As CMS prepares to expand its
Medicare Diabetes Prevention Program (MDPP), Medicare Advantage (MA)
organizations are busily working to set up adequate benefits and provider
networks.
"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," Brenda Schmidt, founder and CEO of Solera Health, told AIS Health. For example, MDPP services, which are categorized as high-risk, could create an additional burden for MA plans in terms of the reporting and audit requirements.
Phoenix-based company Solera Health has been working on behalf of MA clients to create an "integrated benefit network model" by looking for organizations that are interested in the MDPP and then scaling them in sites such as independent pharmacies, grocery, retail or area agencies on aging. As the program could only be delivered in-person and only about 400 out of 1,600 MDPP suppliers nationwide meet the CMS criteria, the pool of suppliers is small.
Solera Health also performs all the beneficiary outreach, determines enrollee qualification for the program and acts like Match.com to find the best MDPP program providers for the beneficiaries.
The expanded MDPP model will be delivered through "structured sessions" and train enrollees in long-term dietary change, increased physical activity and behavioral change. The program aims to achieve at least 5% weight loss by participants.
Although the CMS Office of the Actuary certified that the MDPP pilot program created an estimated $2,650 return on investment per person over a 14-month timeline, many health plans would do their own analysis before aggressively enrolling members.
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