Catalyst for Payment Reform

Extending Value-Oriented Payment into the Kitchen

Extending Value-Oriented Payment into the Kitchen

Nutrition interventions are gaining steam in health care world, and high-profile announcements from Lyft and BCBS at HIMSS19 are just icing on the cake. Whether it’s through medically-tailored meals or investing in social determinants of health, nutrition interventions designed to improve health outcomes from cancer and diabetes to depression are cropping up everywhere.

But, how can purchasers bring these programs to their covered populations?

One option is to include access to CDC-certified Diabetes Prevention Programs as a covered benefit for members, joining the likes of 30+ private insurance companies and 11 state employee benefits organizations. The CDC’s National Diabetes Program is designed to help prevent diabetes and is evidence-based with up to 58% risk reduction. This program could save an employer with 2,600 employees up to $91,096 over three years, and the American Medical Association offers a cost savings calculator specifically for purchasers exploring such an offering. Cost reduction of the $327 billion estimated costs of diabetes may come partly from managing pharmacy costs, but addressing the root cause and stopping the progression of pre-diabetes and diabetes will have a longer term impact on a patient’s quality of life and health outcomes.

Of course, here at CPR, our biggest question is: are payment models adjusting fast enough to keep up with the momentum for nutrition interventions? By expanding the scope of supplemental benefits for Medicare beneficiaries, the CHRONIC Care Act of 2018 represents a big step forward in this area. Medicaid is active in this space as well, with payers like the State of Minnesota helping individuals access housing, food stamps, and care through alternative payment methods (APMs).

For those working in employer-sponsored coverage, there are vendors popping up to specifically address Type 2 diabetes prevention or reversal alongside those providing corporate wellness platforms focused on nutrition. Both Virta Health and Solera Network catch our eye with their risk-based business models for diabetes management. We’d also expect to see more nutrition or social determinants of health interventions integrated into other types of payment reform arrangements. For instance, we overheard in a recent episode of The Commonwealth Fund’s The Dose podcast that hospitals in Portland invested in housing solutions in order to minimize readmissions rates and associated revenue loss.

Here at CPR we’re taking stock of our members’ activities in this space, and as result, our appetite for understanding the benefits of nutrition intervention in helping contain costs and improve patients’ quality of life grows each day.

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