How Employers Can Build A Smarter GLP-1 Benefit

Transcript

Welcome And Why Diabetes Matters

SPEAKER_03 0:00

Power Living with Kimberly Langford, where inspiration meets empowerment. Kimberly is a nurse executive, leadership coach, Reiki master, and your guide on this journey to whole person wellness.

Meet Annette And Mike

SPEAKER_00 0:12

I am so stoked to get to talk with. Oh, I tell you, Mike, you know I'm a big fan of you and the work you do. I know we've been to conferences together and I'm always singing your praises. And Annette, super excited to uh to get to visit with you and about something that's just near and dear to my heart, simply because, you know, when you talk about diabetes management, and of course we're gonna have to talk about GLP1s, right? Because they are the black sheep in diabetes. But really, truly, diabetes is the mother of all that ails us. It's the fountainhead. And, you know, I I think um, you know, as we work through, you know, as we talk about diabetes and specifically through the lens of the employer who's trying to put together a great health plan and trying to afford that, um, being able to talk about outcomes, how, you know, what the member experience is like, how that impacts total cost of care, and really unpacking, if you will, why the GLP1 strategy is really, really important. You can't overlook it. And it's not just a simple yes or no kind of line in the sand that I think that that will uh help help employer sponsor health plans. And so I think today in this discussion, we'll talk about that in particular, why it's not a simple yes or no decision and um where employers get that wrong, what a smarter model might look like, wink, wink, nod, nod, nod to uh diath right. And um, what happens when you combine the clinical support and behavior support and engagement uh in a in a really uh robust benefit design, how that's gonna benefit folks. So if you don't mind, I would love to have you both share a little bit about you and and introduce yourselves, if you will. Um and we'll start with I'm sorry, Mike, you know, clinicians have my heart. And uh so Annette, you've you're an RN and you're certified diabetes educator, is what I understand, right? Yes, yes, I am. I have been studying for that exam and it's like my one of my favorite topics. If it's not nephrology, it's diabetes and endocrinology. So yeah, introduce yourself. Tell us a little bit about your journey and and uh you know why you do what you do.

SPEAKER_02 2:43

Yeah, perfect. Yeah. So obviously I'm very um very excited about diabetes as well. I've made it my career. So I've been certified now for about 11 years, been doing diabetes education a little bit longer than that. Um, I've been doing telehealth specifically for a long time. I was using Zoom long before COVID and it became very popular. Um, but I personally have type 1 diabetes. I was diagnosed as a teenager. So that's kind of what got me interested in diabetes in the first place. And then um I became an RN, very quickly moved from typical bedside nursing to diabetes education and just have loved it and stuck with it for a long time and don't ever plan to change unless we magically cure it, then I'll happily move to, you know, a different topic.

SPEAKER_00 3:36

What a blessing. You know, it's interesting. And type type one diabetes is really tough, especially, you know, your kiddos who don't want to be seen in the cafeteria, you know, shooting up. It's really hard for them to manage. I would imagine it's really helpful to have somebody who totally understands when you're doing that education, really powerful.

SPEAKER_02 3:56

So yeah, sucking with my yeah, my little kiddos up to some of the older patients, you know, have some that are in their 80s or 90s, whatever it may be. Um, you know, there's just so many challenges for all of them. I like to make it visible, I like to make it seen, I wear my products out, I wear them, you know, bold and try to make them, you know, loud and proud, sister.

SPEAKER_00 4:19

Yep, yep. That's awesome. That's another topic we could talk about because I think those sensors, everybody should have them. And you certainly make different choices when you can see that data, right? So for sure. Yes, oh for sure. Yeah. Oh, Mike, my friend, tell us about your journey. I know, you know, where you are the head of Diethrive. Tell us a little bit about you and you know, Diet Thrive. What is Diethrive?

SPEAKER_03 4:48

Yeah, well, I'm happy to do that, but I also want to just note two things that Annette left out, which is that um she's bilingual and and uh also she's got a lot of experience in, you know, different um kind of care settings, which I think is really important and it helps her, you know, to really identify with with um you know a broad swath of the population. So uh we we can keep talking about Annette, in fact, if you want. She's really great at what she does.

SPEAKER_00 5:17

And then you can come work with me, right? Okay, sure.

SPEAKER_03 5:22

She can't leave diatribe, but you know, she you can work together on things.

SPEAKER_02 5:27

Yes, I do speak Spanish, so I do speak, you know, I work with a lot of that population, which I love. My husband is from El Salvador, so I have a huge piece of my heart with um my Hispanic patients. And yes, and working with all types of diabetes. I did want to mention that, so I'm glad you brought it up, Mike. Not just type one, which I have personal experience with, but there's so much bias and there can be so many preconceived notions, whether patients have it or loved ones or others with different types of diabetes. And I love breaking down those barriers and really, really seeing my patients because sometimes they just don't feel seen, they feel judged, they feel missed in this box. And I I love being able to work with them and and break those down.

SPEAKER_00 6:13

Yeah, heaven forbid you have some dessert at the table, right? Somebody's gonna smack you. And yeah, there's pathofiz involved. It's yeah, oh that's awesome.

SPEAKER_03 6:24

Yeah, so Annette can really see things from you know individuals' perspectives and uh has really been there and walked in their shoes a lot of times. So it's just uh we're really fortunate to have her. Uh, you know, as for me, Kim, and as for Diet Thrive, you know, I um, you know, was running a kind of traditional diabetes company um, you know, 15, 20 years ago and really just was uh became I I you know I kind of grown up with healthcare. My dad was a doctor, my mom was a nurse. And um, when I got really involved in a diabetes company, I just realized how broken the system is. I mean, I was I was amazed at the individual uh patient journey where you know we had people who had had diabetes for 30 years and in in in and were pricking their finger every day and had absolutely no idea why. They didn't know what the numbers meant, they didn't know what to do about them, and um and and and really just was amazed at the barriers that they faced, you know. Um, and I know we're gonna talk about some of them, but the the financial barriers, the administrative barriers in terms of all the hoops that um, you know, insurance they had to to fight to get things reimbursed by insurance. And then Annette mentioned some of the psychosocial barriers. Um, you know, you hear people being called non-compliant in the diabetes world. And you know, you only hear that really about um prisoners in in jails, you know.

