BCBS Association Executive Joins Solera Health as VP of Emerging Care Models

August 7, 2018 / in Coverage / by admin

Teresa Clark will lead the integration of social determinants into emerging care models for Solera’s health plan clients

Phoenix, AZ – Aug. 7, 2018 – Solera Health, a leading integrated benefit network, today announced that Teresa Clark, MPH, MBA has joined the executive team as Vice President of Emerging Care Models. Clark is a leading executive with demonstrated expertise in platform technology, population health, and finance.

In her previous role as Vice President, Clinical Affairs, Blue Cross Blue Shield Association (BCBSA), Clark led the design and launch of the wholly owned subsidiary Blue Cross Blue Shield Institute, dedicated to creating a sustainable business model to address the social determinants of health in the private payer market. Clark led efforts for many of the Institute’s most recognizable products, including the development of its flagship geospatial platform technology, the Community Health Management Hub (CHM Hub®), which identifies the social, economic, and environmental barriers to health. Clark managed some of the BCBSA and the Institute’s often mentioned innovations, including the transportation services with Lyft that addressed the needs of BCBS members living in transportation and pharmacy deserts.

“Teresa’s wealth of health plan, innovation, business, and policy experience will be immensely valuable as we develop and scale new offerings that address social determinants of health,” said Brenda Schmidt, CEO at Solera Health. “Teresa’s track record of innovation and her experience addressing social determinants of health will be critical as we expand Solera’s curated network model, which has shown its effectiveness in helping scale the diabetes prevention program nationwide. Clark will be critical in supporting Solera’s strategic focus on innovation to address the highly fragmented community space.”

Clark studied computer science and neuroscience at the University of California, San Diego before moving on to study epidemiology at the Johns Hopkins University Bloomberg School of Public Health, and finance at the University of Pennsylvania Wharton School of Business.

“I am honored and delighted to join Solera, the nation’s premier platform for individuals to manage their health and wellbeing once they leave the doctor’s office,” said Clark. “I look forward to helping build innovative offerings and personalized experiences to patients, providers, and payers in every community Solera serves.”

About Solera Health
Solera Health is an integrated benefit network that connects patients, payers, and physicians with community organizations and digital therapeutics providers, simply and securely. Solera helps consolidate highly fragmented programs and services into one integrated network, allowing health plans and medical providers to increase consumer participation while lowering associated costs. Solera proactively identifies the “best fit” program provider based on each individual’s unique needs and preferences, which has proven to have a significant impact on improved patient outcomes at a fraction of the cost of traditional medical care. For more information, visit Solera Health at www.soleranetwork.com, call 800-858-1714 or follow us on Twitter @SoleraNetwork or LinkedIn.

Solera Health Announces New Contract with ATRIO Health Plans

August 6, 2018 / in Coverage / by admin

Oregon-based health plan joins Solera’s national network to administer the Medicare Diabetes Prevention Program

Phoenix, AZ – Aug. 6, 2018 – Solera Health, a leading integrated benefit network, today announced a new contract with Oregon-based ATRIO Health Plans to administer the Medicare Diabetes Prevention Program (MDPP) for its Medicare Advantage book of business.

Through this new contract with Solera, ATRIO’s Medicare beneficiaries who are at risk of developing type 2 diabetes will be able to access the MDPP through one of the many Solera network suppliers within ATRIO’s service areas.

Solera Health connects payers, consumers, and providers with a diverse ecosystem of proven non-medical behavior change programs delivered by community partners and paid through medical claims. Solera’s integrated benefit network allows health plans to increase consumer access, choice and participation while lowering associated costs by matching eligible covered individuals with the MDPP supplier that best meets each members’ unique needs and preferences.

Effective as of April 1, the MDPP’s goal is to reduce the risk for type 2 diabetes through a series of group classes led by a trained lifestyle coach with a standardized curriculum. The two-year program aims to improve nutrition and increase physical activity with the goal of losing 5% body weight.

“We are looking forward to leveraging Solera’s diverse selection of MDPP suppliers and unique matching capabilities for our Medicare population,” said Matt Gougler, Chief Marketing Officer at ATRIO Health Plans. “We anticipate that this work will help us keep our Medicare population from potentially having to face the serious and costly health implications of a diabetes diagnosis.”

