Omada’s founding story — and our growth as a company — has been inherently tied to the the passage of the healthcare law that turns six this week. Last year, I admitted to reporters that I both kept a copy of the full legislative text on my Kindle, and that our company’s existence was a direct result of the ACA’s passage.
Both are still true, by the way.
The ACA mostly gets headlines for the role it’s played in helping 20 million Americans gain healthcare coverage. Just as importantly though, the law is changing the way healthcare is delivered and paid for across the system — from commercial plans to Medicare and Medicaid. It’s spurred huge innovation in the private sector, while better aligning financial incentives with the interests of patients, and the best instincts of providers.
But today, the Affordable Care Act has aligned incentives in Medicare with our company’s mission like never before. Earlier this morning, U.S. Secretary of Health and Human Services Sylvia M. Burwell announced that, for the first time, Medicare will begin the process of reimbursing providers for delivering the Diabetes Prevention Program (DPP) to at-risk beneficiaries.
This is monumental news for the 51% of American seniors — more than 22 million — living with prediabetes. For years, Medicare beneficiaries has reimbursed providers to screen individuals for diabetes, and treat them if they have the condition. But until today, if a Medicare beneficiary was found to have prediabetes, his or her provider had no financial incentive to refer that individual to programs that may reduce disease risk, and steer that person towards a healthier, and longer, life.
HHS will provide this new benefit by using her authority under the ACA to expand successful demonstration projects from the Medicare Innovation Center. For the past three years, our friends at the YMCA have operated a demonstrated project where they administered the DPP to eligible Medicare seniors at 17 sites across 8 sites. The results from that project have increased the quality of care for Medicare beneficiaries, and today, the Secretary announced the CMS Actuary has certified that it also lowered costs for the Medicare program - saving the program approximately $2,650 per beneficiary in just 15 months. These facts provided the evidence necessary for the Secretary to extend this benefit across the Medicare system.
Today’s news is also hugely important for our company, and our mission of inspiring and enabling people everywhere to live free of chronic disease. As the largest CDC-recognized DPP provider in the United States — in-person or digital — our data set on the engagement and weight loss outcomes of more than 50,000 participants in all 50 states can be a valuable resource as CMS implements this new benefit. Omada Health’s Mike Payne, Chris McGowen, and the public policy team have already helped multiple conversations with CMS about how seniors will integrate a digital diabetes prevention benefit into their daily routines, and how programs can be designed to get optimal results for those over 65.
To date, we’ve served more than 2,000 Prevent participants over the age of 65 — and the results they’ve achieved can provide a roadmap for how Medicare can scale effective diabetes prevention to every beneficiary who needs it. Six months after starting with Omada, 84% of participants over the age of 65 remain engaged with our program. With an average of 69, those participants lose 7.8% of their body weight. According to data from the original DPP trial, this amount of weight loss correlates to an approximate 71% three-year risk reduction for developing type 2 diabetes.
If Medicare can achieve results anything like those, they’ll change millions of lives — and save billions of dollars in the process.
But for Omada, our success has never been fully captured by measuring raw data — whether it be weight loss or reductions in a1c average blood sugar. Success is measured not only in the sheer number of lives we impact, but in how we impact those lives. Our work with Medicare Advantage patients through our partners at Humana is a great example.
In the coming weeks and months, we’ll be working closely with policymakers at CMS, and our allies in the prevention community, to ensure this new benefit is implemented effectively, and reaches as many beneficiaries as possible. We’ll have a great deal to say on that.
But today is a day for celebration. With Secretary Burwell’s announcement, we are entering a new era of preventive chronic disease care for millions of American seniors. For Omada, that means even more of the boomer generation will be going next generation for their own care.
Here is the New York Times story announcing the news.
For more on the demographic and chronic disease trends that have spurred Medicare to invest in prevention, read Chronic Boom, Part 1: Why Medicare Needs Innovation More than Ever.
And for a preview of some of the lessons we’ve learned working with seniors, check out Chronic Boom, Part 2: Tips for Engaging Seniors in Preventive Health Benefits.