Earnings Call - OMADA HEALTH INC

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If any additional resources are provided during today's presentation, you'll find them in the resources panel located on the lower left side of your screen. Thank you for joining us today. We hope you enjoy the presentation. Now let's get started. Good morning, good afternoon, and thank you for joining and spending part of your day with us. My name is Kevin Massey and I'm a clinical pharmacist and I lead clinical affairs at Omada Health. I'm super excited and honored to be your moderator for our webinar today. You know, for the last two years, almost every cardiometabolic conversation I've had with employers has started with one question, and that's, should we cover GLP-1s? I think it's such an important question without a doubt, because GLP ones have really raised the stakes for every benefits leader on this call. But it's not the first question. And it's definitely not the last one. I think the bigger question is, what is your strategy for cardiometabolic care as a whole. And I say that because the employee, those living with obesity, oftentimes they're also living with other conditions, things like diabetes, high blood pressure, maybe it's knee pain along the way. And so they don't experience just a coverage decision. They experience what I like to call a Thursday. It's maybe a prior authorization, a new side effect they're dealing with. Maybe it's a shift change of work or a missed follow-up doctor's appointment. So while that coverage decision is a really important one, we have to also remember and recognize that care is a journey within. So we have an exciting and action-packed agenda for our discussion today. We are going to work and walk through three important questions together that will help us identify what it takes to build a better, more holistic playbook for cardiometabolic care. First, we're going to start off with that strategy question. What are you facing as employers and why are the usual levers, including things like coverage decisions, simply not enough today. Then we're going to dive into the care question. What are your employees actually living with in between visits to their doctor's office? And then finally, we're gonna discuss the value question. You know, what should the future of cardiometabolic care deliver and how do we know it's working? Now, I think in order to have an important discussion like this, you need two key ingredients, in my opinion. The first one is I need all of you joining us on the phone today, virtually. Please weigh in, be curious, ask your questions, share your opinions. Your voice matters. And so we want to hear from all of you. And like they mentioned at the beginning, please share your questions in that Q&A feature throughout. But then the second thing is you need a really powerhouse panel of great experts. And I'm so thrilled because we have two of the very best joining us today. And So without further ado, why don't I introduce them to you right now? Okay, first is Dr. Rajiv Roy. Rajive is a dual borough board certified endocrinologist and an obesity medicine medicine specialist who has over 20 years of practice experience. He works every day at a large multi-specialty group practice and lectures regularly on the topic of diabetes and obesity. Now, if that wasn't enough, on top of that, Dr. Worley has been recognized by his peers as a San Diego top doctor. I've been very lucky and fortunate. I got to meet and work with Dr. Rajiv for a while now. And what I love about him is a practical approach to helping his patients. He sees the people behind these benefits decisions every day, every week. And so I think he is the perfect person to lead us through the care question and the important considerations that we need to think about. Next is Britt Brutman. Britt has spent more than a decade at Omada building customer success, payer access, corporate strategy, and now leads the cardiometabolic business. She really spends her day at the intersection of what I'd say as employers, health plans, and PBMs. And as such, she really has a good pulse on the challenges and the complexities that go into designing world-class benefits offerings. The thing that I really love and admire about Britt is just her amazing curiosity. She has this brilliant way of breaking down complex concepts to make them more manageable and effective for everyone involved. And I'm sure you're going to see that here very soon. But Britt and Rajiv, welcome. I'm so grateful to have you both join the conversation today. Okay. Why don't we get things started? I always like to have a little bit of fun and Rajiv and Brett, I thought maybe we can get the audience engaged right away with a little audience question. So what do you guys think? You open for that? All right, let's do it. All right. So as I mentioned before, in my role, I am lucky because I get to meet and interact with a lot of employers and benefits leaders. And I'll just tell you, wow, it blows my mind because I've been in healthcare for over 25 years. And so I'm going to talk a little more about that. And then I'm And I think it's more complex now than it's ever happened. But with that, we wanna hear from you. And so as you plan for 2027, what is it that it concerns you the most about the way your organization is approaching cardiometabolic health care? What essentially, what keeps you up at night? And so you see the poll question above, you can just click your answers and then we'll compile them. But you have four choices. It's managing the rising costs. It's ensuring high quality care and meaningful health outcomes. It's connecting care across conditions, providers, and programs. How do you help employees stay engaged as life and treatment change and knowing which approaches can deliver value? So just take a few minutes. We're gathering those questions and then we will share the answers in a second. Britt, I know these are questions you get every day, I imagine. Yeah, absolutely. All right, we got them. Ask them. Okay, we've got participants weighing in. Please don't be shy. Drop your vote in there. We're almost at voting season anyway, so this is going to get you ready for the big day. Okay, why don't we open up the poll and see how we did. Okay, so as you guys can see, we have some clear winners like managing rising costs and sharing high quality care and meaningful health outcomes connecting care across conditions, providers and programs. I love all these answers because it makes me feel very confident about what we're about to speak with all of you about today. But my initial reaction when I look at this is, there's still this wide variability across the board right. right cost is real but so is quality so is connection engagement we know that coverage decisions definitely touch all these things but again from your responses it doesn't appear that any of them are solved by coverage decisions alone and maybe brett just quickly maybe like 60 seconds or less again i know you're meeting with employers plans and pbms every single day when you look at these responses from our audience does anything stand out or strike you in these responses you know i think what stands out to me is just how on point these