Navigating the Nexus of Obesity and Behavioral Health in Value-Based Care

By: Erica Stokes

In the rapidly evolving landscape of healthcare, obesity and behavioral health have emerged as significant drivers of rising costs, compelling provider organizations to adapt their strategies. Recent analyses have revealed that national commercial healthcare costs are projected to increase by 8% in the coming year, primarily due to the escalating expenses associated with obesity medications like Glucagon-like peptide-1 (GLP-1) and the rising utilization of behavioral health services (Oss, 2024). This situation underscores the need for innovative approaches that address both the clinical and systemic aspects of these health challenges.

The surge in GLP-1 agonist prescriptions, which rose from 1.6% of total prescription costs per plan member in 2021 to 6.3% in 2023, reflects the growing emphasis on medical interventions in obesity management (Oss, 2024). Simultaneously, behavioral health service utilization has increased by 40% since the pandemic, with 30% of health plans identifying behavioral health as a top area for cost increases (Oss, 2024). This dual trend presents an opportunity for community-based provider organizations to develop comprehensive obesity management programs that incorporate both medical and non-medical interventions.

Carol Cassell, Executive Director of Advanced Health Network, highlights a crucial concern: the root causes of obesity and behavioral health issues extend beyond the scope of traditional treatment models (Oss, 2024). She emphasizes the need for a systemic approach that addresses underlying drivers such as poverty, stress, and poor nutrition. The current healthcare financing model, predominantly fee-for-service, often limits the ability to tackle these systemic issues effectively, despite the potential flexibilities offered by value-based care (Oss, 2024).

Value-based contracting (VBC) offers some latitude for addressing health-related social needs (HRSNs), but it is not a panacea. The existing reimbursement structures, particularly the acute episodic case rate model, lack the flexibility to fully address the complex interplay of social determinants of health (SDOH) that drive demand for both obesity and behavioral health services (Oss, 2024). To bridge this gap, policymakers and health plans must consider expanding funding mechanisms that allow for more comprehensive, prevention-focused interventions.

One potential solution lies in expanding the service portfolios of health plans through mandates that require the inclusion of public health and social service programs. For example, Medicare Advantage plans have begun covering services such as transportation and exercise programs, which can address SDOH and reduce long-term healthcare costs (Oss, 2024). Similarly, state Medicaid plans are increasingly permitted to fund non-medical services through mechanisms like the 1115 waivers, which support innovations in Medicaid service delivery (Oss, 2024).

The integration of public health and care delivery is essential for creating a more effective and equitable healthcare system. As noted in the article “Public Health And Care Delivery—A Common Destiny,” the current divide between these sectors hampers their ability to achieve their full potential in improving population health (Oss, 2024). Moving forward, healthcare leaders must prioritize strategies that align public health initiatives with care delivery models, fostering partnerships that can address the root causes of obesity and behavioral health issues more effectively.

References

Oss, M. E. (2024, August 6). Navigating The Nexus. OPEN MINDS. Retrieved from https://www.openminds.com/navigating-the-nexus