SPEAKER_01 7:53

Or children, naughty children, right?

SPEAKER_03 7:57

Yeah. So really when we started, and then you know, as as that company grew and evolved, um, really the idea to start Diethribe came from seeing a lot of these contracts, you know, the larger um contracts that we had with larger clients and and entities and realizing that there was really no alignment between there's really in American healthcare, I think one of the big problems is that it's not a direct, you know, provider-to-patient relationship anymore. You've got this insurance component out on the side. So it's kind of a uh um, you know, a triangle, if you will, of uh of a relationship. And what we really were trying to do with Diathribe was to make it uh financially the right thing to do from a risk and from a cost perspective for plans, and then also for the individuals, just create the best possible member experience so that you'd make it just you know easier, more intuitive. Uh, you know, just remove all those barriers that people have in front of them in American healthcare to just getting what they want when they want it, you know, make it more likely that they're actually going to take the best possible care of themselves, which is really what everybody wants to do, right?

SPEAKER_00 9:12

Right. If we could, right? Most of us know the things we need to do. It's just figuring out how we're gonna put that in place as a habit. I think that's really tricky.

SPEAKER_01 9:22

Yeah.

The Real Day To Day Struggle

SPEAKER_00 9:23

Well, you know, and I think what I love the most about your platform is, you know, there's there are a lot of platforms out there, um, diabetes management tools and and whatnot out there. But, you know, your focus on the educational component, using a clinician um to educate uh folks as well is really important. So with that in mind, Annette, as an RN and as a diabetes expert and educator, maybe you can walk us through a day in the life and really share about, you know, because I think a lot of people, you know, a lot of unless you work in in healthcare and and um have have been in people's homes and at the bedside, don't really understand what that looks like on a day-to-day basis for for members. You know, things like um you mentioned it in your email, you know, when you talk about rationing supplies, I can still hear members saying, Well, my doctor says I can only check it once a day. So you gotta you gotta you can't even see you can't like driving blindfolded, and you're only gonna take off the blindfold every you know one or two blocks or so anyway. Or how confusing it can be in terms of their benefits or um and even even the sequela or the consequences of having poorly uh poorly managed diabetes just because of the barriers that Mike talked about. Maybe you can help give us a day in the life picture. Help us see that member in the middle.

SPEAKER_02 10:54

Yes, definitely. Yes. So so many times. I mean, just thinking over this past week, I got a new patient who um told me that he couldn't afford his insulin. He was using just his long-acting insulin. He was out of rapid acting because they were asking for over$300 at the pharmacy. His wife also takes insulin. They wanted over a thousand dollars. So neither him nor his wife were really taking their insulin. He was out of sensors, just really in a bad state. Like I said, this was just a few days ago. Um, so we talked about looking at his pharmacy benefits, looking at like the, you know, what's covered, you know, being a clinician, we know that insurances will typically pick one type of insulin that they will cover over another. You have to pick the preferred, so you have to look at the the list of of their preferred medications. So, and this was a Spanish-speaking client. So I was able to kind of look through it with him. We were able to figure it out to be able to get that right, the right stuff for him. But just the stress, just the way he was talking about not being able to get that, not being able to um, he said literally, we're choosing between eating and taking our medication, which no one, in my opinion, should ever be in that situation. Um, so that's just one example that comes to mind in general. Like you said, I like your analogy of driving blindfolded and taking it off once a time, once, you know, just occasionally to be able to see where you're driving. Um, these are constant struggles. Besides that, even for somebody who does have the supplies that they need, just the ups and downs of blood sugars, the not understanding maybe why blood sugars are reacting the way that they do, being not looking not seeing patterns, really just not understanding it. I know you mentioned before having numbers and not knowing what they mean or what to do about them. Too many times I'll get a patient who says, These are the numbers I'm getting, but what's a normal number? And I'm, you know, of course, data is no good if we don't know what to do with it. So um, all of these, and even as I'm teaching people, we're talking about the whole new vocabulary of diabetes. It's almost its own language, it's its own, it's like a whole new thing, a whole new world for these people.

SPEAKER_00 13:17

That's the pathophys is pretty complex, right? It is. I mean, it it really is. You know, how you know the digestion in itself is pretty complex. And then you add into pancreas, right? And and how we can wear it out, and you know, how how can type two become type one? That's a fun conversation as well. But I think I think you know, when I think about the sequela and the consequences of having untreated, poorly managed diabetes. I think about I I was talking to somebody today about a guy took care of as a home health nurse going out, lived in an RV because he's very sick, and that obviously impacts your your pocketbook. And I mean, he'd already lost his eyesight and he lost a few toes. You know, it starts with their toes and then it's their foot and then it's below the knee, and then it's above the knee, right? Haven't you seen people get chopped up into little bits? It's really awful. And I still remember this guy. And watching him, he couldn't even see the ants that were crawling on the cup that he was drinking from. And you know, that life is so hard. And you know, a raindrop doesn't wash away a mountain overnight, right? But it will wash it down. And diabetes is very similar, right? Where where it really does take people and by not managing and not giving people the tools, that's what I see. I see liver failure, I see diabetes, I see joint damage from the obesity that happens just because blood sugars are high, you're in fat storage mode, that's just a pathophys. It's not your fault, it's a pathophys. All those things. So MSK claims expensive ICU stays for a heart attack or a stroke, dialysis, liver failure, all these things, even cancer. Um and go ahead.

