Engaging Underserved Communities in Healthy Behaviors

April 13, 2018 / in Blog Posts / by admin

-by Brenda Schmidt, CEO, and Founder, Solera Health

 

How to address the epidemic of obesity remains a prominent challenge in healthcare today, even though it is preventable. The Centers for Disease Control and Prevention (CDC) has found that more than one-third (36.5%) of U.S. adults are obese and the associated medical costs for them are roughly $1,429 higher than for those who are at what is considered a healthy weight. While these millions of Americans struggle with weight issues, they are also at risk for — or are already suffering from — associated chronic diseases such as type 2 diabetes, heart disease, cancer or stroke.

Socioeconomic issues are tied to obesity. Studies have found that communities with the highest obesity rates are those that are socioeconomically disadvantaged, often lacking in basic resources such as access to healthy food, safe places to exercise, and the overall standard of care that they need to get healthy. Research has also proven that obesity and chronic disease is especially widespread among Americans with the low levels of education and those with the highest poverty rates. However, identifying this causal link is only the first step in working to solve the problem.

The National Diabetes Prevention Program (DPP), is an evidence-based, affordable, and high-quality lifestyle change program proven to reduce the risk of type 2 diabetes. The DPP is delivered by trained non-clinical lifestyle coaches using a standardized curriculum. With a wide range of program options delivered in the community, the DPP is well equipped to meet the needs and address the challenges of diverse populations — whether that be language barriers, need for cultural competency, and understanding of the opportunities and barriers in the community to make healthy lifestyle changes. Local programs are designed to be delivered in group settings where people live, work, play, and pray. These hyper-local community programs include culturally appropriate curricula, connection to resources for health foods, and an understanding of the built environment. However, while many of these DPPs are able to deliver the program that could benefit these underserved communities, they face other barriers to success, including a lack of staff and resources to drive and manage enrollment, and a shortage of back-office administration capabilities for billing and reimbursement.

At Solera Health, we have built a business model that supports community-clinical integration by offering a high-access, lower-cost network of non-clinical providers as an adjunct to primary care.

Solera connects a highly-fragmented grouping of community-based DPP providers by plugging them into an integrated national network as an adjunct to primary care, paid through medical claims. Solera’s integrator role is supported by our technology platform and back office compliance and program integrity oversight. This helps community providers plug into the existing healthcare system so they can concentrate on delivering programs that help their communities get healthy.

As a first step, Solera connects underserved populations with the “best fit” lifestyle-modification resources available in their areas. Meeting consumers where they are and empowering them with choice has proven to have a substantial impact on the ultimate success of the DPP. We leverage our proprietary analytics model to connect them to the DPP that best aligns with their cultural, economic, and personal needs and preferences.

Secondly, as the integrator and administrator with the operational expertise and technology, we work directly with DPPs to manage all of the back-office logistics such as compliance, program integrity, billing, reimbursement, reporting, etc. Thus, program providers are freed up to focus on their core competency — delivering their evidence-based, culturally-tailored lifestyle modification program to help underserved populations achieve health goals to keep chronic disease at bay.

Another Milestone

July 12, 2017 / in Blog Posts / by admin

Today, we announced our latest round of funding – an $18.3 million Series B round led by Adams Street Partners, alongside existing investors Blue Cross Blue Shield Venture Partners, Sandbox Industries and SJF Ventures.

The support of our investors confirms the value of the model we are pioneering in the healthcare space.  Solera has created the preventive care benefits manager category and for the first time, provides an efficient and effective way to connect patients, payers, and physicians to a network of non-medical community and digital providers proven to drive demonstrable results and high satisfaction. The need for our offering is clear — in the two years since we started, the company has grown to over 70 employees and contracted with health plans and employers representing more than 40 million covered lives. With this investment, Solera has the opportunity and responsibility to further scale our model to positively impact the enormous health and financial burdens of chronic disease.

Solera was founded on the vision of transforming the chronic disease prevention and management delivery model by leveraging non-medical providers to keep patients compliant with their care plan between doctor visits. We have executed on that vision by helping community organizations and digital therapeutics providers across the country integrate into the existing healthcare system — creating a network of a new class of providers partnered with traditional care. In doing so, we have given patients access to the personalized lifestyle modification programs that are helping them achieve their health goals to prevent and better manage chronic disease.

