustrating though comparatively fast. Duplicative testing, insurer approvals, work-shift transitions, bedside manners, team morale, and sterile care settings seem the norm more than exception.

So, for me, the practical takeaways thus far are these:

• Don’t have an accident on a holiday weekend.
• Don’t expect front desk and check-out personnel to engage or answer questions. They’re busy.
• Don’t expect to start or leave without paying something or agreeing you will.
• Don’t expect waiting areas and exam rooms to be warm or inviting.
• Do have great neighbors and family members who can help. For me, Joe, Jordan, Erin and Rhonda have been there.

The health system is complicated and relationships between its major players are tense. Not surprisingly and for many legitimate reasons, my experience, thus far, is the norm. We can do better.

Paul

P.S. As I have reflected on the event last week, I found myself recalling the numerous times I called on “my doctors” to help my navigation of the system. They include Charles Hawes (deceased), Ben Womack, Ben Heavrin, David Maron, David Schoenfeld and Blake Garside. And, in the same context, the huge respect I have for clinicians I’ve known through Vanderbilt and Ohio State like Steve Gabbe and Andy Spickard who personify the best the medical profession has to offer. Thanks gentlemen. What you do matters beyond diagnoses and treatments. Who you are speaks volumes about the heart and soul of this industry now struggling to re-discover its purpose.

Sections in today’s report:

• Quotables
• Economic Reports
• Hospitals
• Insurers
• Nursing Homes
• Physicians
• Prescription Drugs

Quotables

Re: Economic confusion: “America has reached the point of mass confusion.As far as the economy is concerned, things are red hot. While the stock market set no new records last week, the Dow Jones Industrial Average, S&P 500 and Nasdaq composite are all still flying high. GDP continues to grow and unemployment is at a near-historic low, though first-time unemployment claims are starting to rise.

On the flip side,more than half of U.S. consumers think we’re currently in a recession,according to a Harris Poll surveyconducted for theGuardian. Nearly half thought the S&P 500 stock index was negative this year, and 49% thought unemployment was at a 50-year high. It isn’t just this study, either. Consumer confidence is at itslowest level since July 2022,according to the Conference Board’s latest readings.

While part of this economic dichotomy can be attributed to the rise of online disinformation and fewer people reading well-reported business news, it isn’t the only problem here.Forbessenior reporter Derek Saul writesinflation has persisted in the post-pandemic years. Although it’s moderated from a four-decade high of 9.1% in June 2022 to 3.4% last month, many prices have yet to recede. Wages haven’t kept up with inflation, either. Since January 2021, the consumer price index has risen 19.3%, while average hourly wages have increased by 16.1%. So even without considering costs,most average consumers find their money isn’t going as far as it used to. Conference Board Chief Economist Dana M. Petersonsaid,“elevated price levels, especially for food and gas, dominated consumer’s concerns, with politics and global conflicts as distant runners-up.”

Today’s Economic Confusion – Forbes C Suite CEO

Re: UPMC -McKinsey agreement gets scrutiny: “A wave of employee layoffs that UPMC announced last month was just one part of a broader restructure and operations “transformation” initiative, for which the nonprofit system has tapped management consulting firm McKinsey & Company…

Slides addressing the layoffs placed the changes under headlines and logos outlining system’s “partnership” with the controversial McKinsey, who UPMC wrote is providing an “objective, non-biased evaluation” of the organization. The consulting firm is also helping UPMCidentify “opportunities” for short-term turnarounds—including organizational restructuring—and subsequent “long-term optimal positioning…

The system’s operations have also been losing money. For the 2023 fiscal year, ended Dec. 31, the organization logged a $198.3 million operating loss (-0.7% operating margin) on revenue of $27.7 billion due in part to rising health plan utilization and insurance claims expenses. Its bottom line fared better at a $31 million loss, thanks in large part to that year’s investment returns.