responses are for the discussion we're going to have today which is how do we look beyond just and i say just lightly because it's a huge part of the equation but how do i look beyond the cost of things like glp-1s to look at like the broader value equation which pulls in things like high quality care meaningful durable outcomes, coordination across the system so patients and providers have a good experience. And so if anything, this was a good tee up and segue to the discussion we're going to jump into today and certainly resonates. I love it. It's kind of validating what we hear and talk about every day. So thanks for it. I appreciate you sharing. Why don't we dive into it? Again, thank you for being vulnerable, sharing your feedback as an audience. But let's start off with that first key ingredient that we mentioned, which is the strategy question. For me, when I think about this, I think the real question is here is like, what are the biggest challenges employers are facing today in this complex, this somewhat chaotic healthcare environment that we're all living in trying to navigate? More importantly, it's why is it? Why are those usual levers that we talked about that we've pulled in the past? Why aren't they working? And so why don't we break that down on the next slide if we can. Okay, there's a lot on this slide, but it's a lot more simple. It really boils down to four things. The first one is cost. Britt, you mentioned this. Employer benefit costs are projected to rise 8.2% in 2027, and that's the biggest increase in over 20 years, since 2003, as a matter of fact. The second one goes back to that levers questions. 36% of employers saw their premium increase by 10% or more even after they made significant plan changes and what's striking about that is the levers that you have always pulled in the past are getting much much harder to pull and why is that the third one is what i like to call concentration just over one percent of members drive more than one third of the spend now i don't think that's anything novel or new but those are often the employees managing several conditions at the same time and we know that number continues to increase year over year as well. And then the first one is pharmacy or medication spend. And this is simple. Great. You mentioned GLP-1s. About eight in 10 employers say GLP1s are driving up their health care costs. And while these are such powerful medications, especially they've been around for diabetes for a long time, Dr. Rajiv, as you know, but now there's new and new indications. We got to think about that cost equation. Now, I shared this quote, and I love this quote from Chris Spartanek at Lockton, and I'm just going to paraphrase it here for a second, but he's basically saying that the challenge isn't necessarily simply about cutting spend. It's about managing costs while still offering something meaningful to the people, your employees, who count on you. And really, as I think about the conversations I've had, that is the tension every one of you on the phone, I'm sure, are holding near and dear to your hearts. And there's even more behind those costs. There's much more bigger numbers. So let's dive into that. If you zoom out to the size of the need, there are about 255 million commercially insured adults in the US. About 188 million of them have at least one cardiometabolic or related condition that needs ongoing care of some sort. And then 99 million are living with two or more chronic conditions at the same time. Think about that. That last number is the one I really want you to remember, because a condition by condition programs, they weren't really built for that 99 million. And again, hold on to that one, because in a few minutes, we're going to meet one of those 99 million. But I think this is a perfect segue to maybe get into some questions. And Britt, I'm going to start with you because in your role, you see this from every side of the market. Again, I mentioned earlier, you sit at this really cool intersection of employers, health plans, PBMs. But my question, Britt, is like, what is the market today getting wrong now about, say, GLP-1s and cardiometabolic care that we should think about. Sure. Yeah. And it's hard to say that the market or that customers are getting anything wrong because this is such a complex topic and the pressure is on like it's never been before. You just shared costs are rising faster than they have been since 2003. And so I and we have so much empathy for just the challenging position decision makers are in right now. But as we think about stepping back for a moment, there certainly is an opportunity for us to look beyond, at least on the GLP-1 front, beyond the near-term cost avoidance to the broader definition of value to say not only how are we managing budgets in the next 6, 12, 18 months, but how are мы putting in place a solution that drives outcomes across the next two, three, five plus years. And then beyond that, it's so hard to look past the weight loss, the GLP-1 equation right now when setting benefit strategies. But per this slide, and I think we all know this, so many individuals struggling with weight and obesity are struggling with a broader mix of comorbid conditions across the cardiometabolic sphere. And so also super important that we tackle the weight loss question, tackle the GLP-1 solution item, but also look more broadly to say, okay, how are we putting in place a solution that supports all that my members and my employees need to consider across their cardiometabolic needs? Yeah, I think it's a really great point. And we talk about the complexities and everything you just said, really iterate that again. Now, Britt, I know in the past, you and I have talked that know many employers as they're kind of balancing the cost equation with value and we'll get into value that their their coverage decisions kind of are based on drug costs versus near-term savings when you think about and you mentioned this earlier kind of like this math equation what have you seen what is the math sort of leave out that we should consider yeah i think i think what we have all been really hungry for is like what are the law the medium to long-term savings that employers can expect from individuals that really receive meaningful outcomes and experience meaningful outcomes from medications like glp-1s so many individuals we know in the real world today don't have a chance at achieving those best possible outcomes because they don't know the support they need to be successful in their journey they're not on the the medication long enough. They struggle deeply with side effects and don't stay persistent or adherent. They don't understand the muscle retention component of the journey that they're on. And without addressing those pieces of the Journey and then without understanding, gosh, if we were to address those, what outcomes could we achieve and how might that drive really meaningful long-term savings? That second piece is sort of like what has been missing, I think, from the conversation today. And I think we're excited to continue to contribute to that in any way that we can. Yeah, I love it. And hold on that, because I know we're going to get to it a little bit better. But perspectives