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:

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.

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