“The MDPP has been shown to reduce the risk for type 2 diabetes by up to 70% in older adults and provides a gross financial return of $2,650 within 5 quarters,” [1] said Brenda Schmidt, CEO of Solera Health. “We’re thrilled to be able to work with ATRIO Health Plans and provide such a robust program to their Medicare Advantage membership.”

About Solera Health

Solera Health is an integrated benefit network that connects consumers, payers, and providers with community organizations and digital therapeutics, simply and securely. Solera helps consolidate highly fragmented programs and services into one integrated network, allowing health plans and medical providers to increase consumer participation while lowering associated costs. Solera proactively identifies the “best fit” program based on each individual’s unique needs and preferences, which has proven to have a significant impact on improved patient outcomes at a fraction of the cost of traditional medical care. For more information, visit Solera Health at www.soleranetwork.com, call 800-858-1714 or follow us on Twitter @SoleraNetwork or LinkedIn.

About ATRIO Health Plans
ATRIO Health Plans is a Medicare Advantage (MA) plan that offers Preferred Provider Organization (PPO) options as well as a Health Maintenance Organization (HMO) Special Needs Plans for Dual Eligibles. The health plan is supported by the trusted physicians who care for individuals and families in the Oregon counties of Douglas, Jackson, Josephine, Klamath, Marion and Polk. For more information, visit http://www.atriohp.com.

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf

Healthcare Technology Innovator Accelerates Diabetes Prevention in the Cloud

July 27, 2018 / in Coverage / by admin

Microsoft Customer Stories

July 25, 2018

Solera Health is successfully fighting type 2 diabetes. Its secret? Using Microsoft Office 365 to give its distributed workforce the power to easily communicate and collaborate with health plans, diabetes prevention programs, and patients in a highly secure way. The company uses Microsoft Azure and Power BI to analyze member data, identify those at risk for type 2 diabetes, and connect them with best-fit diabetes prevention programs (DPP). Everyone wins, from patients enjoying healthier lives to health plans with lower costs.

The dedicated people at Solera Health believe that no one has to fall prey to chronic illnesses, and they’ve taken aim at type 2 diabetes. To help the US population embrace the healthy lifestyle choices that can help them avoid the disease, the Phoenix, Arizona–based integrated benefit network has created an innovative solution: a comprehensive network connecting health plans, healthcare providers, diabetes prevention programs (DPPs), and patients. The result? Happier, healthier individuals and communities all over the United States, lower reimbursement costs for insurers, and falling healthcare expenditures overall. Their catalyst for the innovative solution was Microsoft Office 365 and Microsoft Azure.

Forging a new path for preventative care

According to the American Diabetes Association, diabetes is the seventh-leading cause of death in the United States, costing the country $245 billion every year. Solera Health Chief Executive Officer Brenda Schmidt wanted to change those grim statistics. She saw a gap between the highly effective community prevention organizations that typically deliver low-cost, high-value outcomes and the insurers that aim to connect patients with best-fit prevention programs. Drawing on her deep background in healthcare IT, in 2015 she formed Solera Health, a service that connects insurers, patients, and community-based prevention programs. Now a company of more than 100 workers, Solera Health is disrupting healthcare in the best possible way, solving the need for aggregating and analyzing patient data and connecting patients to the most effective resources with its groundbreaking network platform.

Approximately 1,700 DPP organizations dot the US map, covering a patchwork of geographies and populations. Health plans recognize that prevention is key to better serving patients and lowering healthcare costs. But identifying patients at risk and connecting them with the DPP that meets each patient’s needs and preferences in their geographic area is complex and expensive. Community-based, nonclinical diabetes prevention programs frequently represent the most effective options for helping people make the changes they need to avoid chronic conditions like type 2 diabetes. However, these organizations are historically funded through grants and donations and are ill-equipped to meet the data security requirements necessary to obtain reimbursement from health plans. Enter Solera Health, with its safeguarded data aggregation platform and extensive DPP network—a new curated marketplace for diabetes prevention services.

Crafting a springboard for a modern workplace

For Solera Health Vice President of Technology Dan Hurley, creating a disruptive innovation begins with a leading-edge paradigm for the company’s workers. “We foster an agile, flexible culture,” he says. “At Solera, it doesn’t matter where we work. That’s the whole point of our Office 365 and Azure adoption.” This cloud-based environment involves such easy deployment and management that Hurley’s 35-person IT team has no trouble supporting nationally distributed employees. Everyone has a Microsoft Surface device and an Office 365 license. Hurley finds the flexibility of Microsoft licensing perfect for a rapidly growing startup. “We grew very fast,” he says. “The Microsoft pay-as-you-go approach is the best licensing model I have ever experienced in my 30-plus years in IT.”