there, right? Again, we mentioned value, that is definitely one of those key ingredients. But before we get there, I think it's important just to anchor us on the key thing at the center of it all. And that is a person, you know, before we came and talk about value. Let's meet the person. All of us are doing this hard work who are supposed to help each and every day. And so that brings us to that second key ingredient. How do we think about a more connected, a more holistic and more coordinated care? We talked about just now the changing complexities of our healthcare ecosystem and what that has meant for many of you on the phone, benefits leaders. But what about the employee, the patient who really sits at the center of it all. You know, what are the challenges and experiences that they are living each and every day in between visits to their doctor. And I thought the best way to do this is to bring it to life with a very typical, and I'll admit it, maybe it's a little bit sad reality of what people living with chronic diseases are experiencing on the regular. Okay, so I want you all to meet Michael. Michael is a 50 year old 52 year old man who supervises a large distribution center about 15 miles from where he lives now it's a demanding job and it's a job he's been doing for the past five years but despite the long hours that he works despite some of the stressful days he loves it and so how great is that we all want to wake up and go to a job that we enjoy and love but for michael he's like so many of us not only is he prioritizing his job he prioritizing its job far above anything else and that includes his personal health and well-being now as you move on what we also know is michael has been living with type 2 diabetes for a while now. But recently, he has also gained weight, and it's probably more than he would like. I think we can all have experiences with weight gain that we'd rather not have. But on top of that, he was also diagnosed with high blood pressure and a myriad of other things. Now, sadly, if that weren't enough, because it's a lot already, Michael has developed severe arthritis in his knees. Now, that's a problem because it has caused significant pain, but it's also limited his mobility and activity, including exercise. So now, not only can he not exercise like he used to, which by the way, was one of the things he loved because it was a stress reliever for him. He's now had conversations with his kidney doctor and his kidney doctor told him he has to change his diet. And Michael's really struggling with this because he's having trouble following the advice that his nephrologist gave to him because it means he has to cut out the foods he loves. Now, throughout all this, Michael is desperately trying to get the help he needs, and he's doing a great job of keeping on task with his various medical appointments. And he's doing that again, while balancing his job, personal responsibilities, etc. So he's seeing an orthopedist, he's going to a pain specialist, he is getting advice from a physical therapist, he talks to his kidney doctor and his dietician. And that's great. But each one of those is focused on their specific piece of the puzzle. You know, the knee doctor treats his knee, the pain doctor treats is back. But nobody, nobody is talking about the whole complete picture for Michael. And so what happens is the one person connecting all of it is unfortunately Michael. He has become this de facto care coordinator for a system that was not designed around him. Andso when we talk about the care question, this is what needs to change. There are 99 million adults, like I mentioned, in the US living with two or more chronic conditions. That means there are a lot of Michaels out there in your workforce. And again, sadly, this is just one day in the life of Michael. And so Rajiv, I want to come to you because I feel like Michael's just one example, but you see patients like Michael every single day, every single week. And when you think about his journey that we just mentioned and the many other journeys you see all the time, what does this condition by condition approach miss for patients like Michael or other patients that you see every day? Sure. Thanks a lot, Kevin. What we really find is when all of these guidelines are released by different expert organizations, American College of Cardiology, these guidelines Are released, really focusing on one disease and how to manage that. And so the guidelines don't don't cover the 70 or 75% of patients I see in my practice who have multiple chronic medical illnesses. And So over the years, kind of the key themes that I hear from my patients are, number one, their care is fragmented. There is no quarterback who's kind of overseeing this whole process. Now, I'll have a patient who has diabetes, chronic kidney disease, and CHF, and everybody's kind doing their own part, but all of the people involved are not really communicating with one another. In theory, and in an ideal world, the PCP would be the integrator of all of this, but this fails in practice for a number of reasons. Sometimes it's not easy for people taking care of a single patient to communicate. Sometimes the patient's overwhelmed with how many appointments they have to go to, and if they're already seeing three specialists, they wonder, you know, do they need to even see their primary doc? And our primary docs are really taxed as far as how much time they have to do this. And so often medications are added and medications aren't subtracted when they probably should be. And, and so we have a system where we, that's built for one disease, but patients have many. To kind of make this problem worse, there are, you know, conflicting recommendations from, from the different, you Know, from different expert organizations. And so there can be conflicts between what I recommend for my, for my patient who has diabetes to what the, you know, nephrologist would want to do. And there really is no standard process to reconcile all of the, all of this competing guidance that's out there. And so then the PCP is kind of left to figure out, well, what do I do in this case? There is a lot of polypharmacy in these patients. And the more medications that a patient is on, the higher the likelihood is that they're going to have interactions, side effects, and that there'll be drug errors. And as our patients age, changes in kidney function and liver function further complicate this issue. Patients continue to be on meds that should have been stopped a long time ago. And again, no single clinician owns this whole medication list. This makes it really tough for a patient like Michael because they have multiple doctors. They're on multiple medications. They have different monitoring intervals for what they need. And these drugs are really expensive. And the harder that we make a regimen, adherence really, really suffers. And often the patient is left to decide, well, which of these meds do I take? Why do I not take? What can I afford to take this month? And I think that this is the hardest for patients who have low health literacy or limited resources to manage all of this. Yeah, I thank you, number one, for your feedback. Again, I know each and every day you're dealing