Our company’s mission is “changing lives by connecting people to healthcare solutions that work.”  What have we learned so far?  Behavior change is highly personal and people are more likely to take action to improve their health when it fits into their lifestyle and meets their unique needs and preferences.  The opportunity to meet people where they are – in locations where they live, work, play and pray – can drive lasting lifestyle changes and improved health.  We are excited to use this funding to continue to invest in our technology and team so we can expand access to critical prevention, coping and support services for those with chronic health conditions.

I am proud of all that Solera has accomplished – and even more optimistic about what we will be achieving in the months ahead.

– Brenda Schmidt, CEO, Solera Health

Integrators Can Help Expand Medicare Beneficiary Access to DPP

May 18, 2017 / in Blog Posts / by admin

Integrators Can Help Expand Medicare Beneficiary Access to DPP

 

The Centers for Medicaid and Medicare Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) are in the process of developing a nationwide Medicare Diabetes Prevention Program (DPP) benefit, which will enable millions of Medicare members at risk for type 2 diabetes to significantly reduce their odds of developing the disease.

In theory, once this benefit is implemented in 2018, Medicare beneficiaries enrolled in the Original Medicare Program (Medicare Fee for Service) will be able to choose from more than 1,300 Centers for Disease Control and Prevention (CDC)-recognized digital, national or community-based DPP programs. It’s worth noting that CMS has not yet made a determination whether digital or virtual DPP providers such as Noom or Omada will be eligible as DPP suppliers for Original Medicare Plan beneficiaries, regardless of their CDC recognition status. CMS concerns are primarily with program integrity and the ability to monitor participant activity and weight via a digital app to meet the minimum requirements as the equivalent of a 60-minute in-person DPP session.

In practice, however, connecting these DPP programs with at-risk Medicare beneficiaries while ensuring program integrity and compliance with CMS supplier regulations and handling the intricacies of Medicare billing will be a formidable challenge limiting the availability of this important new benefit. A large percentage of DPP providers currently recognized by the CDC do not have the technical expertise or resources to meet the regulatory requirements proposed in the administration of the Original Medicare DPP benefit.  This is due, in part, to their varying business structures and unfamiliarity with the complex regulatory regime that applies to the Medicare program. Many are small community non-profits or small companies with fewer than five employees. Even the larger, older and more sophisticated providers would be seriously challenged to meet the supplier requirements and other programmatic requirements already announced by CMS or under consideration.

That is why Solera is advocating for the development of a role for a Medicare DPP Integrator in administering the benefit. An Integrator could help solve the challenges of scaling the Medicare DPP by handling all the back-office functions – due diligence, compliance, program integrity, data validation, quality oversight, billing, etc. – that could overwhelm high-quality DPP providers that lack the compliance and technical ability to meet Medicare regulatory requirements. By shouldering these responsibilities, an Integrator could enable DPP providers to do what they do best – deliver the program to drive sustained healthy lifestyle changes for Medicare beneficiaries.

We believe that an Integrator role is critical to expanding beneficiary access to a broad and diverse DPP provider network across the entire country and to providing real-time program integrity oversight in support of CMS’ efforts to prevent fraud, waste, or abuse. For the CMS, the benefits of such a role are numerous: a DPP Integrator could reduce the CMS’ administrative costs by providing a single point of contact; reduce the cost to administer the Medicare DPP benefit; more rapidly expand beneficiary access geographically across the country; enhance patient choice; provide real-time data and claims review and quality assurance; and ensure compliance, among others.

The Integrator role would solve many potential challenges the industry has recognized in implementing the proposed Medicare DPP benefit, and would allow it to scale to improve the health of the maximum number of lives.  At Solera, we believe that given our seasoned experience serving as a preventive care benefits manager, and, more specifically, as an administrator of the National DPP we are in a strong position to take on the responsibility of a Medicare DPP Integrator. In the meantime, we look forward to continuing our dialogue with the CMS and CMMI about DPP benefit design and delivery in the Original Medicare Program to ensure its long-term success.