The performance comes after UPMC had recorded a $162 million operating gain across 2022 but a $1 billion net loss due to that year’s investment markets. And just this week it reported a $103 million operating loss (-1.4% operating margin) for its first quarter of 2024 and 103 days of cash on hand as of March 31…

A 2022 New York Times investigationhighlighted a revenue growth strategy created by the firm to help the 51-hospital nonprofit Providence obtain payments from low-income patients who should have qualified for financial support…

McKinsey is also undercriminal investigationover its work with drug manufacturers, such as Purdue Pharma, to maximize revenues from the sale of opioids. The firm, which has not admitted any wrongdoing, has agreed to about $1 billion in settlement payments related to its opioid industry consulting since 2021.”

UPMC’s layoffs the start of a McKinsey-guided ‘transformation’ (fiercehealthcare.com)

Re: Interoperability: “…How many times have lab tests and imaging been re-ordered because the provider didn’t know, couldn’t find, or couldn’t access the results of previous hospital admissions?…As of today, more than500 EHR vendors have entered the market to meet the increased demand, each offering different products tailored to various healthcare settings. Unfortunately, at the time the program was established, there was no incentive for EHRs to facilitate the easy transfer of data from one healthcare system to another.

This has left the U.S. with fragmented healthcare systems that do not talk to each other. Suchstandards for interoperability only cameseveral years later . But it was too little, too late. By this time, many provider groups could not justify the costs associated with facilitating health information exchange (HIE) with other health systems.

Fortunately, thishas been improving — as of 2021, more than 6 in 10 hospitals engaged in all four key aspects of HIE (sending, receiving, querying, and integrating summary of care records into EHRs). Yet, there are disparities in who is participating: only about 50% of rural and small hospitals and16% of office-based physicians participate in all four domains. So although more facilities are moving in this direction, gaps remain…Interoperability could generate significant cost savings, with potential savings of$77.8 billion per year once fully implemented…”

Imagine What EHR Interoperability Could Do for Healthcare | MedPage Today

Re: healthcare workforce resilience: “Burnout is a growing crisis in health care: More than50% of health care professionals report symptomsof it. Addressing the trauma, they face at work can help.

Halting burnout straddles the tension between addressing the individual factors versus the organizational factors behind it. It wasonce believedthat burnout was related to health workers’ inability to cope with the natural stresses of their job. Butresearch has clarifiedwhat clinicians have long known: They are inherently resilient. Instead, systemic factors are the primary drivers of burnout…

Trauma-informed care offers a framework for upgrading current anti-burnout strategies and infusing a new approach to address the nation’s health care crisis. Patients and their families, health workers, trainees, leaders, and all stakeholders can benefit from safe workplaces that empower everyone, collaborative relationships that promote belonging, and healing environments that foster resilience.”

Addressing health care workers’ trauma can help fight burnout – STAT (statnews.com)

Re: Value-based care alignment, effectiveness: “VBP models are continuing to evolve to improve incentives. For example, ACOs have an opportunity to earn a share of savings from reductions in total cost of care. For hospital-led ACOs, this means primarily reducing their revenue because hospital spending is the largest single spending category. For this approach to be effective, the organization must be confident that the shared savings will outweigh any revenue losses. However, given their substantial fixed costs in beds, surgical suites, and equipment, reductions in hospitalizations, imaging, and laboratory orders, are likely to harm the hospital’s bottom line. Even nonprofit, mission-driven health care organizations understandably exhibit reluctance given their slim margins. However, physician-led ACOs save more than hospital-led ACOs because savings primarily come from reducing hospitalizations and associated services. Therefore, physicians earn bonuses by reducing another organization’s revenue, not their own. Policymakers should learn from this success and design all VBP models to avoid requiring participants to reduce their own revenue to generate savings…

To accelerate the adoption of VBP, practices need timely, accurate, accessible, and actionable financial data, along with confidence they will achieve financial success. This requires robust, intuitive, affordable financial modeling and management tools. CMS makes the necessary raw data available to clinicians, but processing and analyzing them requires significant expertise. Therefore, CMS should facilitate the development and adoption of low-cost solutions by supporting integration with open-source packages and requiring commercial payers to adhere to the same standard data formats. These steps will facilitate the entrance of new, more competitive market solutions for financial modeling, and spur much-needed foundational innovation in health care finance and operations.