with this. You mentioned, you know, it's important to have that quarterback. I know you're a big LA Rams fan, so I'm sure you're doing your best Matthew Stafford interpretation, Dr. Rajiv out there. The polypharmacy one really hits home to me as I think about my time behind the counter. you know sometimes as a pharmacist you are looked at as sort of that quarterback but when you don't have a full picture of someone's medication history and you're trying to connect the dots it's really hard and as much as you want to try to help them you know you're probably letting them walk out the door with not all the answers that they need and so I really appreciate your thought there and we're going to get into this a lot more but why don't we move on which I think is an important one because Dr. Rajiv what you described I think as an important reminder of the realities that people are managing each and every day alongside their health. As I think about the world I live in now with digital health technologies, they were absolutely meant to help between doctor visits and many other ways. But making support, like you said, available, just making it available isn't enough, right? It has to fit into a person's life. And it has to be easier for them rather than giving them more to manage. There's not enough, there's already a lot to manage and so I thought this quote does a really great job of capturing the challenges we've been talking about. And the message is simple. It's that we have to design support around the realities of everyday life rather than asking people to organize their lives around the support. And I still think that's a big problem. I look at it like coverage can help someone get in the car, right? But access alone doesn't help them navigate the journey. And so as we go back to Michael, or for that matter, maybe any patient managing ongoing health needs, the route can changed. I mean, that's the reality. Work schedule shift, new challenges come up, treatments change, like you mentioned, Dr. Rajiv. So support needs to adjust with those realities rather than keep pointing people back to a route that no longer works for them. And I thought about this a lot myself, and it's kind of like, man, how do we somehow create a personal healthcare GPS system for these people? And so that really gets me to the next part. It really brings us to three principles for care that we should consider and how they fit into a person's real life. And again, what we're about to dive into, they're not separate ideas. They really work together to make care more personal, to make it hopefully more relevant and more doable over time. So I want to dive in to each of those right now. And the first principle is this idea of agency and choice. And Rajiv, you talked about this already, but I want to start with you on this first question. When you think about this concept of agency and choice, what does meaningful choice look like in this evolving world of cardiometabolic care, especially when it's paired with, you know, appropriate clinical guidance, which you mentioned can be all over the place, rather than just simply asking a patient to figure it out on their own? Yeah, I think that something that happens a lot in these visits is that, you know, you're talking to a patient or I'm talking to a patient and I'm talking to them about a whole lot of, you know, different things and different recommendations. And often when they don't know exactly how this fits into their overall care plan, you know, the ones who do the best are the ones who ask the questions, like how is it, you know, how is this decision I'm making or this change I'm making going to affect, you know, the other conditions I have? And as far as who helps, yeah, I think that's really the million dollar question is that we've got to kind of communicate with one another. I think the way I'm finding it really helpful is in REHR, if the other specialists are in the same group that we can get on a chat and kind of say, hey, look, I saw this patient back and let's see what we can do to help make this easier for them. yeah i mean i love that i you know as we talked about like the complexities and i think about digital health solutions you know one of the most important things that they can do is having that day-to-day interaction like you're talking about in real time in between visits with a person but curiosity is still important what i love about healthcare and yeah i've seen it more and more since uh you know since i graduated many many moons ago is that people now are taking a more active role in their own healthcare which i think is important it's not that paternalistic view that we've had in the past. But when you think about these solutions, how can they help engage in even more curiosity and help members and patients understand or get answers while also directing them back to these other providers with additional questions to connect with that. So I really like that. Brett, maybe I'll turn to you here for a second, because again, you've been helping to build these cardiometabolic solutions for a long time. And so my question for you is when you think about a cardiometabolic partner, what should a cardiomedabolic partner build into the experience to make this member choice meaningful? You know, what should benefits leaders look for and expect from their partners when they're evaluating, you know, no less than 20 different tools out there in the market? Yeah, well, I mean, one thing we talk about all the time is a digital health partner is only as good as their ability to get people in the front door. And that's hard. And I'm sure many of you sitting here today are, you know have evaluated solutions, you've implemented them. And then they're falling short of the value they could provide because they're not able to get enough people in the doors such that you can drive the actual impact you want to see with that investment. And so I think first thing is how do we show up to help people understand the care we're able to provide, the support we can give them. so they're motivated to engage in their health with a partner like omara and they also have really clear expectations for what we do and how we can support them we certainly don't want to finally you know get someone engaged to enroll and then they they come in with with the wrong understanding of what they're here to do um and then once in the program i think it's you know really important and this has been a learning journey for us over the past 15 years since we've been in the market, which is like, how do we understand as quickly and as clearly as possible what that individual wants to do in their Omada experience? And then how do we take advantage of that as a catalyst and personalize the experience for them throughout their entire journey, rather than, you know, the opposite end of the extreme would be have a set order of curriculum and set of interventions that we put everyone through. And that just might not be meeting that person where they're at. And it may not speak to the unique reason they showed up and they want to engage with us. And so I think those those enrollment and then those like early understanding of why someone's there and how you might personalize the program