– Brenda Schmidt, CEO, Solera Health

Solera Health Remains Committed to Preserving Access to Chronic Disease Prevention Resources

May 5, 2017 / in Blog Posts / by admin

Like many Americans and patient advocacy organizations, yesterday afternoon I was disappointed to see House Republicans narrowly vote on the passage of the American Health Care Act, the first step in an effort to repeal portions of the Patient Protection and Affordable Care Act (ACA). While attention was necessary to fix the ACA in its current form, Solera Health believes the existing legislation successfully broadened the number of people with access to healthcare and provided essential health benefits to millions of individuals, including prevention services as well as services for those with pre-existing conditions.

As the GOPs’ efforts must still gain a considerable support in the Senate before becoming a law, Solera remains hopeful that all individuals who need quality, evidence-based, affordable care will, in the end, retain their ability to access healthcare and that providers will be properly compensated for delivering life-saving care. Until then, we encourage members of Congress to carefully consider the House bill, with special attention to preserving prevention services and providing affordable care for individuals with preexisting conditions and those receiving Medicaid benefits, and work in earnest towards a solution that benefits all Americans.

In the meantime, our team at Solera persists with our dedication to connect people to healthcare solutions that work. In our role, we will continue to build on our commitment to collaborate with all stakeholders to preserve access to life-changing diabetes prevention programs for all Americans and especially for Medicare and Medicaid beneficiaries, employees, and underinsured individuals with minimal disruption. Solera truly believes that prevention is the best way to preserve scarce healthcare resources and direct them toward programs that hold the promise of reducing healthcare spending before it goes to pay for costly treatments after serious disease has set in.

– Brenda Schmidt, CEO, Solera Health

Engaging Underserved Communities in Healthy Behaviors

March 24, 2017 / in Blog Posts / by admin

How to address the epidemic of obesity remains a prominent challenge in healthcare today, even though it is preventable. The Centers for Disease Control and Prevention (CDC) has found that more than one-third (36.5%) of U.S. adults are obese and the associated medical costs for them are roughly $1,429 higher than for those who are at what is considered a healthy weight. While these millions of Americans struggle with weight issues, they are also at risk for — or are already suffering from — associated chronic diseases such as type 2 diabetes, heart disease, cancer or stroke.

Socioeconomic issues are tied to obesity. Studies have found that communities with the highest obesity rates are those that are socioeconomically disadvantaged, often lacking in basic resources such as access to healthy food, safe places to exercise, and the overall standard of care that they need to get healthy. Research has also proven that obesity and chronic disease is especially widespread among Americans with the low levels of education and those with the highest poverty rates. However, identifying this causal link is only the first step in working to solve the problem.

The National Diabetes Prevention Program (DPP), is an evidence-based, affordable, and high-quality lifestyle change program proven to reduce the risk of type 2 diabetes. The DPP is delivered by trained non-clinical lifestyle coaches using a standardized curriculum. With a wide range of program options delivered in the community, the DPP is well equipped to meet the needs and address the challenges of diverse populations — whether that be language barriers, need for cultural competency, and understanding of the opportunities and barriers in the community to make healthy lifestyle changes. Local programs are designed to be delivered in group settings where people live, work, play, and pray. These hyper-local community programs include culturally appropriate curricula, connection to resources for health foods, and an understanding of the built environment. However, while many of these DPPs are able to deliver the program that could benefit these underserved communities, they face other barriers to success, including a lack of staff and resources to drive and manage enrollment, and a shortage of back-office administration capabilities for billing and reimbursement.

At Solera Health, we have built a business model that supports community-clinical integration by offering a high-access, lower-cost network of non-clinical providers as an adjunct to primary care. Solera connects a highly-fragmented grouping of community-based DPP providers by plugging them into an integrated national network as an adjunct to primary care, paid through medical claims. Solera’s integrator role is supported by our technology platform and back office compliance and program integrity oversight. This helps community providers plug into the existing healthcare system so they can concentrate on delivering programs that help their communities get healthy.

As a first step, Solera connects underserved populations with the “best fit” lifestyle-modification resources available in their areas. Meeting consumers where they are and empowering them with choice has proven to have a substantial impact on the ultimate success of the DPP. We leverage our proprietary analytics model to connect them to the DPP that best aligns with their cultural, economic, and personal needs and preferences.