Employees use Office 365 productivity tools like Word, Excel, and PowerPoint along with Skype for Business to work together online with colleagues all over the country. Hurley created a new approach for external collaboration with insurers and DPPs using the Phone System feature in Office 365 (Cloud PBX) and Skype for Business for private branch exchange (PBX) capabilities. Materials are easily shared visually in real time during Skype for Business calls, and customer contact data is contained within the Solera ecosystem. “We don’t use office phones anymore,” he says. “Instead, we assign everyone on the Solera team a Cloud PBX number anywhere in the country. If any customer-facing staff members leave Solera, we retain all their customer contact data.”

The company even designed the physical office space at its headquarters to promote collaboration. Rather than rows of cubicles and desks, clusters of tables form landing spaces for staff members who move fluidly among teams as their collaborative needs dictate. A network of remote marketing reps equipped with the same mobility-ready Surface devices are scattered across the United States. “Our modern physical and virtual workspaces support our ethos of cross-team collaboration,” says Hurley. “Finance people interface with our development team, our own marketing people, and our network partners. By using Office 365 cloud-based tools to work in a connected way, we’re constantly improving our product and processes.”

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Supporting the enterprise with highly secure cloud technology

Solera opted for a cloud-based infrastructure right from its beginning. Hurley sees a plethora of benefits from that approach: automated backups, redundancy, and high-availability network performance. Most important, in an industry where security is king, Solera has earned HITRUST certification, the highest security qualification possible for US healthcare organizations and the desired prescriptive framework for managing the security requirements of the Health Insurance Portability and Accountability Act (HIPAA). “If we’d been a traditional on-premises organization, it would have taken us almost an entire year to achieve HITRUST certification,” says Hurley. “And it would have meant extensive onsite inspections. But having our data in the Microsoft cloud gave us instant credibility—regulators know that our data is segregated from that of other companies and that it’s fully backed up and highly secured.”

Hurley’s team uses Microsoft Power BI as a multipurpose tool, collecting infrastructure reporting to monitor overall system health for proactive evaluation and action. The team drives critical goals by using data from insurers with ArcGIS Maps for Power BI to create compelling visualizations and sharpen the focus on locations with populations most vulnerable to diabetes. “We absolutely love the heat maps we get with ArcGIS Maps for Power BI. We can layer the prevention offerings from our network providers on top of these maps,” says Hurley. “After only two years, we’re seeing phenomenal success with all the high-risk populations, particularly the senior demographic, because our data and insights help connect those people with the diabetes care programs they need. Also, now that health plans use us to safeguard patient information, we can match more people with prevention programs. People tell us that they’re losing 15 to 20 pounds—in some cases, even more—keeping up with their grandchildren, and going places they never could before, because they’re fitter and healthier.”

Working toward a bright future

Solera plans to extend its diabetes prevention work. Core components of a healthy lifestyle—exercise, nutrition, sleep, and stress reduction—factor into prevention of other chronic conditions. Moreover, the diabetes prevention programs Solera amplifies can be also used to mitigate the progress of the disease in those who already have it. Solera’s cloud-based approach has won trust from the traditionally cautious healthcare insurance industry. “Every health plan we contract with performs a comprehensive risk assessment of Solera,” says Hurley. “The industry is still adjusting to our 100 percent cloud-based approach. It’s not what they’re used to, but they’re learning that with Office 365 and Azure, our data is safer than it would be if we used an on-premises datacenter.”

“We grew very fast. The Microsoft pay-as-you-go approach is the best licensing model I have ever experienced in my 30-plus years in IT.”

Dan Hurley: Vice President of Technology
Solera Health

Find out more about Solera Health on Twitter, Facebook, and LinkedIn.