to that to that individual are super important things to look for. I love it. I feel like as the moderator, I need like one of those heart buttons so I could just like blast out a bunch of hearts. I love both of those comments from you guys. So thank you. You know, what I what I heard you saying is that we just need to continue involving patients in the decision-making process, but we also need to do it in a way that's more clear and easy for them to navigate. And so again, what you're saying is choice is great, but it's only as useful if people have the guidance they can act on. Andso I think that brings us to what matters now. And it's not just simply more information. I think we're in information overload nowadays, more than anything, especially with AI, simple, easy to access tools. But let's move on to the second ingredient, because what's important about the second principle is what you just mentioned, Britt. It's all about personalization and timely guidance. And Dr. Rajiv, I want to start with you again, because you're someone who's been in the thick of this for over 20 years. So as we think about those that we're helping, for someone managing several conditions, multiple comorbidities, how should the care team prioritize the next step, especially when we know there's lots of care team members around them? And when you think about that, when should a question absolutely go back to a clinician rather than remain as some type of digital reminder that exists out there in the market? I hope that makes sense. Yeah, absolutely. So I think, for example, I can speak to kind of how my own practice works, which is when I'm starting a medication, like whether it's a GLP-1 or insulin and we're doing titration, you know, my care team includes usually a case manager who will help in between visits, make dose adjustments, address, you know, address side effects. One of the blessings and curses of an EHR are patient emails, but I will tell you, this is somewhere where they really are valuable, because when patients are finding that something doesn't make sense, or they need a little bit of guidance, they can often, they'll send me an email, and often it'll be something that I can address really quickly without, you know, without taking a lot of time. And, and I think the boundary there between, you Know, the coaching is the clinical decision making changes in meds, whether something needs to be discontinued, I think that should remain the realm of the clinician, and that the education and coaching in between is to kind of reinforce that. And if, and if issues come up where the person who's doing the coaching is stuck, then I think that should also come to the clinician. Yeah. I mean, that's super helpful. That makes a lot of sense. I think what I heard you saying is like, even the most relevant plan can stop fitting when someone's life changes, right? And so it's important to have like the tools that are wrapped around them to give reminders, give support. But when it comes to a higher level of clinical decision-making, you need to involve the right people and you need to have an easy way to connect that which again we know in the world of healthcare that needs to continue to evolve and get better but I think the third principle is sort of what you just mentioned Dr. Rajiv it's whether that support can adapt without adding more work so why don't we go there next and that takes us to our third principle and that's all around designing care approaches that are adaptable like you just talked about but again if things were just always as easy as we make them sound like, God, life would be so much easier. For instance, I know, Rajiv, like, you use GLP-1 therapies, you've been using GLP therapy for probably a long time, you know, you're an endocrinologist, they've been a mainstay in helping people with diabetes for a while. But now with the new indications, it's become an additional tool in your tool belt for patients who need them. And so I'm going to start with you again on this one, is we talked about the how the care journey again, it'S never linear, like we wish it would be linear in their course, but how often does that happen? And then there's absolutely the case for people living with cardiometabolic disease of how we help them with that journey. So when you think about that, whether it's before treatment, while someone is taking a GLP-1 or other medication for cardiometabolic disease, it's to your point of treatment changes or stops for some reason, in your opinion, what needs to remain connected so that that person is never left to manage that transition alone? Sure. I think this is also somewhere, I know I just talked about the EHR, but I'll give my real life example is, you know, I'll see a patient and we make the decision to start them on a GLP-1, you now, with, for example, terzepatide. There's six different doses. And so we need, you kno, touch points as we're kind of managing their care because follow-up visits can take four to six months. And so this is somewhere where I really use the power of the HR and say, hey, look, I'm starting you on this dose. When you're done with the third dose, if you think things are going well, just reach out to me. Just send me a quick email and say hey, doc, I am ready to move up on the dose. Or alternatively, hey I went up on this dose and I've been kind of feeling this way. What do I need to do? And I will tell you as far as you know, uh, laps, uh you know laps of medication. This happens often, you know when when my when my you know patients who have Medicare they hit the donut hole and all of a sudden this medicine that was covered is now thousands of dollars. Um and and so we need to be able to you know keep an open communication so they can contact us and say hey what should we do during this you know two-month you know period that I'm not going to be to be on this uh medication. Um, and um and and and this loss of access is, is unfortunate, but it does, you know, this is what, you know, this is what we see with our, with our patients. I think that, you know, I think that communication now is probably better than it's been between the, you know, the, the clinician and the patient that for the entire, you know, 23 years that I've been in practice. Yeah, I love it. I mean, you mentioned the donut hole with Medicare open enrollment season upon us. There'll be a lot of donut hole conversations I'm sure happening over the next month or so, but really appreciate it. Just a quick reminder, if you have questions, we got a lot of questions coming in already, so that's great, but don't be shy. Please feel free to drop your questions in that Q&A feature throughout. But why don't we like transitional? Britt, I know we just spoke about like the problems and challenges with care. Rajiv, thank you. I think you did a great job explaining what connected care should feel like. But Britt, you kind of alluded to this earlier. I think the harder question now is like, what is it worth and what should the future look like? So as we shift gears now move from, you know, what a strong partner should deliver to how that partner should demonstrate value. And so that brings us to the third key question. And that's all around value, because for our folks