Institutional Innovations: Obesity Care Team Innovations in 2026

Health systems in 9 markets are relying on dedicated prior authorization staff, pharmacist-led glucagon-like peptide-1 (GLP-1) management, and primary care–based programs to move patients through obesity care despite coverage barriers and specialist shortages, according to clinicians who took part in Population Health Roundtable events from The American Journal of Managed Care^® on constructing high-impact care teams for obesity and diabetes.

Dedicated Prior Authorization Teams and Staff

Many systems have pulled prior authorization work away from prescribers and given it to people who do nothing else, which they say speeds approvals and removes a reason clinicians avoid prescribing obesity medications.

Optum (Arizona and New Mexico) runs a team of pharmacy technicians that handles only prior authorizations for about 100 clinics, at roughly the cost of a medical assistant. The team knows the formularies of the 50 to 75 payers Optum works with, and integration with Epic and artificial intelligence (AI) chart-pull tools lets staff submit an authorization in about 45 seconds.

Northwestern Medicine (Chicago) and Temple University Health System (Philadelphia) use pharmacy technicians and pharmacists to process authorizations and assess appeal options. Meanwhile, the UNC School of Medicine (North Carolina) trained 2 non-clinical staff members in a quality improvement project that cut authorization turnaround to under 1 business day.

Pharmacist-Led GLP-1 Initiation and Titration

Pharmacists are being used to start, titrate, and monitor GLP-1 therapy so patients are not waiting on busy physicians or nutrition visits.

Boston Medical Center has 3 pharmacists in outpatient cardiology who screen candidates, handle prior authorizations, deliver an initial teaching visit, and run monthly telemedicine titration visits. The model began because high cardiovascular risk patients could be seen sooner there than in other clinics, and BMC also has pharmacists in endocrinology for diabetes and weight management.

University Hospitals (Cleveland) has close to 60 clinical pharmacists in primary care and close to 7 in endocrinology. Physicians refer patients to them, and they work through insurance requirements and often handle up-titration. Referrals can take 4 to 6 weeks. UH's Systems of Excellence program, launched in primary care about a year ago across 5 disease states, risk-stratifies patients at primary care visits and triggers a clinical pharmacy referral; because about 80% of these patients also have obesity, it has put patients on obesity medications, including through the Medicare GLP-1 Bridge Program.

At Mayo Clinic Arizona (Phoenix) and Northwestern Medicine (Chicago), pharmacists work in a primary care clinic under collaborative practice agreements. At Mayo they hold hour-long visits covering medication options, diet, and maintenance goals, followed by titration. At Northwestern they follow provider's preferences, such as a limit on weekly weight loss, and use scripted questions, including a MyChart questionnaire, to decide when to escalate doses.

Optum (Arizona and New Mexico) automatically refers overweight or obese patients leaving the hospital to a clinical pharmacist after a post-discharge medication reconciliation, and its pharmacists steer drug choice toward what a patient's plan covers so visits are not wasted.

Parkland Health (Dallas) employs clinical pharmacists across the system who see patients, and nurses teach patients to use injectable pens, with demo devices available in clinic.

Temple University Health System (Philadelphia) funds an endocrinology pharmacist position through its medication therapy management program, which depends on 340B and specialty medications, and its internal medicine practice runs a pharmacy clinic staffed by pharmacy school faculty and students that handles medication reconciliation, adherence, and titration.

Preparing for the Medicare GLP-1 Bridge Program

Ahead of and after the July 1 start of the Medicare GLP-1 Bridge Program (Bridge), several systems built workflows to find eligible patients and avoid confusion over its criteria.

Cleveland Clinic prepared its pharmacy team for prior authorizations and built order sets that walk clinicians through Bridge eligibility, titration, and supplies such as needles, along with dot phrases for counseling. Clinic leaders credited that preparation, done with industry partners, for its success with authorizations.

KnownWell (Boston) pulled charts of patients likely to qualify for Bridge and for MassHealth and ran test authorizations before July 1, asking clinicians what documentation to include. The University of Chicago's transplant weight loss clinic reran its list of previously denied referrals to find who now qualifies, and plans to try to lower costs for patients paying high copays. Northwestern Medicine's patient care advocates have processed Bridge approvals quickly in the first month, according to its pharmacists.

At the point of care, Piedmont in Columbus, Georgia, hung 2-foot-by-3-foot posters of Bridge criteria on the back of every exam room door and walks patients through them; Bariatric Innovations of Atlanta saves Bridge pharmacy billing codes in templates to paste into prescriptions and gives patients a sheet to hand pharmacists who do not know how to run the program; and a UT Southwestern primary care practice (Dallas) prints the eligibility requirements for patients and is transparent about what can be approved.