SPEAKER_03 15:19

Well, just to yeah, just one thing I think um to build on what Annette said, that is really um, you know, kind of the the underlying uh couple of underlying problems in the the day of a life of a typical person with diabetes is that our healthcare system is really not set up for prevention. You know, it's really set up for treatment. I mean, the the healthcare systems make the most money off of negative health outcomes. Uh and so when you think about that from the perspective of the individual with diabetes, what that means is, and we've I've talked to people, you know, our own members, where, you know, for example, uh they leave a primary care office and they say, well, you know, I think you've got type two. And so here's some stuff to take. Make sure you call and make an appointment with the endocrinologist and you know, be careful with this until you talk to them. Well, the average waiting time to see an endocrinologist in the United States is three months. And in a lot of places, it's longer than that. And if there's rural and things like that, uh access issues. And so you think about um, you know, somebody who, and you know, there's 20 different metabolic conditions or more that are generally classified as diabetes, like Annette mentioned, there's you know, type one, type two, gestational, but then there's a lot of different uh types of type two, if you will, or driving factors behind type two, and and people have different ranges of severity. So, most important thing, I think, for somebody in terms of the day in the life is that you know, if you if you find out your neighbor has type two, you can't just ask them what they're doing and then do that. So, you know, when you're trying to get you know on the right path and you've got a wait time for an enerologist of, you know, even for primary care, sometimes people take weeks to get in to see their primary care physician. And um, you know, that's why we like to get people access as as quickly as possible, because some of these small answers to you know smaller questions can keep in the case of this one person that I was um thinking of, you know, they they were given some medications and sent out the door thing that, in fact, this has happened to multiple people. It happened to my best friend from high school too, given medication, sent out the door, saying that telling them being told that they have type two, but they actually have type one, and they're given the wrong stuff, right? And so misdiagnosis is very common about type one. Annette mentioned our colleague Clem, who sits in the office next to mine, and um, he was misdiagnosed. Many people with type one um are misdiagnosed and have, you know, because of the lack of access in the healthcare system, they they can go through, you know. I mean, Clem had to be basically carried by his parents into the hospital when he was 16 or 17 years old. Um and and so we hear those stories a lot. And if you think about that lack of access, just being able to get simple questions answered, um, you know, that's a big that's a big deal in terms of the day in the life and drives, I think, a lot of these. Um, for first of all, you you know, when you're go through an experience like that, there's kind of disengagement from the process by a lot of people like, oh, well, they can't see me for three or four months. Like, really? I mean, that's you know, that's a long, that's a long time.

SPEAKER_00 18:40

A lot can happen in three or four months. I had a guy one time tell me, yeah, I had diabetes. The doctor sent me home with this metformin and it said take for 30 days and there were no refills. I took it, I'm cleared.

SPEAKER_03 18:54

How would he know, you know, that that wasn't the plan?

SPEAKER_00 18:58

Yeah, how nobody nobody did teach him. And how many diet how many people with diabetes aren't seeing a dietitian? They don't they don't get the benefit of talking with a certified diabetes educator for that education.

SPEAKER_01 19:11

Yeah.

Employer Blind Spots On GLP-1s

SPEAKER_00 19:12

And so here's a question for you, Michael. What about, you know, the the buzzword that I think a lot of our employer sponsored health plans and our employers and uh brokers want to, they want to know what about these GLP ones? Because they're they're tearing up my health plan. And um, it's a big issue for health plans, these GLP ones. But so from both of your perspectives, actually, what are employers and specific and brokers, what are they missing when they think about diabetes management just too narrowly, meaning they're only looking at it from the pharmacy side, the that that that spend side.

SPEAKER_03 19:51

Yeah, I mean, from my perspective, I think that there's a couple of things. One is um, you know, and we built out um, you know, with uh, you know, some well-known, you know, actuaries in in healthcare an analysis module so that we could really give clients an understanding of, you know, let's break out the numbers, right? I mean, we've had people tell us clients that they don't cover GLP1s, for example, for weight loss, and then and then we'll do the analysis for them and actually show it to them in an Excel spreadsheet, and they can see actually there's a hundred people, you know, sometimes more than a hundred people that are actually taking GLP1s that have no signs of diabetes previously. So odds are they're they're taking them for GLP1s. So I think that's one thing is just the actual real claims analysis to show you what's really going on in your plan. I think a lot of people are missing. And then from the um from the perspective, then even though when you're looking at at cost, it drives me crazy that a lot of the a lot of plans and brokers for that matter will focus only on the cost aspect of it. When, like Annette said, I mean, you can buy people everything right under the sun, but if they don't know what it means and you know what, you know, how to really use it, then really, you know, and and that's why in our financial analysis module, we try to show clients this is where you're getting return on the investment. And you know, one of the ways to do that is, you know, like like we do, as you know, I mean, everybody that gets testing supplies also gets access to a diabetes educator and nurse like Annette, so that you know, they're not just testing their blood sugar and you know, or like your like your uh example, Kim, where somebody thinks they got three days worth of metformin, so they can just take that and then their diabetes will be cured. You know, it's not like the flu. Um, and so that's I think some of the like human aspects of it of um what's really behind the costs, I think, are um the top two things that come to mind. But Annette, you probably have some more patient centric things. That uh come to mind for you.

SPEAKER_02 22:03

Yes, definitely. Yes, just adding on top of that, I imagine in my mind that they're just looking at the numbers, they're looking at the costs, which makes sense. They're they can be pricey. But yes, I mean, and I I always tell everybody with I thrive that I'm so lucky. I'm the one that gets to be face to face with the members constantly. I I'm right there in the trenches with them on some of the hard things, the wins. I I I just feel so lucky that I I get to be right there with all of these patients. But yes, they're missing out on a lot of these metrics that can be kind of hard to follow. I'm hearing how people are improving blood sugars and how they're avoiding going on insulin. I'm hearing how their sleep apnea is getting better, their heart failure is getting better, a lot of these things that a lot of them things that they weren't really expecting, uh, which is just amazing to see these wins. Um, I'm also seeing where they're losing coverage of them. I'm seeing where they're having some of these come back because for whatever reason they're not able to get them anymore. So I think these are a lot of these things that we're unfortunately they're they're not seeing that can be really hard for these people.