Paying for value rather than more health care is without any question a wise approach. VBP fits with the intrinsic motivation of doing good, which led most physicians to medicine. Yet, achieving this is difficult due to operational and financial challenges inherently associated with the transition to VBP. A more efficient, economical method of assessing the underlying risk of a population and measuring the value and quality of care is needed. Various stakeholders across the public and private sectors are working to realize this vision.”

The Promise and Challenge of Value-Based Payment | Health Care Economics, Insurance, Payment | JAMA Internal Medicine | JAMA Network

Re: Caregiving for aging society: “Despite such promising developments, policymakers will need to address at least 3 major challenges so that the health care system can adapt to an aging society. One challenge is the chronic shortage of caregivers. Restructuring remuneration, simplifying licensing, and improving career ladders are needed to recruit and retain direct care workers.⁷A second challenge is the crushing financial burden of institutional care, for which few middle-aged and middle-income families are prepared. A federal “catastrophic” public insurance programis likely needed to supplement and stabilize the declining private long-term care insurance industry and to provide relief to burgeoning state Medicaid costs for long-term care. And thirdly, a future Congress and White House will beforced within the next few years to address fundingfor the rapidly depleting Medicare Hospital Insurance trust fund and for other Medicare and retirement benefits.

Failure to address these challenges will unfortunately undermine the many positive steps developed to address aging.”

Caring for an Aging US Population—the Good News and the Bad News | JAMA Health Forum | JAMA Network”…

Re: Bird flu pandemic link: “Nonetheless, the situation in America is concerning. The widespread presence ofh5n1 in mammals with whom lots of humans are in close contact increases the chances that a version adapted to humans could emerge at some point. The virus mutates as it spreads among cows, so a human-infecting mutation may occur by chance in a viral particle that is picked up by a person. Another possibility is the emergence of a recombinant version ofh5n1, which happens when a person is infected with both the cowh5n1 and one of the seasonal flu viruses that circulate every year in humans. Influenza viruses are notorious for swapping bits of their genetic code between them when they infect a cell. The cowh5n1 virus could acquire, in that way, the genes it needs to make the seasonal flu highly contagious among humans.

Though it is impossible to predict what will happen, the way the current outbreak has unfolded in America does not bode well for preventing a future pandemic, whether byh5n1 or another virus. “

A second human case of bird flu in America is raising alarm (economist.com)

Re: PE market profile: “Private equity has a problem.:The industry is failing to exit investments at a pace that keeps up with limited partner demand, creating a tension that could have broad impacts. PE firms are sitting on $3.2 trillion worth of unsold assets,Bain & Co. says, and sponsors have an estimated $4 trillion of dry powder. Normally, that would be a decent balance. Exits aren’t really happening, and neither are sponsor-to-sponsor deals. GPs are stuck in an IRR model and clinging to companies for dear life. Distributed to paid-in capital is the dominant industry conversation. Gone are days when GPs would routinely hit a 2X home run for investors. Now they can barely get to 1X, and LPs are asking: Where’s our money? In fact, the global DPI average for funds raised in 2019–22 is at 0.12X, according to Goldman. Getting to 1X, and doing so early, is usually the goal — LPs are paid back and the rest is gravy. That isn’t happening.”