Secondly, as the integrator and administrator with the operational expertise and technology, we work directly with DPPs to manage all of the back-office logistics such as compliance, program integrity, billing, reimbursement, reporting, etc. Thus, program providers are freed up to focus on their core competency — delivering their evidence-based, culturally-tailored lifestyle modification program to help underserved populations achieve health goals to keep chronic disease at bay.

Solera Health Achieves HITRUST CSF Certification

February 23, 2017 / in Blog Posts / by admin

In the world of healthcare, information security is vital. Companies dealing with a patient’s personal health information must meet key healthcare regulations and requirements for protecting and securing all materials and data to avoid an information security breach. Achieving security certification by trusted third-party organizations can assure partners and patients that their information is maintained with the highest level of security.

Solera Health is honored to announce to that we’ve earned a certified status from the Health Information Trust Alliance (HITRUST) high-level security framework. The HITRUST Common Security Framework (CSF) certification provides assurance to Solera’s health plan, employer and health system clients that Solera meets the healthcare industry’s highest standards in protecting healthcare information and managing risk. This is a significant milestone and certification for us, as no other Diabetes Prevention Program (DPP) digital therapeutics platform is HITRUST certified.

The HITRUST CSF was developed to address the multitude of security, privacy and regulatory challenges facing healthcare organizations. By including federal and state regulations, standards and frameworks, and incorporating a risk-based approach, certified organizations meet a diverse set of requirements through comprehensive and scalable security controls.

As a market category creator and integrator of non-clinical services, Solera performs all due diligence to downstream DPP providers. DPPs in our network are able to offer clients a much greater sense of data privacy/security when utilizing nonclinical community and digital providers. Now, we can continue to validate our commitment to the highest standards for privacy, security and compliance.

Taking Security One Step Further

Through our integration with DPPs, Solera also helps to educate customers and business partners. As a company, we promote data privacy and security in a cloud-based environment and work exclusively within the healthcare cloud space.

By creating a culture of compliance and completing the steps necessary to obtain the HITRUST CSF Certified status, Solera is distinguished as a company that our payer and Diabetes Prevention Program provider partners, and their participants, can trust to secure protected health information.

With the HITRUST Certification, Solera Health can continue to scale – securely.

 The HITRUST CSF Certification indicates that Solera meets key healthcare regulations and requirements for protecting and securing personal health information, including HIPAA, HITECH, PCI, ISO 27001 and NIST.

Heart Health and Diabetes

February 15, 2017 / in Blog Posts / by admin

February is American Heart Month – a time to take stock of our cardiovascular health and remind ourselves of the importance of staying “heart healthy.”  Oh, and to wear red, too!

At Solera Health, we are acutely aware of the relevance of American Heart Month, because of the strong correlation between cardiovascular disease and diabetes. There is even a term — “diabetic heart disease” (DHD) – that refers to heart disease that develops in people with diabetes. According to the National Heart, Lung and Blood Institute, compared with people who don’t have diabetes, people who have diabetes:

  • Have a two- to threefold higher risk for heart disease
  • Have additional causes of heart disease
  • May develop heart disease at a younger age
  • May have more severe heart disease

Studies have also shown that women in particular are affected – women with diabetes have an even greater risk of heart disease compared to those without diabetes. Overall, for both men and women with diabetes, cardiovascular disease leading to heart attack or stroke is by far the leading cause of death.

The good news is that individuals of all ages can reduce their risk for heart disease by making lifestyle changes and managing medical conditions like diabetes through appropriate lifestyle modification programs.  That’s why health plans like Blue Shield of California and many others are now offering Diabetes Prevention Programs (DPPs) as a covered benefit to their health plan members. And these plans are turning to Solera to help connect their members with the more than 1,000 Centers for Disease Control and Prevention-recognized digital, national or community-based DPPs. By consolidating these DPPs into one integrated network, we are helping health plans and providers to increase patient participation while lowering costs. Most important, giving members choices of the “best fit” DPP for their individual needs ensures better engagement and better outcomes. And that’s something we can all .

Solera DPP Spotlight: Yes Health

December 6, 2016 / in Blog Posts / by admin

alex-yeshealth

 

Alex Petrov is the Founder and CEO of Yes Health Inc.