SPEAKER_00 23:16

Yeah, it's interesting. I I've my my passion is you as you know, is been in neprology for a long time. And you know, in the models where I've built that we you know help people improve kidney function. I mean, I've seen people avoid dialysis for 10 plus years, and that primarily comes from improving diabetes.

unknown 23:37

Okay.

SPEAKER_00 23:38

You improve people's blood sugars, weights go down, the damage that happens to the inside lining of the blood vessels, you know, it's hard on on that that little coating, that internal layer of the blood vessels, high blood sugars and scraping it up and pressures because it's a sugary and therapy in there, that's hard. And when you think about GLP1s, and I think this is where payers miss, is that I have not seen clinical research of that of this caliber with GLP1s for for any other drug that I've I've witnessed in my lifetime, quite honestly, where you know, the those pleotrophic benefits and how it protects that inside lining of the blood vessels and and has been shown to reduce the risk of in a phenomenally so the the research findings were so powerful so early on that they actually concluded that study early because it was just so profound in terms of avoiding heart attacks and strokes, helping with liver failure and kidney failure. Matter of fact, like we were talking before we started about uh you know how they are part of the clinical guidelines for kidney disease management. I don't know why they're cardiologists, I don't know why they're not part of their guidelines, but those the pathophysiology and the benefit that that these medications bring. The drug's expensive, but so is uh ICU today. Uh and so is dialysis and liver failure, very expensive. Um but it's a shame that they are as expensive as they are. But um let me ask you let me ask you a different question. What do you think is the biggest mistake? When employers talk to me, a lot of times they're they're talking about, you know, do you have a strategy for GLP1? What's your strategy? Like it's you know, so what do you think is an employer sponsored health? What do you think is the biggest mistake that they're making when it comes to their GLP1 strategy?

SPEAKER_03 25:44

I I think that the, you know, once you get the analysis that really shows you what's going on, I think that the um the biggest mistake that uh people make is now actually starting to come out in studies. Um so so there's several studies out recently where where they're showing that adding GLP1s to your plan really doesn't do anything without uh a lifestyle management strategy behind it, right? And um I've personally witnessed, I mean, my barber, who's not actually one of our members, but you know, he's lost, I think, 128 pounds. He told me the last time I saw him, uh, over the last, I think it's about 18 months that he's been on GLP1. So I mean, it's totally changed his life, you know. Um, but you know, if if you just uh he's made a lot of um, you know, lifestyle changes to go along with that. It's not just solely due to the medication. Um, because you know, it really what the GLP1s, you know, the effect is for the average person is that it takes longer to digest food, you know. And if and if you eat, that means that if you eat McDonald's uh every meal, you know, that just sits there for longer and makes you feel even worse. And and that actually is one of the major um problems with GLP1s. They're they're beyond the um, you know, so I think the biggest mistake, I guess we'll just stick with the the question that you asked, but biggest mistake really is that um there isn't a care management strategy to go along with you know, whatever the pharmacy, you know, and you know, Kim, there's a lot of negotiation with the PBMs and you know how to get them added to the plan. That's one part, but from the patient's perspective, you know, the members, your employers, if you're a self-funded plan, it's really, you know, it's just like with diabetes. I mean, that's great, you give me the tools to manage it, but if I don't know what the numbers mean, you know, I how much improvement am I really going to make? And you can give, you know, similarly, you can give somebody a GLP one, but if they don't have the other support there to help them, uh, you know, not just with lifestyle changes, but also symptom management, you know, up front. And when you're two and three months between doctor's visits at the at the best, and you've got these, you know, three to four month wait times, getting to see um experts, you know, that's a big problem. So, and that really contributes to the to the high uh discontinuation rates that you see with GLP1 medications too, where people just are overwhelmed trying to manage symptoms. And you know, if you haven't eaten in or been able to eat in five days and you know, some of these extreme circumstances that you hear about, um, that's a big problem. And, you know, if you have a care management strategy, you can deal with things like personalizing titration schedules and things like that that um can make a huge difference. And then and then you have a care strategy that kind of complements your pharmacy strategy in that you're really trying to get, you know, bang for the buck. You're trying to help people by covering this. You're not just covering it for the sake of covering it, you're actually seeing changes in the lives of your members. Uh, and that of course generates um, you know, financial benefits for the plan.

SPEAKER_00 28:57

No, 100%. What do you think?

SPEAKER_02 29:03

I mean, 100% I agree. And maybe I'm biased because that's kind of my role with a lot of these patients is going through what are the side effects you're having, what dose are you on? Let's look at maybe, you know, changing the dose, or let's look at trying a different medication. Um, we talk a lot about nutrition, we talk about making sure that they're getting enough water, getting enough protein, getting in strength training, a lot of these things that we as clinicians know are very important on a GLP one that maybe they never had any training on, or maybe, you know, they they just don't really know, um, really talking about the quality of their the food they're eating. I'll get too many patients who are eating McDonald's and are just eating whatever they want, and it's great because I lose weight anyway, and I can eat whatever I want, and not realizing that that's that's not okay. You know, we're seeing I see the studies coming out, we're seeing scurvy coming back, we're seeing severe malnutrition coming back on a lot of people taking GLP1s, which of course was never the intent. Um, and just there's that lack of education there with how to manage them and how to manage your your diet with them. So um, yeah, so 100%, I think that that's a big thing is is that we're lacking. Another one that I will throw out there is losing access to these medications, um, which I always say it's a good thing and a bad thing when you go off of the medications. A lot of times you do gain back a lot of the weight. Um, you know, there's a study that came out recently showing that if you truly make the lifestyle changes, if people are very active, if they're eating correctly the right foods, they're less likely to gain the weight back when they go off of the medication. Um, but a lot of times, you know, again, with the deciding to eat or pay for their medication for whatever reason, people have to go off of them. So um so giving them continued access, giving them the ability to be able to have a maintenance dose that they can continue on for, you know, for an extended period of time, I think is important as well.