Coverage Navigation Tools Built Into the Clinic Visit

Clinics are giving prescribers and patients quick answers about what a plan will cover so visits are not spent on drugs patients cannot get.

UNC Endocrinology (North Carolina) built Epic smart phrases listing GLP-1 coverage by payer, Bridge, and cash-pay options, which are being added to UNC's Agile MD pathway, and emails patients before their first visit asking them to check their coverage. Because only 1 non-formulary appeal was approved in 2 years, the clinic does not routinely appeal those denials.

A clinic pharmacist at Banner University Medical Center (Phoenix) built a sheet of which GLP-1s common insurers cover and at what tier, which an endocrinologist pulls up in the exam room; its residents are trained to discuss a plan B and plan C, including cash pay, at the same visit when coverage is uncertain.

The Wellstar-affiliated pharmacotherapy clinic (Atlanta) logs each patient's insurance type, denial reason, and submitted diagnosis code in a spreadsheet and uses AI to find trends in what each plan approves.

Scottsdale Weight Loss Center writes 2 or 3 numbered prescriptions so patients can try each at the pharmacy before the clinic files an authorization.

Obesity Programs Embedded in Primary Care

Rather than sending every patient to a specialty center, these systems train primary care clinicians or place obesity specialists inside primary care clinics.

UNC Health (North Carolina) has placed a board-certified obesity physician in 20 of its 83 primary care clinics across 10 counties, up from 3 clinics in 2019, and trained more than 30 physicians and 10 to 15 advanced practice providers to treat patients in their own communities. Patients are seen within 60 to 90 days, compared with 6 months to a year elsewhere. After a needs assessment found out-of-pocket cost was the top barrier, UNC offered the service at primary care copay rates; a patient registry showing the first 3 clinics were financially sustainable helped win expansion. A monthly obesity conference lets community clinicians dial in, and the model was published in NEJM Catalyst in June.¹

Emory (Atlanta) runs a lifestyle and weight management clinic inside a high-volume primary care clinic. Patients whose prescriptions are approved easily stay with their primary care physician, so the clinic mostly sees patients whose plans do not cover treatment or who need options such as older oral or off-label drugs. Emory also has a centralized prescription system run by nurses and licensed practical nurses and is drafting a medication-selection algorithm that considers contraindications first, then comorbidities, then obesity phenotype.

Beth Israel Deaconess (Boston) runs an embedded weight management program within a roughly 40,000-patient primary care practice, offering co-management and consultation so primary care clinicians can start and maintain GLP-1 treatment themselves, with standardized criteria for escalating to specialty care and stepping back down.

Heart One Associates (Phoenix), a private cardiology practice, runs a 1-day-a-week cardiometabolic renal clinic with an advanced practice provider, led by 1 super user who teaches partners and rotates other providers through; it is branded as cardiometabolic rather than obesity.

A Single Front Door and Risk-Based Triage

Systems are replacing scattered clinic lists and long waits with 1 entry point that sends patients to the right level of care.

Duke (North Carolina) is building a single referral access point across 9 obesity clinics. Primary care referrals would go to a telehealth obesity clinic staffed with health coaches, patients with more severe comorbidities to endocrinology, cardiometabolic, or hepatology clinics, and those interested in surgery to lifestyle weight management or surgery. It replaces a website list of clinics in alphabetical order that confused patients. Duke administrators were persuaded by an 11-fold increase in referrals to procedural care as patients lose weight and qualify for orthopedic, transplant, and cardiac procedures.

UNC Health (North Carolina) triages referrals by risk: patients who are pre-transplant or have severe heart failure, idiopathic intracranial hypertension, or post-bariatric complications go to specialists, while those with diabetes, sleep apnea, or fatty liver disease stay in the community.

Team-Based Cardiometabolic and Multidisciplinary Clinics

Clinics are putting prescribers, pharmacists, dietitians, and surgeons in 1 program so patients do not move through each service in sequence while titration stalls.

University Hospitals' CINEMA clinic (Cleveland) is a cardiometabolic program in which a referring cardiologist or nurse practitioner sends patients to a team of a nutritionist, pharmacist, and diabetes educators. It offers Monday lifestyle discussions, a medication education series, and a food-as-medicine series that includes grocery store tours. Clinicians there said patients seldom stop GLP-1s because of side effects, which they attribute to the team approach, slow up-titration, and early goal-setting.

UNC School of Medicine (North Carolina) combines bariatric surgeons, family medicine, cognitive behavioral therapy, an eating disorder program, and medical weight management, with complex case conferences so patients move between surgery and medicine.

