The American journal of managed care
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Two guidelines-one by the American College of Cardiology (ACC)/American Heart Association (AHA)/The Obesity Society (TOS), and the other by the American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE)-remain the standard of care in the management of overweight and obesity in adults. However, since the publication of the ACC/AHA/TOS document, several relevant pharmacotherapies have been approved by the FDA, a medication was withdrawn from the market, and several procedures and device types for weight loss have been recommended or FDA-approved. Simultaneously, research in obesity treatment has advanced, and leaders in the field have issued complementary guidance. ⋯ To stage disease severity, weight-related conditions should be assessed. Although lifestyle therapy remains the cornerstone of treatment for this disease, both pharmacotherapy and metabolic and bariatric surgery produce greater and more sustained weight loss in treatment-approved populations as compared with lifestyle modifications alone. An ongoing partnership between the patient and clinician is highly recommended to manage this serious, progressive, chronic disease.
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To explore the perceived impacts of a variety of telehealth services on hospital finances and assess how hospital administrators make decisions about adopting telehealth programs. ⋯ Understanding how CFOs think about the return on investment of telehealth can inform efforts to promote telehealth utilization in rural communities and to develop policy solutions to make telehealth more sustainable. CFOs may benefit from guidance on promising practices and cost-effective implementation strategies. Policy makers could take steps to improve telehealth's financial attractiveness (eg, through payment parity, subsidies to improve technology infrastructure).
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This paper examines (1) the rate of plan switching among beneficiaries enrolled in a Medicaid managed long-term services and supports (MLTSS) program in Virginia, (2) barriers that prevent beneficiaries from changing plans, and (3) the extent to which a change in plans is associated with greater satisfaction with the current health plan. ⋯ Greater dissatisfaction after a recent plan change may indicate that these members have specific needs beyond the scope of services offered by managed care organizations.
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Anti-obesity medications used with lifestyle intervention produce greater and more sustained weight loss than does lifestyle intervention alone. However, until 2021, FDA-approved medications for the long-term treatment of obesity in the general adult population had not demonstrated the sustained loss of 15% body weight needed to meet or exceed all guideline-recommended targets for weight-related complications. To meet this need, investigators launched the Semaglutide Treatment Effect in People with obesity (STEP) program of phase 3 clinical trials to assess the safety and efficacy of a weekly 2.4-mg subcutaneous injection of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). ⋯ Safety and tolerability of this treatment in STEPs 1 to 4 was consistent with those of other GLP-1RA-based therapies. Ultimately, the results of the first 4 STEP trials demonstrated that semaglutide 2.4 mg is a safe, well-tolerated, and highly effective treatment to promote weight loss, avoid weight regain, and mitigate the effects of the prevalent, chronic disease of obesity. In November 2022, based upon the results of STEPs 1 to 3 and other trials, the American Gastroenterological Association recommended that semaglutide 2.4 mg "be prioritized over other approved [anti-obesity medications] for the long-term treatment of obesity for most patients."
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The growing prevalence of obesity in the United States has presented an opportunity to increase knowledge about optimal treatment approaches based on a better understanding of patient and provider biases, health care coverage and practices, and social determinants of health. Guideline-recommended obesity treatment begins with lifestyle intervention, and weight management may be enhanced by metabolic and bariatric surgery or anti-obesity medication (AOM) use. ⋯ Limited patient access to these treatments carries the potential for negative health consequences and higher health care costs. For these reasons, managed care decision makers are encouraged to improve access to effective obesity treatments, including coverage of AOMs such as semaglutide 2.4 mg.