Axios Pro Rata: PE pressure point

Re: Drug price regulation: “High drug prices in the US are a serious problem for both patients and the health care system. Prices of branded drugs are driven higher by monopoly dynamics: patents and other exclusive marketing rights allow companies to increase prices and restrict supply. Firms earn extraordinary profits from exclusive rights and so have incentives to sustain or extend these rights, including in unfair and abusive ways. Firms build “thickets” of secondary patents (e.g., for devices used to deliver a drug) around successful medicines to extend market control by many years, sometimes earning billions of dollars in return. In “pay-for-delay” deals, companies settle lawsuits brought by generic companies challenging patents by paying them or providing other benefits if they agree to stay out of the market. Market power comes not only from patents and regulatory barriers, but also market consolidation, which has affected the pharmaceutical industry like many others. Today, the 3 largest firms control 65% of the world market for generic drugs, and 75% of the national market for pharmacy benefit managers (PBMs), and evidence has emerged that firms in both settings are driving prices higher in ways that involve collusion or other anticompetitive practices…

If the FTC is to play a larger role in pursuing unfair and anticompetitive conduct in the pharmaceutical industry, it requires not just concerted leadership, but also more authority and funding from Congress, particularly if courts broadly weaken regulatory agencies, as they appear to be poised to do.”

Federal Trade Commission Oversight of the Pharmaceutical Industry | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network

Economic Reports

Altarum Health Sector Economic Indicators Highlights:May 22, 2024 Report:

National health spending approaches $5 trillion

• “In March 2024, national health spending was 6.7% higher than in March 2023 and represented 17.6% of GDP.
• Nominal GDP in March 2024 is 5.8% higher than in March 2023, growing 0.9 percentage points more slowly than health spending.
• Personal health care spending growth in March was 7.3%, year over year, with utilization growth continuing to outpace price growth.
• Growth among major spending categories was fairly consistent. Spending on hospital care grew the fastest, at 7.9%, year over year, while spending on home health care and dental services grew the slowest, at 6.4% and 6.5%, respectively.

Health care continued posting large job figures during a cool month for the economy in April

• The health care industry added 56,200 jobs in April 2024, which accounted for 32% of total job growth (+175,000) across the economy.
• April’s health care job growth was led by growth in ambulatory health care services, +33,400 jobs), hospitals (+13,500 jobs) and nursing and residential care facilities (+9,300 jobs).
• Nominal health care wage growth in March 2024 was 3.3% year over year, compared to 4.2% in non-health care industries: highest in nursing and residential care facilities (+ 4.5% year over year), followed by ambulatory health care services at 3.2% and hospitals at 3.1%.

Medicaid price growth exceeded that of other payers in the first four months of 2024

• The overall Health Care Price Index (HCPI) increased by 2.8% year over year in April, decreasing from the growth rate of 3.1% seen a month prior.
• Economywide inflation held mostly steady, with year-over-year growth in the overall Consumer Price Index (CPI) falling slightly to 3.4%, while growth in the Producer Price Index (PPI) increased to 2.2%.
• Among the major health care categories, prices for nursing home care (4.5%), dental care (4.1%), and hospital care (3.2%) were the fastest growing, while prescription drug price growth was the slowest in April (0.4%).
• An alternative measure of hospital price growth, the CPI index for hospital and related services, continued to rise in April, up a much greater 7.9% year over year.
• Among major payers, year-over-year Medicaid price growth (6.3%) exceeded services price growth for private insurance (3.2%) and Medicare (1.7%) patients
• Our implicit measure of health care utilization growth was 4.3% year over year in March and continued to drive the majority of spending increases, as it remained above overall health care price growth.

Health Sector Economic Indicators Briefs – May 2024 (mailchi.mp)

Federal Reserve Board Report: Economic Well-Being of U.S. Households in 2023: “…financial well-being was nearly unchanged from 2022 as higher prices remained a challenge for most households and workers continued to benefit from a strong labor market.” Highlights:

• During 2023, 72 % of adults reported either doing okay or living comfortably financially, similar to the 73% seen in 2022 but down 6% from the recent high of 78% in 2021.
• 65% percent of adults said that changes in the prices they paid compared with the prior year had made their financial situation worse, including 19% who said price changes made their financial situation much worse.
• 17% of adults said they did not pay all their bills in full in the month prior to the survey.
• As in the prior year, 63% of adults said they would cover a $400 emergency expense using cash or its equivalent and 13% would be unable to pay the expense by any means. 48% of adults said that they had money left over after paying their expenses in the month prior to the survey, similar to 2022 but below 2021 and pre-pandemic levels.
• The share of adults who received a raise and asked for a raise remained unchanged from 2022 at 33 percent and 13 percent, respectively. Reflecting the continued strength of the labor market, these measures remained above their 2021 levels.

