Building Accountability Into GLP-1 Benefit Design: Lessons From Delaware and Philadelphia

As employers weigh the growing role of glucagon-like peptide-1 (GLP-1) therapies in benefit design, 2 US cities, Philadelphia and Wilmington, are demonstrating how accountability, communication, and data-driven strategies can shape sustainable programs.

Employers explore GLP-1 therapies' impact on health benefits, showcasing accountability and data-driven strategies in Philadelphia and Wilmington for sustainable health programs. | Image credit: zimmytws - stock.adobe.com

At the Greater Philadelphia Business Coalition on Health (GPBCH) Annual Conference, a session titled “Two Way Traffic Ahead: Building Accountability in Your GLP-1 Strategy” featured lessons from Wilmington, Delaware, and Philadelphia, Pennsylvania. Speakers included Marsha Greene-Jones, deputy human resources director for Philadelphia, and Dany Bourjolly Smith, communications and program consultant for Wilmington.

Bourjolly Smith described Wilmington’s work to build a culture of health beginning in 2019. At that time, just 26% of employees engaged with primary care, while high emergency department utilization drove up costs. The city sought to shift the benefits team from a transactional role to one that emphasized guidance and accountability, encouraging preventive care and sustained engagement. By 2023, 62% of employees were seeing a doctor, and overall medical costs had decreased. A citywide wellness initiative, “We Go Hard for Health,” supported these efforts by motivating participation in chronic disease management and preventive screenings.

“Really the goal of our program was just actually to drive accountability. And what ended up happening is we really felt we built this culture of health that has really produced benefit for us long term,” Bourjolly Smith championed.

A key change was Wilmington’s decision to move to unlimited pharmacy coverage, including GLP-1 medications. Pharmacy spending initially rose, but medical costs—particularly surgical spending—declined as employees better managed diabetes and other chronic conditions. Bourjolly Smith noted that pharmacy coverage should be treated as an investment, pointing to her own positive experience with GLP-1 therapy as an example of improved health and financial impact. Wilmington’s self-funded status also allowed close monitoring of vendor data, which revealed meaningful savings. In diabetes care, per-member-per-month costs decreased from $17.10 in 2019 to $7.62 by 2023.

Greene-Jones highlighted how Philadelphia designed its benefit program with accountability at the center. The city convened a vendor summit to align health care partners, then implemented a 25-week structure of weekly coaching for employees prescribed GLP-1 medications. Accountability was shared between employees and providers: participants who missed 6 consecutive coaching sessions were disenrolled, with an option to return the following plan year. Greene-Jones stressed that such guardrails are essential to balancing the significant investment in GLP-1 therapies with employee responsibility.

Effective communication was another central theme. Philadelphia relied on newsletters, enrollment guides, and a dedicated email channel to answer employee questions. Greene-Jones emphasized the importance of equitable treatment, ensuring all employees—regardless of position—were held to the same expectations.

Both speakers offered lessons for other employers. Bourjolly Smith urged organizations to stay closely connected to the data, to track both financial and health outcomes, and to look beyond diabetes to address multiple chronic conditions. Greene-Jones called for a whole-health approach rooted in equity and emphasized the importance of educating leadership on the value of comprehensive benefits programs.

The panelists agreed that successful GLP-1 strategies depend on accountability, trust, and strong communication. By combining coverage with engagement and carefully designed accountability mechanisms, both Wilmington and Philadelphia demonstrated how public-sector employers can advance health equity, improve employee outcomes, and achieve sustainable cost savings.

Greene-Jones concluded, “Whole health is so important. I think addressing and attacking the whole health of your employee population, understanding who they are, meeting them where they are…. Take those thoughts back as you talk to your employee populations, as you talk to your leadership. They're the key, and we'll help you in that journey.”

Reference

Bourjolly Smith D, Greene-Jones M. Two way traffic ahead building accountability in your GLP1 strategy. Presented at: GPBCH Annual Conference; June 5, 2025; Philadelphia, PA.