Content from Blue Cross Blue Shield Association: Improving health through personal touch, technology

June 21, 2018 / in Coverage / by admin

President and CEO of Blue Cross Blue Shield Association Scott P. Serota moderates a conversation about how technology combined with a personal touch is uncovering community solutions and improving health for patients fighting chronic disease.
June 20, 2018 | 1:28 PM EDT

https://www.washingtonpost.com/video/postlive/wplive/content-from-blue-cross-blue-shield-association-improving-health-through-personal-touch-technology/2018/06/20/788646c2-74cb-11e8-bda1-18e53a448a14_video.html?utm_term=.2d8d9a46cc08

 

April 1 Brings Day One of the Medicare Diabetes Prevention Program, and Challenges for Health Plans

April 2, 2018 / in Coverage / by admin

by Mary Caffrey

“Some Medicare Advantage plans may not be fully ready for the requirements of this history-making preventive service.”

Sixteen years after a National Institutes of Health study showed it worked, and 2 years after the CMS actuary said it could save millions of dollars, the Medicare Diabetes Prevention Program (DPP) launches today, making history in the way CMS fights a disease that accounts for $1 in every $3 spent in Medicare.

Medicare DPP achieves 2 key milestones:

  • First, an evidence-based preventive service will be expanded to all beneficiaries at no cost, which means every Medicare Advantage plan must have a way to offer it to members under CMS’ rules.
  • Second, community groups with nonclinical providers, such as the Y-USA, can be paid to offer the plan through medical claims instead of grants.

The American Journal of Managed Care® spoke on Friday with Brenda Schmidt, founder and CEO of Solera Health, a company that serves as an integrator—the only one of its kind—to provide technology, regulatory, and support services that will allow community programs, health systems, and Medicare Advantage plans meet CMS requirements. At the same time, Solera touches the consumer, connecting those interested in the DPP with a program best suited to their needs. The company adds Medicare DPP to its network after years of working with commercial plans, community groups, digital providers, and other network participants.

It’s been a busy time leading up to April 1. “We’ve been doing a lot of testing,” Schmidt said. “There are so many new administrative requirements, and new CPT [Current Procedural Terminology] codes.”

And there were still Medicare Advantage plans calling over the past week, unsure if their steps to meet CMS requirements would meet demand. “A lot of Medicare Advantage plans thought the launch would be delayed,” Schmidt said. Unique features of the program—such as those to accommodate seniors with 2 residences—are catching some health plans off guard, she said.

This morning, Solera launched MedicareDPP.org, which directs users to a short questionnaire to help gauge eligibility; those who meet baseline criteria are instructed how to learn more.

Read more…

As MDPP Launch Looms, Solera Builds ‘Flex Model’ of Suppliers

March 21, 2018 / in Coverage / by admin

Reprinted with AIS Health permission from the March 15, 2018 issue of Radar on Medicare Advantage.

As the April 1 launch date of the expanded Medicare Diabetes Prevention Program approaches, Medicare Advantage organizations are busily working to ensure that their own benefits and provider networks are sufficient to offer MDPP services. Designed with the goal of preventing the onset of type 2 diabetes among Medicare beneficiaries diagnosed with pre-diabetes, MDPP services that were tested through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards must now be covered by all MAOs. But setting up adequate networks of MDPP “suppliers” in what many plans viewed as a short implementation timeframe has proven to be a challenge, contends Brenda Schmidt, founder and CEO of Solera Health.

“Any new benefit that’s covering all of their beneficiaries is a big lift for a health plan because it touches so many parts of their organization. And the expanded MDPP is creating a unique set of issues for MA plans for a variety of reasons,” observes Schmidt in an interview with AIS Health. Namely, a “highly fragmented” supplier market that is traditionally made up of community-based organizations delivering the services through non-credentialed or licensed Lifestyle Coaches. Moreover, MDPP services are categorized as high-risk (similar to home care) due to the opportunity for fraud, creating an additional burden for MA plans in terms of the reporting and audit requirements, she explains.

The MDPP expanded model includes an evidence-based set of services that will be available to beneficiaries meeting certain criteria with no cost sharing through Medicare-enrolled MDPP suppliers. The services are delivered through “structured sessions” using a curriculum that is approved by the U.S. Centers for Disease Control and Prevention (CDC) and trains enrollees in long-term dietary change, increased physical activity and behavioral change. Participants must attend a minimum of 16 core sessions in a group-based, classroom-style setting over a period of six months, followed by less-intensive monthly follow-up meetings to help maintain healthy behaviors. The primary goal of the program is at least 5% weight loss by participants.