joining us on the call benefits, leaders, employers, this is often the most important question. And I will just tell you, it's sometimes the hardest thing to measure. And so I think it's important that we spend some time on this one. We just spoke about meaningful choice, how critical that is. We talked about timely guidance and personalization. We talked About recognizing that the journey isn't always linear and how we have to adapt support. Those are all key aspects to helping people along their journey. But while the principles that we just covered here describe the care experience we're trying to create, we also know that solution partners like ourselves also have an obligation. And it's a very important obligation to explain how they evaluate the experience and the potential clinical and economic value they deliver. And so I think if it's not crystal clear for benefits leaders and employers, it's going to be tough. And so, Britt, I want to go to you here because, again, knowing you, this is gosh, you probably spend many more hours than you would like to, but it's an important one. When you think about designing better, more effective, more value-added programs and solutions like the ones you do at Omada, what evidence should a cardiometabolic partner bring to help benefits leaders evaluate value beyond, to your point earlier, just pharmacy spend, medication spend? And how do you do that while being transparent about costs and when they should expect that value to emerge? Yeah, I love this question. And man, it's really top of mind right now, both because of the cost pressures we've already talked about in today's session and also because there are a lot of claims out there in the market right now that perhaps are too good to be true when you initially see them. And I'm sure many of you on the line are actively kind of parsing through, OK, what does that claim mean and how can I really trust something that looks so compelling? And so the way we think about it is outlined here on the screen. And I think the top two are sort of the leading value measurements that we would look to. And then the bottom two are the more lagging. So on the top, you know, looking at how is the solution helping members stay persistent with their medication plans? Are they helping the right members get on the right medications, helping the members understand what does persistence mean? Why is it important? What are the tools and tips and tricks you can put in place to help you overcome barriers to persistence? Is it side effects? Is it cost? Is het just lack of understanding? And those are all, you know, things that we can measure and offer through our solutions. On the right, then, is program engagement. On the GLP-1 front, you know, we talk a lot with our customers and our members about not just the quantity of weight loss, but what is the quality of weight loss that you're seeing? And we can get to things like quality through program engagement. And so how are we helping individuals engage in healthy lifestyle changes like eating better, like picking up an exercise routine that helps preserve lean muscle mass, like sleep and stress management and program engagement? Again, it's not the end all be all, but it's a really important early indicator of our members engaging in a way that will drive durable outcomes that will ultimately result in financial value for you all as employers. So then on the bottom, it's all about how are those behaviors driving and turning into clinical outcomes, both better outcomes like blood pressure outcomes, A1C outcomes, weight outcomes? And then how are those outcomes using peer review literature able to be projected and turned into risk reduction? How are we lowering the risk of heart attacks, of stroke? How are we lessening the need for expensive orthopedic surgeries in a population that we're getting to healthier weight? And then, of course, finally, is the utilization in economics. So how do we measure either from a model perspective or with real claims data, the actual impact all of our interventions are having on how someone is utilizing healthcare and the costs that they are putting into the system. So really all of these come together, I think, once we look past kind of the near-term pharmacy spend part of the equation. And so I think turning to this next page, A lot of this was behind a recent major investment in Workstream that we did here at Omada, which was our analysis with a collaboration with Global Data, which led to a clinical report that helps consider how components of our program, where we're supporting medication persistence, we're helping members adopt healthier lifestyles. We're helping members understand how to preserve their weight if they discontinue to Rajiv's point. Maybe they need to come off for a couple of months due to cost pressures, or maybe they need to come up because they've lost coverage completely. And how could these interventions influence downstream disease burden and ultimately healthcare costs? So this report is a five-year Markov-based micro-simulation model. It allowed us to compare outcomes for commercially insured adults with overweight or obesity who participated in one of our GLP-1 solutions with a modeled standard care scenario. And we had over 20,000 OMADA members in our sample size. So this is a model based on a huge amount of really robust data. And what makes this really important, we think, is it's really one of the first of its kind to add the clinical and economic value part of the story alongside GLP-1 therapy. And so it just allows us to have a much deeper, richer understanding of if we invest in these medications and if we put the right support around individuals to really unlock the best possible outcomes they could, what are the clinical and economic value you could expect over the one to five-year period? in. And so I think you can click forward, and it'll start to show some of the results that we found. And these are in our GLP-1 investment guide that are, you know, was developed to help employers navigate their GLP solution questions as we go into next year, and really, you know, beyond next year as well. So what you see on the left that we found is the improvements in those leading indicators I mentioned earlier. So the 67% improved persistence for members in an Omada GLP-1 program alongside their medication and 22% greater engagement in lifestyle change. And these higher levels of engagement and persistence did produce meaningfully different savings in the Markov model. In addition to this, moving to the blue box in the middle, the investment guide talks about what we absorb. And when you put in place a digital program to support members in their GLP-1 journey, you can also avoid some of the in-person visits they may have typically needed. For example, a visit to discuss side effects with their provider or a visit to titrate their meds. And with the digital program that has those capabilities, you can really do that, you know, virtually without going back to the in-person provider, without having to take off time work or find childcare to do that. And that also is real meaningful savings to consider when putting in place a solution. And then finally, like kind of the holy grail of the results