Brenda Schmidt, CEO of Solera Health, discusses how Solera has been getting ready for the launch of the Medicare Diabetes Prevention Program on April 1, 2018.
Now that the rule is final, what are the priorities of Solera Health between now and April?
Solera is really busy right now. We are contracting with almost all of the Medicare Advantage plans because they’ve realized that, again this is a highly fragmented market, there are 1500 diabetes prevention programs, and they’re nonmedical and nonclinical. So, inherently it’s really hard for a health plan to contract with a nonclinical, non-credentialed provider, and the other reality for health plans is that all of them would have to have a national network because part of the rule states that people can switch program providers at any time for any reason.
There’s a lot of seniors that live in one part of the country part of the year and another part of the country a different part of the year. The opportunity to network these providers together and offer some fluidity around their data and their experience covered by a health plan that may be covering them but is located in a completely different part of the country is fueling a lot of the realization that a network model makes sense to efficiently rollout the Medicare DPP benefit April 1. So, we’re working on making sure that our providers are ready so that DPP network partners become both Medicare suppliers and Medicare DPP suppliers, and we’re helping them work through that process. With our health plan clients, working out all of the details around beneficiary eligibility and denials and CMS regulations to make sure that this benefit is rolled out in a way that is compliant with all the CMS regulations.
If a primary care physician has someone walk into their office on April 1 who meets the criteria for prediabetes and could be enrolled, what should that physician do?
We have recognized that there’s a need in the marketplace to establish a national referral and enrollment site for DPP because that’s exactly the problem. I think physicians want to identify screen tests and refer their patients to a diabetes prevention program, but they don’t know what to do. So, we’ve registered a couple of URLs; MedicareDPP is one of them, and 1800Prevent is another. We’re now doing the market research around what would be a national DPP referral and enrollment site that could enroll people efficiently in a national network of programs or find grant funded programs for those people who may come to that site and not be covered by their program; perhaps they’re not Medicare beneficiaries, but they don’t have commercial coverage, and also create a directory of grand funded programs. So, we will find a home for everyone. Right now, if they have someone we have wide coverage in a couple of states including California and Florida. Send them to Solera4me.com and we will do the same thing; we will find a home for them and a best fit DPP partner to help them on their journey to a healthy lifestyle.