Given the high cost and prevalence of obesity and diabetes in the U.S., CMS with the November 2016 publication of the 2017 Physician Fee Schedule (PFS) established MDPP services as a Part B service, meaning all Medicare health plans — including MAOs, cost plans and Programs of All-Inclusive Care for the Elderly — are required to cover MDPP services for eligible beneficiaries. A year later, CMS in the 2018 PFS established policies related to the set of MDPP services, including supplier enrollment requirements. CMS had originally proposed a Jan. 1, 2018, start date for Medicare coverage of MDPP services, but in the 2018 PFS pushed it back three months after hearing from concerned stakeholders about not having enough time to contract with suppliers.

Solera Health, a Phoenix-based company that integrates payers and providers in chronic disease prevention, has been working on behalf of MA clients across the country to create an “integrated benefit network model.” Solera handles the “credentialing” and auditing of MDPP suppliers and assumes the responsibility for meeting CMS requirements as the delegated entity of the health plan. Solera has about 60% of MA lives under contract already and as of earlier this month was still receiving calls from prospective clients, according to Schmidt.

“What we’ve done is found organizations that are interested in scaling the DPP who meet [the requirements] and then we’re scaling those in independent pharmacies, grocery, retail, area agencies on aging, etc., creating a flex model,” she explains. Solera works with many of the Blues insurers as well as larger insurers such as Aetna Inc., Cigna Corp. and Kaiser Permanente to determine where to set up classes based on their members’ ZIP codes, she adds.

Program Must Be Delivered In-Person

Despite requests from stakeholders to include telehealth and digital forms of coaching, the program can only be offered in-person, thus limiting it further. Moreover, only about 400 out of about 1,600 MDPP suppliers nationwide meet the CMS criteria, and many have chosen not to apply because of what it takes for them to be a Medicare supplier from a compliance perspective, adds Schmidt. And other experienced organizations simply don’t qualify because they haven’t delivered the program for a full year, “so that pool of suppliers ended up to be pretty small,” she remarks.

The company also performs all the beneficiary outreach and determines enrollee qualification for the program. “Then, we act like Match.com to find the best DPP program providers for the individuals. And if the members switch [plans] or move out of state, we have the ability to move the data with them because all of these community DPP providers use our technology to document the engagement and weight of participants in our programs,” explains Schmidt. “The technology piece of it is what makes this work.” Solera is also launching a website, MedicareDPP.org, on April 1 aimed at simplifying clinician referrals and consumer enrollment in the MDPP.

Although the CMS Office of the Actuary certified that the MDPP pilot program created an estimated $2,650 return on investment (ROI) per person over a 14-month timeline, many plans are interested in doing their own analysis before they aggressively enroll members, adds Schmidt. Moreover, the services provided by MDPP suppliers are submitted as medical claims, and plans were not able to submit any additional costs associated with the MDPP in their bids to CMS, “so a risk-adjusted MA plan perceives the costs associated with the program as an expense until they see an ROI,” she explains.

For more information, contact Brenda Schmidt or visit https://tinyurl.com/ycm346zm.

U.S. Preventive Medicine, Solera Health Partner to Deliver Comprehensive Health Coaching

February 21, 2018 / in Coverage / by admin

HIT Consultant covers Solera’s new partnership with U.S. Preventive Medicine to deliver comprehensive health coaching and nurse based chronic condition care management services for Solera clients.

Click here to read.

Purpose-Driven Healthcare Innovation

January 25, 2018 / in Coverage / by admin

Solera Health’s CEO talks with the Business of Healthcare on purpose-driven innovation and how it aligns problem, purpose, and business model.

Click here to watch her interview.

The Integrator Role in Expanding Medicare Beneficiary Access to Diabetes Prevention Programs

/ in Coverage / by admin

Solera’s CEO, Brenda Schmidt, on the integrator role in expanding the Medicare Diabetes Prevention Program benefit, which for the first time ever, creates a preventive service for seniors delivered by a diverse range of non-clinical MDPP providers.

Click here to read.

Solera Health and WellDoc Announce Partnership

January 22, 2018 / in Coverage / by admin

Solera Health and WellDoc, a leading digital therapeutic company, announced that WellDoc’s BlueStar digital therapeutic will join the Solera network as a diabetes management solution of choice.

Click to read the article.