Omada GLP-1 program to prioritize muscle mass restoration through expanded care track

Chronic care provider Omada Health is expanding its GLP-1 program to better care for patients interested in maintaining weight loss progress while discontinuing usage of the drugs.

For patients prescribed to GLP-1 drugs for weight loss, up to 40% of the weight loss can be due to loss of muscle mass. Omada is building upon its weight management solution to help users regain muscle throughout a member's journey and when the drug is no longer utilized, a solution that would improve health outcomes and allow patients to not stray far from weight-related goals. Members of Omada's cardiometabolic programs can benefit from the expanded care track, the company said.

Omada execs say the program expansion serves several purposes. For one, a patient's care team staff will collaborate with physical therapists to provide a personalized training regimen designed to improve a member's lean muscle mass. Losing muscle while on GLP-1s is a critical issue that needed investment of resources, said Omada Chief Medical Officer Carolyn Jasik, M.D, in an interview with Fierce Healthcare.

"First, it affects a person's ability to have energy and be mobile," she explained. "The second piece is an interesting aspect of GLP-1s that a lot of people don't talk about. After you go off the medicine, your hormones flip where you go into hyperphagia."

She's referring to metabolic adaptation. This is when a person has high levels of hunger and low levels of satiety, or the feeling of being full, when a person quits taking weight loss drugs, the opposite cravings as when an individual is taking GLP-1 medications. Jasik said the only way to reverse the metabolic imbalance is to rebuild muscle mass.

"If your metabolism stays at a low rate after these medicines, it's very hard to maintain the weight loss because it's calories in, calories out," she said. "You're not going to be able to eat very much to stay in balance."

Members on the care track will be screened to determine what level of physical activity they are comfortable with. Since some of the people that go through the GLP-1 Care Track are not comfortable or accustomed to extensive physical activity, physical therapists may suggest patients start slow, before building up to more strenuous exercises. Omada suggests starting with cardio and resistance training before incorporating strength training. Exercises can include gym work, but if members don't have access to fitness equipment the program will recommend exercises to do at home.

The goal is for all members to eventually work out for 300 minutes a week, per the recommended allotment to maintain weight loss from the National Weight Control Registry.

The expanded GLP-1 track also allows for more robust reporting capabilities so employers and patients can better understand the effects of GLP-1. This allows everyone to track medication impact to see how to best keep the weight off.

"With our new reporting capabilities, we can now provide recurring data and insights on how well the GLP is working, and for whom, and we believe this is going to be super valuable to help buyers make future benefit design decisions," said Omada President Wei-Li Shao.

Members receive a digitally connected scale, and employers (as well as Omada) have access to real-time data that shows how the customer is responding to GLP-1s, if a body is tolerating the medication and whether the person has been able to receive and use refills.

Payers, increasingly worried about the financial ramifications of covering GLP-1 drugs for weight loss, are mixed in how they choose to respond to the challenge. Starting April 1, the North Carolina State Health Plan is opting to stop covering the drugs for weight loss, citing financial pressures. If plans could be confident GLP-1 usage for weight loss would be short-term, and that a lifestyle program could be shown to be effective, they would likely be more willing keep the drugs covered on their plans.

An analysis from healthcare consulting firm Wakely, commissioned by Luna, a provider of in-home outpatient physical therapy, found there is a strong correlation between increased PT utilization and reduced healthcare costs for payers. Of the Medicare members that have knee pain and high PT utilization, savings equaled about $4,000 on average, although the study didn't look at savings associated with GLP-1s.

Omada Health has more than one million members who have enrolled in its programs and more than 1,900 employer, health plan and health system partners. The company doesn't prescribe weight loss drugs, instead leaving that conversation to the patient and the primary care doctor. Any eligible person can join the GLP-1 Care Track, no matter the stage of the journey they are in, as the program's expanded purpose is not just for discontinuation. The company said it also helps patients manage the potentially tricky prior authorization process.

In May, Omada launched its GLP-1 Care Track for the first time. It included training tools and resources for members, plus peer-supported communities that encouraged dialogue between members to support each other as their bodies change.

"I think the big difference between last year and this year is we've learned a lot more about these medicines for the obese population," said Jasik. "As we started to see that data come in ... we realized we really needed to invest in the discontinuation phase and boost up our weight maintenance programming."

Promising results

While individuals that take GLP-1 injectable drugs for weight loss can achieve impressive results,researchers have thrown cold water on the belief users can simply quit taking the drug and expect to keep the weight off.

However, more data has come to light indicating sustained weight loss without GLP-1 intervention may be possible after all.

A recent Epic Research study found 56% of patients can maintain weight loss, or continue losing weight, one year after discontinuing the medicine. Results vary, as some patients put weight on and 17.7% of semaglutide users regained all, or more, of their initial starting weight.

Illant Health CEO Elina Onitskansky said the results were "incredibly exciting" but offered some reasons in a LinkedIn post as to why these results may be different than other studies.

But others say they think it could be possible, too.

Telemedicine company Virta Health says nutrition may be a key factor, specifically through carbohydrate restricted nutrition therapy (CRNT) as a form of maintenance therapy. A Virta Health paper, yet to be released, shows a safe off-ramp may be possible, as hemoglobin A1c and body weight measured 12 months after de-prescription did not significantly differ between patients that continued GLP-1 usage and those that did not.

Patients' nutrition consisted of a "medically-supervised ketogenic diet" through an app where users connect with a care team. The care team and patient have access to resources, support and biomarker logging. Virta says results indicate that nutritional ketosis can be achieved with this approach, which helps a person maintain hemoglobin A1C and body weight following de-prescription.

The research concludes that dietary carb restriction can be effective because participants reported reduced perceptions of hunger after 10 weeks of therapy. Virta Health execs told Fierce Healthcare the study has been reviewed and should come out in a peer reviewed journal early next month.

Digital metabolic health company Calibrate boasted positive results (PDF) in January. It showed coupling GLP-1s with Calibrate's intensive lifestyle intervention resulted in 16% weight loss at 12 months for more than 14,000 participants, and nearly 18% weight loss at 24 months for more than 1,100 participants.

When patients decided to quit using GLP-1 medications, the results showed 92% of patients maintained at least 10% of weight loss.

While people on GLP-1s for diabetes may need to be on the medicine for life, Jasik says there's a desire from individuals taking the drug for weight loss to stop. Side effects can be uncomfortable and the price remains high, so patients might want to experience life without GLP-1s again.

"The thing to remember about obesity is it's not really cured with weight loss," she said, noting that risk factors are still prevalent. "The barriers, genetic or metabolic, don't go away once you lose the weight, so people really do need support before, during and after."