What would you say are the unique qualities of the Yes Health DPP?
Our unique quality as a company and a DPP program is to be able to scale the delivery of the human touch and expertise of our health coaches on a member’s smartphone with asynchronous, “in-the-moment” live coaching.  We do this through our proprietary lifestyle and behavior change technology platform that blends human coaching with Artificial Intelligence for all aspects of DPP content and intensive lifestyle interventions.  This unique approach allows members to incrementally and iteratively improve their wellness and preventative habits in a continuous manner throughout the duration of the program.

Fundamentally, we believe we are in the business of “You Are Not Alone Anymore,” on this journey of preventing diabetes. Based on my own experience with prediabetes and based on our research we realized that being at risk of developing type 2 diabetes puts a person emotionally through ups and downs. Trying to get better can be scary, confusing and frustrating. Our earliest research insights were that the best way to address this human challenge was to have a compassionate partner there when it counts. And when it counted was not in a class room session or in front of a laptop, but in those often very private moments when you made those healthy or unhealthy decisions on nutrition, fitness or well-being. To deliver this human touch in real-time in a scalable way became hence one of our key objectives.

What type of member would be most successful using a DPP like Yes Health?
Any adult at risk of type 2 diabetes that has a smartphone (IOS or Android) and is interested in making the necessary lifestyle changes to avert the disease.

Do you have any interesting patient success stories/metrics?
One of the most rewarding aspects of being on the Yes Health team is hearing our members’ success stories. It truly fuels our spirits and makes us want to do more, faster. Here is one of them: Yes Health member, Amy, who was diagnosed with gestational diabetes when she was pregnant, had her doctor notice that her HbA1C level had crept into the pre-diabetic range a few years later. Her solution? Yes Health. Though she felt she was already eating healthy and wasn’t ‘sure what to change, she learned how to make changes that resulted in success. Her HbA1C levels are now almost within the normal range.

Click here for her full story and to see other Yes Health success stories: https://www.yeshealth.com/healthy-habit-heroes-amys-story/

What is Yes Health doing to enhance the patient experience?
Enhancing patient experience and engagement is really the crux of what we are doing every day from a continuous innovation standpoint. We are a learning and innovation organization and gaining insights and ideas, and making rapid, continuous improvements is what we love to do. For example, our very visual communication features where we invite members to simply snap meal photos to get instant feedback and coaches share how to make their meals a little bit healthier. This engagement came from observations of how cumbersome it is for members to “do math” especially when they are on the go like counting carbs, or calculating calories by categorizing foods.

Another way for us to enhance the member experience has been recruiting the very best coaches, training them according to continuously evolving best practices and fostering a culture of care and excellence.

What does the Solera partnership mean for Yes Health?
It has been wonderful to be so naturally aligned in our mission to stop diabetes, the entrepreneurial approach and corporate values. It has been very helpful for Yes Health to be able to focus on helping thousands of members be successful in preventing diabetes, while Solera focuses on managing the back-end relationships and integrations with health plans, for example. While we are early in the partnership, we are very excited about the Solera matching algorithms that should lead to high quality referrals on a large scale.

What’s next for Yes Health and chronic disease prevention?
Our primary focus in the near future is, of course, diabetes prevention and making Yes Health available to as many people as possible. As a society we must see the terrible numbers of prediabetes and type 2 diabetes come down in a significant way, and fast. Being part of a group of innovative companies that will accomplish that is awesome and is our goal.

As a unique lifestyle and behavior change technology platform that has improved compliance and solved
the problem of translating the latest in diabetes and behavior sciences research into scalable practice there are always new opportunities. Our platform can be leveraged for many other chronic disease management areas beyond diabetes prevention where lifestyle change is paramount.

Tell us a little bit more about how Yes Health came to be? What was the vision for the company when it started?
When my father died in 2000 from type 2 diabetes-related complications, it was the most painful, life altering moment I had ever experienced. Seeing him suffer from diabetes deeply affected me and also made me worry about my own health.

I tried to stay fit and maintain a normal weight, so I was shocked when, in 2013, my doctor diagnosed me with prediabetes during a routine checkup. A few unhealthy eating habits, stress and too much time spent sitting in my office and car had sent my blood glucose levels into the prediabetes range.