Temple University Health System (Philadelphia) started a service line in early 2024 pairing bariatric surgeons, a full-time obesity medicine family physician, a nurse practitioner, and a gastroenterologist who offers endoscopic procedures; callers are scheduled with both medical and surgical teams.

Group Visits and Peer-Support Programs

Group formats stretch scarce clinician and nutrition time and add peer support.

Cleveland Clinic has long run weight management shared medical appointments in which a group sees a nurse practitioner or endocrinologist together, with exercise physiologists, clinical psychologists, and social workers on the team.

University Hospitals Endocrinology (Cleveland) runs group medical weight loss visits that include a nutritionist, because an individual nutrition visit can take 3 to 4 months.

MetroHealth's STRIDES program (Cleveland) is a group behavioral weight loss program that meets after hours at the health center; participants often report relief from joint pain at weight losses well below the usual 5% threshold.

Weill Cornell Medicine (New York City) is expanding group classes to reach more patients given long waits, and coaches a year-long diabetes prevention program that meets weekly for 6 months, then every 2 weeks, then monthly, with a 5% to 7% weight loss goal; it struggles with recruitment and retention, and Medicare patients cannot continue seeing a dietitian afterward.

Comorbidity Screening and Body Composition Built Into Intake

These programs build liver, cardiovascular, and body composition checks into intake so treatment decisions rest on more than BMI.

Emory (Atlanta) integrated the Fibrosis-4 (FIB-4) score into its health record to decide who needs liver imaging; its ambulatory pharmacotherapy clinic uses a FIB-4 smart text to revisit patients previously denied a GLP-1, recommending a FibroScan when the score is above 1.3.

UNC School of Medicine (North Carolina) populates FIB-4 in Epic at intake and has a hepatology agreement for same-day FibroScans for fasting patients, finding about 2 cases of cirrhosis a week in people without symptoms; it also measures body composition at baseline and every visit and bills for it.

Bariatric Innovations of Atlanta measures body composition in every patient, using waist circumference when a scan is not available, to anchor the treatment conversation and identify patients with low muscle mass and high visceral fat who look acceptable by BMI.

EHR Prompts and AI to Offload Prescribers

A few systems are using prompts and AI to cut the administrative and follow-up load that keeps primary care clinicians from prescribing.

Montefiore (New York City) is building clinician-designed prompts that fire when a patient with type 2 diabetes has a BMI over 30 and is not on a GLP-1, letting the clinician prescribe now, defer, opt out, or choose the GLP-1 matched to the patient's insurance; ordering triggers a symptom management workflow that escalates to human care when needed. On the back end, an AI-assisted prior authorization team has completed authorizations in seconds in tests and flags prescriptions not picked up within about 2 weeks, and an AI call is planned 2 weeks after the first fill.

Mayo Clinic Arizona's embedded pharmacist uses OpenEvidence to generate appeal letters in seconds, and Beth Israel Deaconess clinicians use AI to draft appeals and portal check-ins for what they call asynchronous titration.

Pharmacy Team Driving Blood Pressure Control

The Centers for Families and Children (Cleveland) was 1 of 4 practices in its state to lead improvements in blood pressure control, driven mostly by its clinical pharmacy team, which repacks adherence packages after medication changes and delivers them to patients' homes the same day, about a half dozen a day. Its pharmacists also review whether a patient's antipsychotic is a high weight-gain option.

A Pre-Transplant Weight Loss Clinic

University of Chicago liver transplant pharmacists and a dietitian started a weight loss clinic for transplant candidates disqualified by body mass index (BMI), after insurance approval to enter the system's general weight management clinic proved a barrier. Patients see a dietitian, pharmacist, and nurse practitioner at every visit and set small goals, with physical activity framed as movement and diet changes as dietary changes to reduce stigma. The clinic prescribes for 1 year across 7 visits, begins discussing the handoff to primary care or endocrinology at visit 5, and accepts only patients whose sole transplant barrier is weight. It does not manage insulin, which can leave care fragmented. Administration shut the proposal down for 8 months until the team agreed to do its own scheduling and audits.

Neighborhood-Level Data on Where Obesity Care Goes

MetroHealth's population health researchers found that Cleveland-area obesity rates range from about 12% in the least affected neighborhoods to 80% to 88% in the most affected, yet the lowest-rate neighborhoods have the highest GLP-1 prescribing and the most access to obesity medicine specialists and clinical pharmacists. They argue systems should set population health goals around where need is greatest and note that 3 institutions care for more than 90% of the county's patients and could share the burden.

Reference

1. Ro S, McCauley J, Schaeffer J, Gupta S, Fiscus LC. Breaking barriers in obesity care — scaling a primary care weight management program statewide. NEJM Catal Innov Care Deliv. 2026;7(6):CAT250345. doi:10.1056/CAT.25.0345