Behavior Change Pathway and Medication Re-evaluation

This guide outlines the process for Medical Weight Loss (MWL) program members on the Behavior Pathway who are due for medication re-evaluation. Use this to quickly manage member inquiries regarding their prescribing support status.

Policy & Program Context (The Why)

These facts explain how a member enters and exits the Behavior Pathway:

• Pathway Entry: If a member does not qualify for an oral AOM or a GLP-1 at the initial consult but still qualifies for the MWL program, the VMP discharges them to the Behavior Change Pathway.
• Pathway Duration: The Behavior Pathway lasts for 12 weeks from the date of their very first consult with any Vida provider (RD, VMP, HC).
• Decision Finality: If a VMP has discharged the member to Behavior Change, that is the final decision. Putting the member with another VMP for a "second opinion" will not change the outcome, as all VMPs must follow the same guidelines.

Agent Action & Escalation Pathway

This section details the criteria you must confirm and the required action you must take.

How to Confirm Member Status

Before proceeding, confirm the member's status using the following steps:

1. Prescribing Status: Check the Admin tool under programinstances. Click into the Team Code for Advanced Prescribing to see if it shows Complete. Confirm that the chat also indicates discharge from prescribing.
2. Timeline & Sessions: Check the member's profile in HGP (or the date indicated in the Admin chat for the discharge) to confirm:
   • The last VMP session date to calculate where the member is in the 12 weeks.
   • The total number of Dietitian sessions completed.

Automatic Re-evaluation Criteria (Checklist)

A member is automatically added back to the VMP care team for reassessment only if they meet at least two of these criteria:

1. More than 12 weeks have passed since their last consult with the Vida Medical Provider (VMP).
2. Member has not lost 5% of their body weight 
3. Member has completed 4 or more sessions with their Registered Dietitian (RD).
   • Note: The 4 sessions count from their date of starting with Vida, not the date they were discharged to Behavior Change.

Behavior Pathway Re-evaluation Decision Chart

Required Escalation Steps (VMP Not Added Back)

If a member has met the criteria but the system failed to add the VMP, follow these steps:

Create JIRA Ticket: Create a [System] Service Request using the JIRA integration.

3. Final Member Follow-Up: Once the ticket has been worked and the VMP is added back, follow up with the member to confirm they now see their VMP in the app or schedule their follow-up call, and close the ticket by marking solved.

Macro: Prescribing Support::Behavior Pathway 

Use this script when communicating the program status and next steps to the member.

Our program is designed to ensure long-term success and sustainable weight loss through a comprehensive and evidence-based approach. As part of this, you have access to a registered dietitian (RD). We will also closely monitor your labs and blood pressure to track improvements in your risk factors and overall well-being. Adjustments to your care plan will be made in an ongoing fashion as necessary to optimize your progress.

Please note, this decision is final and aligned with our clinical policy. You are not being removed from the Medical Weight Loss program, and you will continue working with your RD and coach with continued access to the Vida platform. However, you are being referred to the behavior change component and temporarily discharged from medication prescribing.

If, after 12 weeks of consistent work with your RD and coach, your weight loss goals are not met, we will reevaluate your plan. This process is in place to ensure we are providing the best possible care based on peer–reviewed literature and evidence–based guidelines.