Federal Reserve Board – Federal Reserve Board issues Economic Well-Being of U.S. Households in 2023 report

Health Insurance

eHealth Survey: Value of insurance benefits to younger workers: In asurveyof more than 1,000 Millennials and Generation Xers born between 1965 and 1996 (28-59 years of age) eHealth found:

• 94% say they are entitled to healthcare coverage in retirement.
• 84% are willing to pay higher payroll taxes to ensure Medicare’s sustainability.
• 65% worry that Medicare won’t be there for them

GenX_Millennials_Medicare_eHealth_Report.pdf (ehealthinsurance.com)

Aetna-NY Pres dispute: “Peter Goldberger, who leads a major union benefits fund, was on the verge of completing a new health-insurance deal with Aetna to cover its 210,000 members.

Then he learned the union fund would have to pay the powerful New York-Presbyterian hospital system $25 million—to stay out of its plan.

The 32BJ Health Fund didn’t want its insurance to include New York-Presbyterian, which the Service Employees International Union affiliate says has high prices. But Aetna’s contract with the hospital system required the insurer to get a signoff from New York-Presbyterian to omit it from a client’s plan.

Aetna told the union fund, Goldberger says, that the price for excluding New York-Presbyterian from its network would be the $25 million, which the hospital system argued that 32BJ owed it for past medical services. Otherwise, Aetna couldn’t offer the plan the union fund wanted…

32BJ wound up ditching Aetna, its first choice to provide health coverage in 2025, and sticking with the insurer it had been using to keep out New York-Presbyterian.”

Exclusive | New York-Presbyterian Hospital System Demanded $25 Million to Stay Out of a Union’s Health Insurance Plan – WSJ

Hospitals

Hospital financial performance in 2024: “Americans, especially Medicare beneficiaries, are getting more medical care these days. Demand from aging Baby Boomers is keeping people in doctor’s offices, and health care providers are continuing to build capacity post-Covid.

Those trends — the same ones thattanked health insurance stocksa few weeks ago — made a strong mark on nonprofit health systems’ first quarter financial reports. STAT took a look at 20 large nonprofit health systems and found that all but four reported higher operating and net margins in the first three months of 2024 compared with the same period in 2023. Hospitals are seeing more patients and cutting down on the expensive contract labor they relied on during the Covid-19 pandemic. And they’re seeing strong investment gains on the non-operating side.” Highlights:

• Operating margin range: +12.7% BayCare FL to -3.6% Allina MN in 1Q2024 vs.+4.6% BayCare FL to -7.6% Common Spirit in 1Q2023.
• Positive to Negative Margin Ratio: 18/2 in 1Q2024 vs. 16/4 in 1Q2023

Higher profit in Q1 at nonprofit health systems

As health system earnings go up, health insurance stocks go down – STAT (statnews.com)

Hospital price increases in April: “In April, prices for medical care rose 2.7% year-over-year, the Labor Department reported last week. Prices specifically for hospital services, meanwhile, rose 7.7%…. Since 2020, prices for medical care have increased 119.2%, compared with an increase of 85% for all goods and services, according to the Peterson-KFF Health System Tracker, which monitors the healthcare industry’s performance. Prices for all medical care began declining in November 2022, hit bottom last September and then started climbing…

At the same time, however, recent research has shown an increase in claims denials. Final claim denials on inpatient care increased by more than 51% between 2021 and 2023, according to a report Tuesday from Kodiak Solutions, a technology company.

The American Hospital Association attributed higher hospital prices to costs including staffing, supplies, drugs and equipment as well as inadequate reimbursem*nt, particularly from Medicare and Medicaid.”