SPEAKER_00 31:12

I agree. And I think you hit the nail on the head. I've always said, you know, I don't think that the GLP1 program is worth anything unless you pair it with a clinician. I mean, to because to your point, people who don't know better can't do better. Um, it it's there's things that change when you understand why something is the way that that it is, you understand that. And when you understand potential side effects, you can choose to do something different. And uh, you know, having a having certified diabetes educators and dietitians at the table is so uh so important. I mean, I've uh I've worked with endocrinologists and physicians, they'll say, oh, they're just let the let the CDE or the RD let them let them come up with that, right? Because they're working with the member, they're educating the member. And you know, here's the other thing I think too. I think I think that employers sometimes miss the vote because whether you're planning covers it or not, some people are some people are gonna get it um and not have clinician guidance. And then you have a whole nother ball of whack. I had my neighbor came over one day and just because she didn't know how to inject herself. And I mean, I've talked to folks, they can get these medications off of Facebook and never really interface with a physician or you know, a clinician for guidance, and you know, that's a problem. And so um, you know, when you talk about the you know, some of these mistakes you know, that that we're making in in short-sightedness, they can have a profound impact on on the member as well. And you spoke a little bit about that. Do I get my food or do I get my medicine? Or when that runs out and you know, the weight gain comes back without that clinician there, you then you know, I that's that's a real real struggle for for folks.

Off Ramps Microdosing And Access

SPEAKER_01 33:11

Yeah.

SPEAKER_00 33:12

And you know, I I don't think these meds are gonna go anywhere. I think plans, you you know, if you want to attract good people, good workers, I think you're gonna have to have a good good GLP one plan. Or it was interesting. I was talking with uh my friend. Do you know Dr. Clement with uh SIBA Health? Have you met him yet, Mike?

SPEAKER_03 33:36

Um the name sounds familiar. I can't I can't place his face.

SPEAKER_00 33:39

Innocent Clement. So he's the founder of SIBA Health. I've he's a fantastic guy. I was talking with him once and I said, What do you think about this microdosing? I've been hearing a lot about microdosing. And he thinks that that as well, that's gonna be a thing that's not gonna go anywhere uh because of the longevity, because of the health benefits. Um and so I just think, you know, a plan, it behooves them to to learn and to craft a really good GLP one program, uh, including what to do when people, like you mentioned, when they are ready to go off. Some people can go off. Maybe you can share a little bit about that. I think sometimes we talk about um, you know, how do you get people off the GLP1s? And again, there's not a clear-cut line in the sand, right? Some people can, some people probably can't. How do you, you know, how does the clinician, how do how do you help in that scenario?

SPEAKER_02 34:37

Yes, I can definitely speak to that. Even today, I had a patient earlier today who, because she switched employers, she went to a different plan. She was taking Triceba. Um, no, not Treceba, sorry. She was taking um Victosa. I've got to get it right here. Victosa, which we know is one of the older GLP ones. It's been around for a long time, the once daily injectable. Um, with her new plan, it's it's not covered. She has to go through sometimes. We know there's a few hoops. She has to try so many different medications. Oh, sorry, and I have my sidekick here. I forgot he was in here. He's always he always takes the show in all my meetings. Um, but anyway, she was taking her Victosa. She ran out. We had been working with her, you know, I've been working with her for a few months now, talking about what we're going to do. She's trying to be approved for Monjaro, I believe. She's still working through all of the hoops to be able to be approved to take it. But anyway, we have really worked on lifestyle. We've really worked on getting, you know, enough water is really hard for her with her job, getting enough protein. So I've seen a lot of improvements. And today she was actually in tears telling me she has a surgery coming up. She was in tears telling me I have made these changes and I was cleared for surgery because my numbers are still looking good. She went off of her GLP1 about two months ago, and it was a little rocky for a little while, but we were able to get her on another medication. She was, she's just doing so well. And she's been able to maintain her weight. Like I said, her blood sugars are looking good. So not that I want people to go off of it. Clearly, that's not the best outcome that we're looking for, but but really coaching people through that. And I do see it all the time. For whatever reason, people go off of it. Um, sometimes I'm helping them stay on it, telling them, hey, guess what? Yes, there's higher doses of the medication, but we don't need to do that. We don't have to go up. We can stay at a lower dose. And even, you know, it's not FDA approved, but doing the microdosing, hey, if you click it, you can count, you know, 20 clicks. Let's just click to 10 and give a half dose because who says that we can't take a half dose? If you do well with the half dose, but not with the full dose, that's okay. Let's do it. I know we've done that with Victosa forever since I've been an educator. So really going through those things and and helping them with that transition off or finding a way that they can stay on. Um, I wanted to mention too, you mentioned kind of I call it the black market of GLP ones. Um it's, I mean, and I always say I think that we will catch up eventually. I think insurers are going to start covering it better, employees are start, employers are going to start covering it better. That's the hope. That's obviously why we're here. That's what we're we're all aiming for. But being able to have a better structure to support these patients and keep them on the GLP ones and do it safely really is just what we're looking for.

SPEAKER_00 37:47

Yeah, a hundred percent. Um, as well, as well as for some folks that can, you know, having a having a plan to, you know, taper off of that if you can. Not good to do that without a clinician, though. Certainly not.

