A Framework for a Population-Based Payment Model for Obesity Treatment

Executive Summary

As obesity rates have rapidly increased in the U.S. over the last few decades, so has medical expenditure to treat both obesity and co-occurring clinical conditions. While there is a range of effective treatment options for obesity that demonstrate transformative health effects and may reduce health care spending, persistent barriers to patient access exist. These barriers include stigma against initiating treatment, lack of provider training and bandwidth, and issues around affordability and resulting insurance coverage of treatment options. Population-based integrated care and payment models can support sustained access to treatment for obesity. Integrated models couple value-based payment strategies for medical products with care delivery reforms. Value-based payment strategies can address pricing, coverage, and payment barriers that limit uptake of novel therapies. However, sustained population-level access to these therapies requires additional steps to address common care delivery barriers. These include patient engagement, linkage to care, care coordination, and non-clinical determinants of health, such as geographic proximity to health care services. Novel care delivery models can facilitate more comprehensive and coordinated care that supports sustained access to therapies.

The Duke-Margolis Institute for Health Policy has developed a framework for an integrated population-based care and payment model for obesity to facilitate treatment for Medicare beneficiaries.

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