I was determined to turn my health around and knew I would need support and encouragement along the way. I wanted a program that was both scientifically based AND fun. The program also needed to travel with me. I’m a busy person who’s very dedicated to my family and my work. I didn’t want to let prediabetes get the better of me.

I started to feel frustrated when I couldn’t find what I was looking for. Then, a few weeks after my diagnosis in a conversation with a family member, I learned that prediabetes is a pandemic.  And in that moment, the idea for Yes Health was born.

My wife and I worked hard to assemble a team of experts, including our rock star health coaches, doctors and engineers, who are now the heart and soul of our organization. Together, we are pursuing our mission to stop diabetes and have created the first all-mobile, fun and motivating diabetes-prevention program. We successfully tested Yes Health a few years ago with a group of participants diagnosed with prediabetes, and the program has been available to everyone since. On a personal note, my blood glucose levels are now normal and I’ve found a way to keep those pesky, unhealthy habits in check.

Can you provide readers with a little bit of insight into your background prior to becoming Yes Health CEO? Have you always been interested in the digital health space?
I am a consumer products person with experience in the technology, retail and food industries at both large companies like PayPal, Safeway and Nestle and start-up ventures. I have always been interested in the psychology of consumers and have been fascinated in truly understanding and serving them. My sweet spot has been creating new products, new brands and new businesses and I simply found working on innovation teams and risky projects the most exciting experiences.

With consumer centric thinking becoming increasingly more important in the health care industry and technology and retail companies becoming the disruptive forces driving innovation, I felt my experience from those industries could provide unique perspectives on a new digital health venture like Yes Health.

How has Yes Health as a company evolved over the past 12 months?
Rapidly- we had a super run this past year and achieved some major milestones. The credit goes fully to my amazing team. In Q1 2016 we launched our consumer marketing and rapidly grew our membership. Some important organizations took notice and we forged a great precision medicine partnership with the University of California, San Francisco’s (UCSF) Diabetes Center and shortly thereafter with Solera Health. We also achieved CDC-recognition and made great strides on our technology. We launched an Android version in the Google Play store and built out device connectivity to activity trackers and digital scales. The team has also grown with some great new experts coming on board.

Where do you see Yes Health in the next 12 months?
Driving member growth and serving those members with excellence is our priority. Building out and evolving our technology road map and existing partnership, as well as  forging successful new alliances will be a few of the ways we’ll ensure we’re meeting our priorities. Finally, keeping our special culture and team spirit along with adding new expertise in some key areas will make it all happen.

 

November Marks National Diabetes Month – A Time for Action

November 17, 2016 / in Blog Posts / by admin

November has been named National Diabetes Month which appropriately rounds out this past year’s focus around the theme- Managing Diabetes – It’s Not Easy, But It’s Worth It. More than ever, it is important to highlight the need for managing diabetes to prevent diabetes-related health problems such as heart attack, stroke, kidney disease, vision loss, and amputation. The 2016 national campaigns put on by the American Diabetes Association (ADA) and the Centers for Disease Control and Prevention (CDC) aim to serve as a reminder to those who may be struggling with the demands of managing diabetes that they are not alone and that prevention of type 2 diabetes is possible.

National Diabetes Month is also an opportunity to highlight the need for diabetes prevention. One in three U.S. adults is currently at risk for developing type 2 diabetes. One of the key initiatives highlighted during National Diabetes Month is the National Diabetes Prevention Program (DPP). The evidence for the effectiveness of the National DPP is strong – these programs work. Both randomized clinical trials and real-world implementation studies have proven that structured lifestyle change programs can help prevent or delay type 2 diabetes by 60% for people at high risk. The CDC has taken the lead to build capacity for community-based organizations and digital therapeutics providers to deliver the DPP in their communities as an adjunct to primary care, and many commercial payers have begun to cover the program as a preventive benefit for their members.

As community and digital DPP providers expand the availability of and participation in evidence-based, cost-effective intervention programs in communities across the United States, Diabetes Month aims to create awareness around the prevalence of type 2 diabetes.

In 2016, the DPP’s efforts to stem the epidemic of type 2 diabetes in the U.S. gained significant momentum. Among the year’s highlights include:

January, 2016

The DPP launched a new public service campaign aimed at raising awareness about prediabetes, featuring resources for clinicians to facilitate patient engagement in diabetes prevention. The campaign, jointly sponsored by the ADA, American Medical Association (AMA), and the CDC, ran TV and radio ads and also included a social media component.