Here’s how much hospital prices are rising – and why | Modern Healthcare

Nursing Homes

KFF Analysis of Nursing Home staffing rule compliance: Per the KFF analysis of CMS’ nursing home staffing mandate’s 3 requirements (April 2024):

• In 45 states, fewer than half of nursing facilities currently meet all three staffing minimums required in the final federal rule The share of facilities that meet these requirements ranges from 5% or lower in four states (AR, TN, TX and LA) to 50% or higher in five states (AK, ND, ME, HI and OR) and DC.
• In rural areas, 20% of nursing facilities currently meet these standards, compared to 18% in urban areas. Despite having similar starting points, nursing facilities in urban areas have two fewer years to comply with all provisions of the rule, facing a deadline of May 2027 compared to May 2029 in rural areas. Though they face different challenges, urban and rural facilities currently have similar staffing patterns and both face potential staffing shortages. Rural facilities may struggle to find staff because there are fewer available workers, while urban facilities may struggle because available workers have more job options.

A Closer Look at the Final Nursing Facility Rule and Which Facilities Might Meet New Staffing Requirements | KFF

Physicians

Medcape: Physician compensation in 2023:

• On average, physician compensation grew by 3% in 2023 vs. 2022 from $352K to $363K: +4% for PCPs (from $262K to $275K) and +3% for specialists (from $384K to $394K.
• 34% think doctors are underpaid, 61% think they’re paid fairly and 5% think they’re overpaid.
• 17% say the pay was a major factor in choosing their specialty vs. 83% who said it was an important/the most important factor in their decision.

Medscape Physician Compensation Report 2024: Bigger Checks, Yet Doctors Still See an Underpaid Profession

Doxemity Physician Compensation Report: Highlights,

• Average pay for doctors increased nearly 6% in 2023, rebounding from a decline of 2.4% in 2022.
• 40% are satisfied with their compensation vs. 36% who are dissatisfied
• 62% think their compensation undervalues their expertise and effort vs. 31 who think it fair”

doximity-physician-compensation-report-2024.pdf (doxcdn.com)

Commonwealth: PCP Survey: Highlights from the Commonwealth Fund 2023 International Health Policy Survey of adults 18 years and older:

• The majority of low-income adults reported worrying about their economic security, including their employment stability and ability to pay housing bills, yet only about a third of physicians screened their patients for financial security.
• Three-fourths of physicians working in community health centers reported screening patients for social needs and 62% reported coordinating their care with social services or other community providers.
• Over half of state Medicaid programs are taking advantage of federal programs and policies to address beneficiaries’ needs related to drivers of health

How U.S. Health Care Providers Address Social Drivers of Health | Commonwealth Fund

Prescription drugs

Report: Weight loss drugs use: “In the United States, 7 out of 10 adults and e out of 10 children have overweight or obesity…Adults with obesity average a total of $1,861 more in medical costs annually than people who are a healthy weight, and severe adult obesity was linked to $3,097 in excess annual costs per person… The average monthly list price for semaglutide is over $1,000. Nearly half of U.S. adults are interested in taking a weight loss drug, and a recent report by the Institute for Clinical and Economic Review shows that if just 0.1% of the 142 million qualifying Americans took GLP-1s, the impact on the nation’s healthcare spending would be significant.” Related findings:

• More than 30% of patients dropped out of treatment after the first four weeks, when the dose was still being increased to reach the targeted dose and most individuals did not stay on their prescribed treatment for a minimum of 12 weeks.
• Younger patients, age 18 to 34, were more likely to drop out of treatment sooner. Gender had no impact on dropout rates within the first 12 weeks.
• Patients who were prescribed GLP-1s by providers with expertise in weight management and obesity, like endocrinologists and obesity specialists, were more likely to complete 12 weeks of treatment.
• Individuals who completed 12 weeks of treatment saw their providers more frequently after the prescription of GLP-1s than those who dropped out of treatment sooner.
• People who had health inequities or lived in underserved health regions were also less likely to complete 12 weeks of treatment.

Real-World Trends in GLP-1 Treatment Persistence and Prescribing for Weight Management BHI_Issue_Brief_GLP1_Trends.pdf (bcbs.com)