Blue Shield of California Adds Diabetes Prevention Program

February 2, 2017
Mary Caffrey

A study last year found that more than half of all California adults have diabetes or prediabetes.

Members of Blue Shield of California will have free access to the National Diabetes Prevention Program (DPP), the evidence-based lifestyle management and nutrition program recognized by the CDC.

The announcement means that DPP providers will have an easier way to connect with the insurer's base of 4 million members. A study last year by the University of California, Los Angeles found that more than half of all adults in California have diabetes or prediabetes; DPP targets patients with prediabetes to prevent them from progressing to type 2 disease. According to a statement from Blue Shield of California, an estimated 1.9 million people in California have type 2 diabetes.

“Diabetes is one of the most common and costly chronic health conditions in the United States. The good news is that it is preventable,” Marcus Thygeson, MD, MPH, said in the statement.

Blue Shield members can access the program through Solera Health, which serves as an integrator for both community-based and digital programs. Those meeting the criteria can be referred by a physician or enroll after completing an online risk assessment at Solera4me.com.

“We’re thrilled to bring Solera’s technology for selecting the ‘best fit’ Diabetes Prevention Program to Blue Shield of California members who are at risk for type 2 diabetes or chronic conditions,” said Brenda Schmidt, CEO of Solera Health. She added that the company works with more than 1000 CDC-recognized programs.

Under a directive from the US Preventive Services Task Force (USPSTF), doctors are advised to refer obese patients with at least 1 cardiovascular risk factor to behavioral health counseling. USPSTF gave this recommendation a “B” rating in August 2014, which means that commercial health plans must pay for this service and have a way to deliver it.

As Omada Health CEO Sean Duffy wrote in Evidence-Based Diabetes Management.™ in 2015, the USPSTF recommendation offered “both a challenge, and hope for US health plans and employers.”

Several digital health providers are competing to offer their programs through health plans or large employers, and the American Association of Diabetes Educators is working to scale the program across its existing network that offers diabetes self-management education and support in all 50 states.

CMS announced last year that it plans to bring the DPP to Medicare starting January 1, 2018. However, the agency is still working on reimbursement designs and had not finalized how it would work with digital providers. Schmidt and a coalition of DPP providers, the Council for Diabetes Prevention, are working to ensure that Medicare’s plans move forward if the Affordable Care Act is repealed.