you see on the right-hand side of the screen, which is what were the disease risk impacts of individuals in the program, and how did those translate into really meaningful healthcare savings? You can see over $1,400 at year one and over $4,700 of savings at year three. And those grew out to five years. And as mentioned earlier, for those that were highly engaged and persistent in their care plan and their medication plan, those savings were even higher. So we're excited to share this. Yeah, I mean, I love it. Thank you. I think it's super important. And we'll make sure we share this out after the webinar ends too. But it took me back, like when you were talking about all this, you know, I think about my own clinical training and my time in practice. You know,I think medications play such an important role, especially for those living with chronic disease. But any medication, and Rajiv, I'm sure you would agree, it's just one part of the equation, right? You can give someone a medication, but if they're not doing all those other things around it, getting the support, eating healthy or exercising, you know, the medication will only do so much. You need to help keep them adherent. You needs to understand their side effects, all of those things. And then, Britt, to your point, when you think about that in terms of the value equation, we talked about how the math works out. It's really important. So I appreciate you sharing that with the group and with us. So, I just want to say thank you again. This was super great. Before we transition into open Q&A, I want to thank you, Britt. Thank you, Dr. G, for your amazing expertise and feedback. I think you gave us a lot to think about. I always like to think of some key takeaways. Again, this is your opportunity. We have lots of questions. We're going to do great on time. If you have any burning questions. If we don't get to them today, please still drop them in the Q&A feature because we will answer those questions and share them out with you. But the key takeaways I think I learned in the past 45 minutes or so are, number one, look past the coverage decision. The best partners help employees get clinically appropriate care. They make the requirements easier to follow. They can help manage costs without actually adding more work for you as a benefits leader or an employer or your people. The second one, which I think is simple but always something to think about is pick partners who can change with you. Whether it's coverage, treatments, whether it's your workforce needs, all those things keep shifting. So choosing solutions that adapt over time, whether the ones that lock you in are really what you should look for. The third one goes without saying. You got to make it simple for employees. Keep it simple, right? Strong support works alongside existing care, covers overlapping conditions in one place, and absolutely fits into everyday routine so people can keep using it engaging and driving those results and then lastly maybe my most important one and great it goes to what you just mentioned ask for clear proof you know it is not you should never you know feel ashamed to ask for what outcomes and costs reported you know whether they're observed or modeled or what over what time frame that's how you tell real value from projected value so i think if you take one thing from today let it be these questions i hope that you'll find partners that deliver for your employees and your budget appropriately and uh with that why don't we open it up for questions what do you think rajiv brett you ready for some rapid fire because we got some good ones that came in yeah sure absolutely okay and again remember if you have any additional questions feel free to drop them in um maybe this this first one here is uh how should new glp-1 options again because now we have oral medications coming out we have you know read a true tribe coming out of the market which is the big one how should new GLP-1 options and pricing change our 2027 plans? Britt, maybe I'll go to you there. How do we support employees who do not qualify for or do not want medications? But how should we think about these new options? Yeah, yeah, there's a lot in there. So let me start with the options and then let's talk about pricing. So as it relates to new options, I mean, I think it's really important that you find a clinical care partner that is practicing evidence-based medicine that has, you know, licensed practitioners that is routing people to brand name medications and ultimately, you ask them about the clinical protocols they have in place for how they make prescribing decisions and make sure that, you the latest formulations, the latest options like are included in their consideration set for how you drive clinical strategy. Because I think this market is moving so quickly and it's really important, you know, to work with a partner that is staying abreast of that and sort of staying on top of like, what's the best practice of medicine we can offer patients today. And then pricing changes, man, this is like such a dynamic part of the market. And what's really neat is there are now solutions that can support you if you're covering on your pharmacy benefit and lots of great solutions that kan support you even if you're not. And I think a lot of the pricing changes, especially on the D2C side, have propelled organizations like Omada to develop models where we bring the best of our lifestyle support, our prescribing and medication management support to the cash pay audience. And so maybe you as an employer say, gosh, you know, I can't cover these meds on the pharmacy benefit, but I do want to provide my members with some support. I do want to help them navigate, you know, kind of the wild west of what's going on out there today. And I want to make sure they're getting the best chance at achieving meaningful clinical outcomes. And so, you can put in place solutions like an OMADA that we would route members to the best DTC prices if those are options that you're considering. So that's where I would speak to that one. Maybe I'll turn it to you, Dr. Roy. When you're looking or working with a patient who doesn't want to use a medication, how do you think about supporting them in your practice? Sure. I mean, I think ultimately what I've found over all of these years is that, you know, all of this will only work if the doctor and the patient are kind of on the same page. And if I think, for example, an injectable GLP-1 would be my preference for a patient, but they're like, no, that's not an option, you know, now with these, you know, with these other options and orals that we can usually find common ground. And two, I think we also have to remember, you know, specifically with, you know, GLP-1s and COST, that we have other medications that have also been around for a patient who may not, you know, who may want to or afford a GLP1, you know, that can look at, and we really, really can help with the lifestyle uh modification uh piece uh which will you know which will often you know be what a lot of my patients want so thank you thank you both um this was an interesting question because you know brett you mentioned different options available um whether it's health plan or pbm you