SPEAKER_03 38:04

And and if I can just if I can chime in uh if you don't mind, Kim, I think that the, you know, when you when when I um talk to people about this and hear about people's um plans, I I think that this is first of all, I agree with what you said at the beginning that I think microdosing and other um alternatives are here to stay, and I think are only going to get um bigger. Um I talked to a guy who who was formerly a salesperson for one of the big pharma companies, and uh he said he'd never seen any clinical justification for the titration schedules for these medications. Um just some other, just anecdotal um things. Um, Annette knows Rob, who joined us last year or so, and um uh, you know, I don't know, a few months after he joined, uh he called, I was talking with him and he said, Well, my stepfather, um, and I've met his stepfather, and you know, he's uh a shorter guy, uh, I don't know, 5'7, 5'8, and was at 220 pounds. And he took a GLP one, I forget which one, for one month, and Rob said, Yeah, um, he's going back in because they're going to double the dosage. And um, I said, Well, what weight is he is he trying to get to? And he said, Well, I think he's really happy at 180 pounds. He's like, Amazing, he's lost 40 pounds in 30 days. Um, and I said, So why are they doubling the dose? And um he said, Well, that's just what the clinician said. And um, so I you know, I think that the uh it's another one of these ways in which you know, big pharma, they're they're for-profit companies. Um, there isn't anybody really, I mean, you know, the PBM, I mean, everybody makes money if that person takes more of the medication. And, you know, on the other side, there's what's right for the patient. And what we're always trying to do is do what's right for the patient. And if the patient tells us that, you know, they want to come off, well, then we're we're gonna transition them to more of the nutritional counseling and lifestyle um type thing so that they can learn what they really need to do to be able to come off and not have, you know, like you mentioned, it can be dangerous to just stop them, you know, cold turkey. So, you know, that there's uh for for the self-funded plan that has these options, you know, I think they really need to be looking at, you know, how can we have, you know, what kind of what off-ramp do we have for this? And and is there one? And and the fact of the matter is in traditional healthcare, you really don't. I mean, it's in everybody's um financial interest uh for you know the PBM and everybody involved wants people to just keep taking this medication for the rest of their lives. But you know, if if you've accomplished your goals, you know, do you really need to? There's there's um there's also a lot of research. If you look at the independent research from the American Diabetes Association versus the research from the big pharma companies, I mean, you know, they claim the the the the the complication rates are down here, independent research is you know up here, where 80% of people versus 12% is the exact small difference, right? And those those those complications are a challenge to manage. Um so yeah, you know, that that's I think really important for people to realize is that there it's not just like a magic, you know, you you see these big pharma things with people playing with their dog in the park and whatever else. Like there's a lot more from the individual patient's perspective that goes into it. Um, you know, other than just, you know, yeah, let's cover the medication, right?

What A Smart GLP-1 Program Needs

SPEAKER_00 41:46

Oh, a hundred percent. Yeah, very short-sighted to only cover the med. Well, what about if we know what what mistakes what the mistakes are? Tell us a little bit about what does a smart GLP1 management program look like?

SPEAKER_03 42:03

Well, we we've always felt that you know the the analytics that we offer are really at the forefront of it. So really understanding the population. Um, you know, we started a GLP1 solution because we started going into meetings with our diabetes clients, and we would say, Hey, we saved you whatever,$250,000 last year. And then they'd say, well, then how come my spend went up by$8 million? And the reason was because it was all attributed to GLP1s, you know, all of the increase in spend. And um, so I think that forms the basis of it. And then, you know, what our philosophy is is hey, um, you know, if you look at the traditional way that things are done, you add it to a formulary, and then really it's kind of open season. And, you know, if you look at BMI criteria, 40 plus percent of your population might start taking these medications at you know, thousands of dollars a month per per person, right? And so we think that a smart strategy is let's I let's set some criteria, and and this is one of the things in our solution, you know, they basically carve it out of the PBM. They everybody who gets a GLP1 has to come through Diethrive. And we do an at-home blood test and a physician's interview to make sure that the person is really that it's appropriate for the individual. And we work at the plan, we have guidelines for the plan, medical guidelines, you know, above a certain BMI and and things like that, so that you're really identifying the cohort of people who where it's gonna be good for them and good for the plan to take them. And then once once you prescribe uh, you know, the medication and deliver it to the person, we we're checking in with them on a weekly basis. What symptoms are you having? Because, you know, again, contrary to what happens, it's very likely that you're gonna have at least one. And a lot of people have multiple symptoms from these medications and then. what can we do to help you manage them like if you've i if you've reduced it to the the number of people who really are going to get you know medical um you know benefit and and from the plans perspective kind of return on investment if you will then gosh let's do everything we can to keep those people on the medications for as long as they need to so that you realize that benefit from that from that spare emotional benefit that you're you're offering them so that's really the um the idea that's the kind of high level idea behind it there's a lot of moving parts but that's it just you know identify who really needs it and then support them like crazy so that they stay on it and they get the results that they really want. And that means you know if you look at traditional healthcare like I was saying you don't go months right between checking in on somebody when they're starting with these are very powerful medications. So the notion that you know traditional healthcare like you start on this you may not see a physician for three to six months and you're going you know crazy with some of these side effects. So yeah 100% and so we can you know the very next week we if somebody has nausea you know we can add Zofran you know and for all the different there's about a dozen different things that we can we can prescribe in addition to the GLP1 to help them manage those side effects and really dial in how much and and maybe it's the titration schedule you know if you haven't eaten for five days you're taking too much meta too much of it you know um so things like that.

SPEAKER_02 45:32

Maybe yeah oh sorry go ahead no no go ahead oh I was just going yeah just agreeing with that yes just having you know from my perspective just following up on those things um in addition to like the titration in addition to prescribing other medications sometimes just talking about what are you eating your meals, how much are you eating we know a lot of people if you overeat you're not going to feel good. If you eat late at night maybe you're not going to feel good. So talking a lot about about that as well and just having that lesson to their body right yes yes yeah a lot of times I'll get patients who've been on it for years and have never really had that support or education maybe haven't had the results that they want and we'll talk about it and we'll start making those little changes and then they start to see the blood sugars come down. They start to see the weight come off because they just didn't really know how to use them properly.

