Expanded Preventive Service for Medicare Advantage Members at Risk for Type 2 Diabetes
Posted July 25, 2018
Blue Cross and Blue Shield of Illinois (BCBSIL) has partnered with Solera Health, Inc. (Solera) to facilitate Medicare Diabetes Prevention Program (MDPP) services for our members with Medicare Advantage plans. According to a National Institutes of Health (NIH) trial, this type of program has been shown to greatly reduce the progression of prediabetes to Type 2 diabetes.1 The MDPP is recognized by the Centers for Disease Control and Prevention (CDC) to be a proven lifestyle change program. It seeks to help participants establish healthy habits and make positive changes, such as losing five to nine percent of their body weight, as this modest weight loss may help reduce the risk of developing Type 2 diabetes.2 Members who meet eligibility requirements may participate in the program at no cost to them.
MDPP Eligibility Criteria
· Blood value:
o Fasting plasma glucose of 110 to 125 mg/dL, or
o A1C value between 5.7 to 6.4, or
o Oral glucose tolerance test between 140 to 199 mg/dL.
· Body mass index (BMI) greater than 25 (or if Asian, greater than 23).
· No diagnosis of end-stage renal disease or Type 1 or Type 2 diabetes; previous gestational diabetes is not an exclusion to participation.
Solera will work closely with each eligible member to enroll them in a two-year program in their area. The program is focused on encouraging healthier food choices and increased activity. The first year includes weekly lessons in a small group setting for six months, followed by monthly lessons for six months. The second year provides ongoing support for participants who, during the first year, meet the five percent weight-loss goal and attend a minimum of two sessions every three months. Throughout the two years, participants have access to a one-on-one lifestyle health coach to help them set goals and stay on track.
Your patients who may be eligible may have received letters from BCBSIL informing them of Solera’s services. The letter explains that our members may verify their eligibility and enroll in the program by going to solera4me.com/bcbsil or by calling 866-671-8597 (TTY 711), Monday through Friday from 9 a.m. to 9 p.m., CT.
1 The Lancet, Volume 374, No. 9702, p1677–1686, Nov. 14, 2009. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Published Oct. 29, 2009. Accessed at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61457-4/fulltext
2 National Diabetes Prevention Program, CDC, Jan. 16, 2018, https://www.cdc.gov/diabetes/prevention/index.html
Solera Health, Inc. (Solera) is an independent company that provides diabetes prevention services for BCBSIL. Solera is wholly responsible for its own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by Solera.
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.
The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.