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New Preventive Service for Medicare Members at Risk for Type 2 Diabetes

July 19, 2018

The Medicare Diabetes Prevention Program (MDPP) has been proven by a National Institutes of Health (NIH) trial to greatly reduce the progression of prediabetes to Type 2 diabetes1. Effective immediately, your at-risk senior patients who have a Blue Cross and Blue Shield of Oklahoma (BCBSOK) Medicare health plan and meet the eligibility criteria outlined below can participate in this program at no cost to them.

MDPP eligibility criteria:

  • Blood value:
    • Fasting plasma glucose of 110 to 125 mg/dL, or
    • A1C value between 5.7 to 6.4, or
    • Oral glucose tolerance test between 140 to 199 mg/dL
  • BMI greater than 25 (or if Asian, greater than 23)
  • No diagnosis of end-stage renal disease, Type 1 or Type 2 diabetes; previous gestational diabetes is not an exclusion to participation.

BCBSOK has partnered with Solera Health Inc. (Solera) to facilitate MDPP services for our members. Solera will work closely with members to enroll them in programs in their area.

This program is meant to help participants change their lifestyle, establish healthy habits and lose five to nine percent of their body weight. This modest weight loss dramatically decreases the risk of developing Type 2 diabetes.

The two-year 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 set goals and stay on track.

Your patients who may be eligible received letters from BCBSOK in November 2017 and June 2018 informing them of Solera’s services. If you or your patients need additional information, please refer to the Provider FAQ Sheet PDF Document. Patients can verify their eligibility and enroll in the program by going to solera4me.com/bcbsok or by calling 1-866-671-8597 (TTY 771), Monday through Friday from 8 a.m. to 8 p.m. CST.

 

1 https://www.cdc.gov/diabetes/prevention/prediabetes-type2/preventing.html

Solera Health Inc. is an independent company that provides diabetes prevention services for BCBSOK.