March, 2016

Health and Human Services Secretary Sylvia Burwell announced that the DPP would be eligible for Medicare coverage as part of new Medicare regulations that the Centers for Medicare and Medicaid Services rolled out later in the year. The coverage for the National DPP marked that first time since the passage of the Affordable Care Act that Medicare coverage has been extended to a preventative health program.

June, 2016

The AMA formally announced a new policy encouraging private and public health plans to include the DPP as a covered benefit for their beneficiaries. The AMA’s new policy encourages hospitals to offer the program to their patients and supports allocating community benefit dollars to cover the cost of enrolling patients in an in-person or digital DPP.

July, 2016

CMS announced its proposal to expand its Medicare DPP to a full-fledged national program by the beginning of 2018, making it the first preventive service model to be certified for expansion out of the CMS Innovation Center.

The decision followed a March announcement by the CMS Office of the Actuary that the program’s pilot had helped reduce Medicare spending, at the same time that officials “determined that the program demonstrated the ability to improve the quality of patient care without limiting coverage or benefits.”

The same month, the Institute for Clinical and Economic Review (ICER) released its Diabetes Prevention Programs: Comparative Clinical Effectiveness and Value report, which reviewed the comparative clinical effectiveness and value of CDC-recognized DPPs, and put forth a number of key policy recommendations, including:

  • Encouraging payers to cover CDC-recognized DPPs in a variety of formats across all plans with no copay.
  • Directing clinicians to screen eligible patients for prediabetes using established clinical measures and, when prediabetes is identified, to immediately refer patients to a local or digital DPP.
  • Noting that DPP providers should apply for CDC recognition for their programs, and should tailor their programs to include culturally appropriate curricula for diverse populations, as well as collaborate with payers in developing pay-for-performance reimbursement strategies.
  • Highlighting the benefits of a DPP integrator as a national scalable model as the single point of contact for payer contracts and operational support to community-based DPPS to support patient choice

November, 2016

The CMS issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) which includes the National DPP. At this time they have finalized the definition of the benefit, member eligibility, supplier eligibility and enrollment criteria while additional details related to the reimbursement eligibility of digital DPPs as well as those with pending CDC recognition remain pending.

At Solera, we are encouraged by these promising National DPP developments and achievements and will watch further amendments to the CMS Physician Fee Schedule intently in the months to come. Especially as we strongly believe that these new proposed National DPP modifications make any even stronger case for our role as a chronic disease prevention integrator and technology platform to achieve economies of scale for program integrity, health coach “registries” for compliance, and the need to document / benchmark program outcomes, and a single point of enrollment and eligibility verification.

Given the dire statistics about diabetes in the U.S. – it’s been found that more than 29 million adults and children in the country have diabetes, and every day, more than 3,700 people are diagnosed with the disease- highlighting the need to mobilize efforts to combat this chronic health epidemic. This past year, government and health officials showed that they are ready to step up to the challenge and prevent diabetes, and we look forward to playing an integral role in ensuring that members continue to have the opportunity to select a DPP where they are most likely to be successful in the long term.

In the last week, the healthcare industry has seen a lot of speculation over what the new presidential administration will mean for the future of the Affordable Care Act and related Centers for Medicare and Medicaid Services’ initiatives. As an industry, we should expect a number of months of waiting before we see what the longer term impacts of Trump’s health policy initiatives truly are. Regardless, it is unlikely that Obamacare can be repealed quickly.

At Solera, we are optimistic for a future where chronic disease prevention remains a top-line priority on Capitol Hill. In the meantime, we look forward to continuing on our mission to push for legislative support and healthcare reimbursement for the services and resources being made available to helping our nation prevent the onset of Type 2 diabetes.

Solera DPP Spotlight: Gain Life

October 13, 2016 / in Blog Posts / by admin

Sean Eldridge is the CEO of Gain Life

What would you say are the unique qualities of the Gain Life DPP?

We’re the only company that provides mindset-­‐focused and gender-­‐specific DPP options. This matters because weight loss is largely a battle between the ears yet most programs prioritize the physical component and neglect the mental component, and despite there being more American men than women who are overweight or obese only ~15% of DPP participants in other programs are men. We tailor the approach and language to men and women differently in order to honor gender differences in life roles, values and identity, which translates to improved program engagement.