SPEAKER_00 46:26

Yeah gosh and there's so many savings when you watch what happens in their lab values as anyone sees the blood sugars come down and you know liver function tests get better kidney function tests get better cholesterols go can go down I just think that's amazing. What about you know from your from the clinician's perspective right um how should how how do you think employers should look at GLP ones differently for folks who are coming to them for diabetes management or for weight loss. I'm sure you know what's the difference there and how should employers think about the two the two uses I'll let your leg wrestle for it sorry I was gonna say I can jump in either way.

SPEAKER_03 47:22

Yeah you said from the clinician's perspective so I just figured you were talking about Annette.

SPEAKER_02 47:26

Yeah perfect yeah so I will take that so um yeah and I mean I know that that can be can be tricky I know from my perspective I see a lot with can be helpful and hurtful maybe sometimes having those requirements a specific BMI or other comorbidities whether they have some you know kidney failure or other metabolic disorders or whatnot can be kind of difficult. I've had patients who want it so so so bad but they're just under the limits so they're not able to get it or had those that are resistant and definitely in my opinion should be on a GLP1 but feel like it's cheating or it's going the easy route or or whatever. But um I think too you know so many times I always say pre-diabetes is really diabetes stage one. If we don't make changes we're going to develop type two diabetes it you know for a lot of people oh it's fine it's just pre-diabetes it's it's not a big deal yes just a touch of sugar no it's fine it's not that bad. Well it will get bad it will get worse so um a lot of you know kind of with obesity as well taking a GLP1 to avoid getting diabetes and avoid heart failure and avoid kidney disease and avoid all of the other things that can come with obesity um I you know those are important too so in a perfect world I would say yes please let's give this as an option for anybody whether they have diabetes or not I know it's not that simple um from a payer perspective but um I like you know kind of our our system I like that we do have those requirements we do have the you know some different requirements that they have to meet to be able to to get those but again I think the more we can destigmatize it and and even recognize obesity this is a whole other thing we could go into but recognize it as a condition not as laziness not as something people choose but as a true condition it's important.

SPEAKER_00 49:37

Yeah 100% absolutely what about here's a topic um what about because you know I like data and I like metrics what about um what about what what do you usually say Mike for for an employer who you might be talking with and and who wants to build this good GLP1 strategy and they're on board and they say okay Mike how do I know this is working? And when an employer puts a a plan like this in place, a benefit like this for their folks how how are they going to know that it's giving them the results that they are that they're looking for yeah that's a good question.

SPEAKER_03 50:18

The I think you know it some of it depends on the employer's situation. A lot of times we get brought in both for diabetes and GLP1 to replace a solution that they don't feel was working and usually that revolves around engagement. But again that's why we started the the and have invested a lot into our claims analysis so that you know you can really have a baseline starting off you know for GLP1s for example, you know, what percentage of the population is taking it and uh you know we we we now have some data like how does that compare um you know to other companies your size or to the area that you're in. And really you know from a um in terms of the the efficacy of the program the way we measure it is like I said before it's kind of like are the people that we really want to have it you know getting it and are they staying on it? You know I mentioned that that uh ADA um the at the American Diabetes association scientific meetings they showed some discon you know if you look at the discontinuation rates that the big pharma companies claim uh versus the ones that are found independently I mean they're they're crazy it's 60 to 85% um are the discontinuation rates in independent studies at the one year mark depending on which medication you're taking so if you think about it gosh I mean if 85% of your people are stopping the medication after a year you might as well just lit the money on fire right or flush it down with me there's no ROI there. Yeah I mean that's a guarantee because like Annette said all the research shows and it's definitely our our clients' experience is that if they stop it, they're actually what what really happens um you know if they're on a few months they tend to lose weight but they also in that process especially since if they've been on a program other than ours they haven't had any exercise support. So what tends to happen is they lose weight and they lean lose lean muscle mass which is uh you know Peter Otia and others have taught have have talked about how that's the biggest single predictor of longevity. Well they lost that lean muscle mass because they don't have to carry around the weight and then they put back on the weight and so they're actually you know have even more fat proportionally than before and they're you know arguably you know worse off than before. So some of the plans and this is why we started this a couple of years ago because some of the plans were coming to us going like I just spent$20,000 on this person and I actually made them sicker. That's not what we want our health benefits to do. So I think the um you know it's it's you know where are you starting from first of all from a numbers perspective because you know we're diabetes we by by by our roots are in in diabetes and so you know if you're in Louisiana you can find populations that are 70 to 80% of the population has diabetes. So having an individual I think it varies by by company based on you know what your claims are really really telling you and the data like like you said Kim are really telling you but at a at a baseline I think it's it's that engagement are the people who are getting them you know staying staying with them and uh and then you know if you've got the data picture you can then see that data evolve over time too and that's pretty cool.

SPEAKER_00 53:49

Yeah I love that you know engagement is everything um that engagement is where you you can't educate somebody you're not engaged with right and then you can't then they can't understand well the what's in it for them to change the behavior to support the medication so that they can stay on it so that you will see the ROI and that you will see those results show up in labs in terms of their A1C and their cholesterol and their GFR and their LFTs and all those majors that we look at in terms of their you know laboratory uh data and and you're just not going to get it without without that human interaction with a trusted therapeutic you know professional helping them along that way.

SPEAKER_02 54:36

Yeah any thoughts from you Annette yes I mean I I definitely agree and again I'm probably biased because I do work with these patients one-on-one um I just there's something about that human touch there really is people can read I mean there's so much information out there on online now with you know AI people can get a lot of information from that but sometimes they just need that human interaction they need to have somebody to follow up with when I'm working with people and I promise I'm not just putting out a plug for myself here but just from my experience as a clinician coaching these people we're setting goals we're talking about lifestyle change really it comes down to to lifestyle change. So many of these people dieted their whole lives they've basically been on a diet since they were 11, 12 years old they've lost weight gained it lost weight gained it I hear all the time I've lost over 200 pounds but then I lose it gain it lose it gain it you know so yeah so a lot of it is the it's that behavioral change that we're working on and we're talking about making improvement we're talking about that there is no wagon that you fall off of the wagon's always moving where sometimes we do better than other times we talk about how holidays are always going to come up birthdays are going to come up vacations come up these are normal we're talking about how to deal with these things we're talking about maybe change you know slow change over time we're talking about long-term success so you know whether they're on a GLP one or not these are things that I'm coaching people through but but really just that that human interaction that that coaching is what that's what they really need and that's that's kind of where we're seeing the long term success and that's where we're we're really seeing them succeed with their GLP ones.