know there's direct to consumer options i think we've seen in the market now is folks are trying to make choices around coverage decisions and they want to maximize the value the medication. They're putting engagement requirements involved. But hey, Britt, I'll start off with you on this one. So how do you tell whether engagement requirements, whether they help a patient get better results? You sort of mentioned this in the study that you shared, but how do like tell if they help versus create just another hurdle that people want to talk to? So I'm just curious your thoughts and what you've seen. And then Rajiv, maybe I'll go to you after because you know Britt's looking at it from how to build it so there's not a burden of course but then you're the one who's in the doctor's office hearing it from patients so maybe Britt we'll start with you like how do you balance that and then achieve maybe what are you doing in real life practice yeah I mean on this one we always start with the original you know clinical trials of these medications for patients taking them for weight loss and in all the trials uh patients have lifestyle support throughout their entire journey. And that allowed them to realize the outcomes we all saw in the trials that are just unbelievable. And so we strongly believe pairing someone's medication journey with lifestyle support is best practice. And yes, absolutely, there are groups that have used kind of that philosophy and made it a requirement. And we typically see that being quite successful for our customers. We've invested a lot in really clear kind of, we talked about this earlier, but really clear expectation setting and communications around what those requirements are. And certainly, you know, at times we'll have individuals coming in reluctant to engage with Omada as part of their journey. But more often than not, as they get going, they see the value of having that support at their fingertips so quickly, whether it's asking about an injection technique, you know, in the middle of the night, or it is, you know, managing side effects and seeing what others on these medications in a peer community are doing to manage their side effects, there so often is like near-term value received that members ultimately see it as a positive add-on to their overall journey and their experience. And, you know, we see, interestingly, in our member set that GLP-1s are really a catalyst for people engaging even more in behavior change. I'm sure many of us on the line have seen this in our workforces or even in members in our own communities that are taking these medications. But all the time we see the anecdote of, gosh, I never liked going to the gym. And now I'm starting to kind of see this, see these results. I have some momentum and I'm motivated to start an exercise routine or something like that. And so we also, you know, feel like that only adds to the reasons to add a lifestyle support program alongside the medication. The final thing I'd say, and then Dr. Roy will turn it over to you, is ask for the data. right we have data that taught that helps explain um what are we seeing in our deployments where there are engagement requirements versus not and and i think most partner programs would be willing to be transparent with you and and that can help you make a really informed decision about how you design your your strategy going forward yeah i mean i think the funny part is like go ahead sorry no i think when you sit when you see the data too like what i've seen again there's different aspects. But I always, when I looked at people are engaging much, much beyond the thresholds that even, you know, require them to do. So, I mean, that's a good sign too. And yes, Rajiv, like Britt, I think did a great job, but you're the person, you're sitting in the middle of these discussions. What do you hear from your patients? Sure. I mean I think that obviously, you know, each person is different. I have some patients who very much kind of welcome that extra support, whereas others kind of view it as, well, gosh, I have to do this so I can get my medication. And what Britt said rings true. When I talk to patients and I talk about these amazing percentages of weight loss that are seen in these clinical trials, that these are patients who are closely followed and that patients who are not closely followed may not really get the same results. And I also tell them that, look, change is hard. And the more help that we have along the way to reinforce and check in ultimately does lead to better outcomes, better compliance, and kind of talk about that part with them. And, and I do find that, that more patients than not are ultimately happy to, to be engaged and to have somebody following along with them and how do I measure at all? You know, I think I measure it by outcomes, right? Differences in BMI, differences in weight, differences in A1C. That's kind of how I look at it. Yeah, I love it. This is a good question. Rajiv, I'm going to start with you on this one. Because gosh, we started with a couple medications, right now we got dual agonists, triple agonist, we got orals, we get injectables, we we got a myriad of things. So as you think about saturation occurring, and this is a tough question, but we see the pharma pipeline as well. When do we think that the prices might start decreasing? I know you're in, you know, your channels all the time, but what are you hearing when pharma reps come in or what's the word on the street? Yeah, I mean, if anything, I think that when all of these drugs were new, you know, I, I thank a lot of them were, you know, $9.50, $1,000, and I think as more and more, you know, drugs have hit the market and we've had more experience with them, you know, I think the prices have come down. And I think what's going to be a challenge going forward is when the next, you know, when RETA comes out, which has better data than, you know, than Gerzepatide, which, you know, has slightly better data that than SEMA, we still got to realize that as a class, these drugs are helping people lose weight. way beyond anything that we had before. And is the difference there between 21% weight loss and 23% weight lost that relevant? I mean, doesn't it all help? I think my idealistic self would like to think that as more of these come to market, that prices will in fact come down, but I don't know whether my crystal ball will be right or wrong on that thought. But we're going to check in on your crystal ball here over the coming months, Rajiv. So I just want to say thank you. First of all, Britt, Rajeev, thank you, it's been such a fun and fascinating discussion, really appreciate the time and energy you took. I want to thank you to our EBM partners who've managed the production behind the scenes, thank you it's always great to have forums like this to share, ask questions, talk, and most importantly I just wanted to thank the attendees on the phone, we had some amazing questions coming in i hope you got a lot out of the discussion for the questions we didn't have an opportunity to answer we promise you we will get back to you on those for sure but i hope everyone has a great rest of your morning afternoon wherever you live and thanks again We'll talk to you soon.