What type of member would be most successful using a DPP like Gain Life?

Our program is for anyone who wants to find a renewed sense of purpose in life and is excited about making a big change in his or her health.

Do you have any interesting patient success stories/metrics?

Our programs, PowerUP and ManUP, achieve on average 12% and 14% weight loss (respectively) at one-­‐year, which makes them one of the most effective DPP offerings available. And with our gender-­‐specific approach we experience more than two times the number of male sign-­‐ups than traditional one-­‐size-­‐fits-­‐all programs.

Beyond the metrics, we’re inspired by the way our member’s apply the motivation and confidence they’ve built during our program into other aspects of their lives. From venturing out to pursue lifelong passions, to improving relationships with family and friends, our member’s consistently remind us that losing weight and preventing diabetes can be a transformative experience in a multitude of ways.

What is Gain Life doing to enhance the patient experience?

Because we’re a team of consumer health veterans, we design experiences for consumers, not “patients”. We leverage consumer packaged goods design principles and best-­‐in-­‐class science for programs that are highly effective and that consumers love. We credit our health outcomes to our mindset focus, which leverages a broad evidence-­‐base, packaged in a way that gives individuals what  they want (reduced health risks and weight loss) while building into the process what they really need (change in mindset).

We’re firm believers that a “one-­‐size-­‐fits-­‐all” approach to healthcare –especially with regards to lifestyle intervention–isn’t going to work. By meeting individual’s where they are, understanding their circumstances, and tailoring our programs to meet their needs, we’re creating a more personable approach to diabetes prevention that empowers patient’s to take control of their own health.

What does the Solera partnership mean for Gain Life?

It expands the reach of our programs to more consumers who want to transform their life and prevent diabetes. We’re excited to partner with Solera to increase access to care for those in need, and to be part of this ambitious solution to one of our country’s biggest healthcare problems. In our eyes, more folks teaming up and working together to prevent chronic disease can only be better for all of us in the long run.

What’s next for Gain Life and chronic disease prevention?

Greater personalization is going to be a continued focus for us. Our vision is to offer enjoyable, engaging and effective lifestyle change programs that are perfectly designed for each unique consumer, at scale.

Tell us a little bit more about how Gain Life came to be? What was the vision for the company when it started?

My co-­‐founder, Dr. John Peters, and I, spent ~50-­‐years (collectively) in the health and wellness space at Procter & Gamble, Johnson & Johnson, Weight Watchers, and in academia before founding Gain Life. Having spent our careers at consumer-­‐ focused, innovation-­‐driven, companies, we’ve logged countless hours with consumers-­‐trying to understand what makes them tick and learning how they think about and manage their health. What we found along the way is that most health and wellness offerings don’t fully address the pain points of the consumers they intend to serve. They miss the mark on two key fronts

1.) There are significant differences between and within genders resulting in unique health needs, yet most every solution out there is one-­‐size-­‐fits-­‐all; and

2.) that weight-a key driver of preventable chronic conditions such as diabetes and cardiovascular disease – is largely a battle fought between the ears, yet most products and services don’t adequately address the root of the issue: an ineffective mindset.

We at Gain Life build programs that solve these needs, which translate into improved consumer engagement and sustainable health outcomes.

Can you provide readers with a little bit of insight into your background prior to becoming Gain Life’s CEO? Have you always been interested in the digital health space?

My interest in tech started in college when I took several programming courses. At the time I didn’t fully grasp the potential of digital health. That soon changed when I started my career at Johnson & Johnson. What excites me about digital health is the ability to meet consumers on their own terms-­‐ when and where they want.

How has Gain Life as a company evolved over the past 12 months?

We continue to build our gender-­‐specific brands, ManUP Health and PowerUP Health, listening to consumers and refining our consumer experiences delivered digitally.

We recently launched the newest version of our coaching platform that has changed the way we deliver our programs and significantly improved our member experience.

We’re firm believers in continuous innovation, and we’re always refining our services to help our member’s more completely with each passing day.

Where do you see Gain Life in the next 12 months?

Helping more consumers, more completely.