SPEAKER_00 56:35

Yeah yeah 100% it's not a quick fix people are not instapots that's for sure that's right so you know as we wrap up I'm just wondering you know for for those employers and brokers out there who might be wrestling with this right now what do you think what are the hard truths what are the what if you could help them give them one nugget or three that would help them be able to make a a solid decision for their plan. What are those hard truths that you'd want them to know?

SPEAKER_03 57:14

Well I think I think one thing you know we haven't covered actually yet is that um really the Consolidated appropriations act in 2021 and now there's some new stuff um you know last year and this year too where it's requiring now it's really starting to say to these planned fiduciaries hey you actually have to be good fiduciaries you know you're deducting money from somebody's check you know every every pay period to give them benefits you Mr or Mrs plan sponsor are in charge of actually evaluating your population and then identifying what that population's needs needs are and then bringing in solutions to address those needs in a financially you know a fiscally prudent way um where to your point Kim you know you're getting results so I I think the first point is that you know people really are now required by law to do stuff like this and that's why we've really invested more and more into that analytics and we do that by the way for no charge for people just you know if you want us to look at your claims we'll tell you what's going on in diabetes and GLP1s so that's that's one thing. I think the second thing is um you know like like we've talked about um we you really have to have an overall strategy and of course we like our strategy there's a strategy for both diabetes and GLP1s that's really the right thing to do for the patient, you know, the right thing to do for the plan. And then of course it's it's compliant with the legal things that we we talked about. And then the third thing is you know we frequently hear um because I think I told you you know we get we get uh brought in we've got you know I don't know 700 plus plans across the country that use us and um we frequently hear from them that they are you know tired of of point solutions and uh I always say them we're you're tired of point solutions that don't work. That don't work you know getting measurement and being able to show you know real engagement that's making a difference in people's lives I would hope is what every you know HR professional, every C level executive you know every broker I mean you want to bring in things that actually work and uh and that can show that they're working. And so I think those would be my my two or three um things that you know they're really not that hard to accept um but you do have to take the first step of you know sending some claims files and you know let's take a look at your population and see what we got and see what we can do.

SPEAKER_00 59:49

I love that look under the hood before you buy the car. Yeah that's that's good advice for sure.

SPEAKER_02 59:55

What about you, Annette, from the heart and soul of the clinician what would you most want employers and brokers to understand yeah I think you know and we've talked about this before with Mike that a lot of times they're getting the complaints they're getting the the things that don't work they're getting people asking for additional benefits or whatnot but a lot of times they're not hearing the success stories. They're not hearing how much these people are are enjoying these benefits and their how much their life has changed you know and so sometimes hearing the success stories hearing the testimonials hearing how meaningful this is and impactful for these people's lives in addition to the stats and the numbers that they're seeing I think is huge seeing it as a huge benefit to these people happy employees are going to do better at their jobs and healthy employees are going to do better at their jobs. So just from that perspective seeing the success that their their employees will get is huge.

SPEAKER_03 1:01:00

Healthy employees cost less too yeah that too of course yeah lowering costs is great but like Annette says I mean I think what really makes us and you know we've got over 200 um you know testimonials from individual members but we will we will hear that people from HR directors like you know we had one in particular where three people showed up uh at her door on Monday after after we launched and they were in tears because they said you know what two of them were married a married couple they both had diabetes and they said we're actually going to be able to afford a house now we've never had a benefit like this um and you know the most common question that um people get actually after implementing our solution is what's the catch here like this is so much better than any any benefit that we've had for diabetes um or GLP ones but um you know it's saving the money and it's better so they they think that like I don't know I don't know what they think but they're they're nervous that you know there's a catch and it really is about changing people's lives. That should be why I think employers should offer benefits, right? Is to actually meaningfully make their employees' lives better and their employees' families' lives better. So um yeah that's one reason it's fun to do what we do.

How To Reach Diathrive

SPEAKER_00 1:02:21

Yeah I love that well changing lives for the better in a meaningful way. Well I think that's brilliant and I I don't know how anybody puts anything into place without looking under the hood. And guesswork doesn't get you very far just like you know I can drive good blindfolded by I can't drive well blindfolded by the way until I until I hit a tree. But it will happen right you will hit a tree if you it's a matter of time.

SPEAKER_03 1:02:51

So yeah well Mike and Annette if people want to know more about diathrive if they want to know more about you know what is your approach for diabetes management what is you know what could you do for me and my plan how how do people uh find out um more how do they reach you Mike well you know they can contact me directly at michael at diathrive.com um that's probably the easiest uh but as you know Kim we have a lot of great partners out there like Boon Chapman and others that um they can go through too but um yeah call me directly or you know email me directly and uh and uh we'd love to connect with you.

SPEAKER_00 1:03:32

I know I know you'll answer folks on LinkedIn too. If you're not connected with Mike and Annette because Annette I just sent you a request if you're not connected with Mike and Annette on LinkedIn you guys always share good content. I know I've worked with you on a number of plans before and and can really attest to the the quality and how you've helped helped members really truly save you know save and make their lives better. And that's a great thing. So yeah thanks for the great work you do it was so wonderful to get to spend time with you both. And again Annette uh Annette's on LinkedIn so make sure you connect with her as well follow dietrive and live well yeah thanks guys thank you Ken thank you Kenny