Digital diabetes programs

Quick reference guide

What are the digital diabetes programs?

Capital Blue Cross, with the help of two new providers, is launching three new digital diabetes programs.

These programs, with no cost share for eligible members and no referral required, are effective October 1, 2021 for Commercial group and individual members, age 18 and older, with Capital Blue Cross medical coverage, and January 1, 2022 for Medicare Advantage and Vibra members. They will not be available to CHIP or FEP members. Diabetes Reversal program eligibility may be dependent on employer group for Large Group ASO coverage.

Who are the providers and how do they work?

Virta

Virta’s focus is on reversing diabetes, and the program is very different from other diabetes programs. With Virta, members learn how to change their diet so that the body burns fat for energy, instead of sugar (nutritional ketosis) which naturally lowers blood sugar and the need for diabetes medication. Members get care online through their smartphone app. Virta provides a physician-led care team, a personal health coach, free diabetes testing supplies, ketone and bodyweight tracking tools, and access to a private online patient community.

Omada

Omada focuses on both preventing and managing diabetes and is a digital lifestyle change program that helps people with Type 1 diabetes or those with/or at risk for Type 2 diabetes build sustainable habits that improve their health. Omada’s approach combines proven science with personalized support to help participants build healthy habits that last. The program includes a professional health coach for one-on-one guidance, a wireless scale to monitor progress, weekly online lessons, and a small peer group for real-time support.

Which program is right for my patient?

Diabetes prevention (Omada)

Your patient has prediabetes and is at risk for developing Type 2 diabetes if preventive steps are not taken.

  • Your patient is interested in tips on eating better, moving more, and managing stress and received a high-risk result (score of 5 or higher) on the CDC’s Prediabetes Risk Test.
  • Your patient is overweight and has had a blood test results in the prediabetes range within the past year:
    • Hemoglobin A1C: 5.7 – 6.4%
    • Fasting plasma glucose: 110-125 mg/dL
    • 2-hour plasma glucose (after a 75g glucose load): 150-199 mg/dL

Diabetes management (Omada)

  • Your patient wants to learn more about how to manage their condition (Type 1 diabetes, or Type 2 diabetes).
  • Your patient is interested in taking smaller, incremental steps to manage their diabetes.
  • Your patient is not ready to try the rigorous nutrition plan (including carbohydrate restriction) required by the Diabetes Reversal Program.

Diabetes reversal (Virta)

  • Your patient has Type 2 diabetes and is ready to commit to a Diabetes Reversal Program, including following a personalized nutrition plan that involves carbohydrate restriction.
  • Your patient does not have any medical conditions that Virta is unable to support through its continuous remote care model.

How can members enroll?

Providers may direct their eligible members to go to the program sites for more information.

Here’s an overview of how the enrollment process works for Omada and Virta1:

Diabetes prevention & management (Omada)

  1. Complete Omada’s health screener online.
  2. Complete the online application. If a member is determined to be eligible, they will enter brief contact and health information.
  3. Set up a private account by choosing a password and answering some health questions.

Diabetes reversal (Virta)

  1. Submit an initial online application.
  2. Complete a no-obligation phone consultation with a Virta enrollment advisor.
  3. Submit their health history and release of information.
  4. Provide requested lab results.
  5. Complete a no-obligation video consultation with a Virta medical provider.

How does this benefit my patient?

Diabetes is a growing public health epidemic. According to the Centers for Disease Control and Prevention (CDC), more than a third of U.S. adults (88 million) have prediabetes, and about 1 in 10 people (34.2 million) have diabetes. Nationwide, the healthcare costs for people with diabetes are more than twice as high as for those who do not have diabetes.

For individuals with prediabetes, the program focus is weight loss through healthy eating and exercise to reduce the risk of developing Type 2 diabetes by half. For adults diagnosed with diabetes these programs may help members take steps to manage their condition and avoid associated complications such as kidney failure, stroke, and heart disease.

Helping our members prevent, manage, or reverse diabetes has the potential to reduce healthcare costs, and more importantly, may lead to improved health outcomes and better quality of life for your patients.

Do Omada or Virta ever reject applications for participation?

Yes. During the initial screening process, It is possible that, during the initial screening process for both programs, that Virta or Omada may determine that an individual is not a good fit. For example, the Diabetes Reversal Program may be unable to accept applicants who have additional chronic conditions (including, but not limited to, conditions such as advanced heart disease, advanced liver disease, and advanced neurologic disease) that can’t be supported by the program’s remote care model.

Note that, even if an individual is not accepted by a program, high-risk members with diabetes who require additional clinical support will continue to have access to Capital Blue Cross’ telephonic care management program at 888.545.4512 (TTY: 711) if their group has opted in to the Care Management Benefit. Additionally, some members who are not accepted by the Diabetes Reversal Program may still be good candidates for the Diabetes Management Program.

How do members communicate with their health coach and/or program peer support group?

Communication occurs through the program’s app or website.

Will all members who participate in the Digital Diabetes Programs receive devices that can be linked to their smartphone or other mobile device?

During the application process, Omada and Virta will determine which devices are appropriate for each member. While not all members will receive a device, most members accepted into a program will.

If a member already owns a device such as a digital scale that can be linked to the app, can they use their own device?

The Virta program welcome kit comes with everything a patient needs to get started with and successfully participate in the Virta treatment. It includes devices such as a digital scale and a Keto-Mojo meter that enables patients to measure their glucose and ketone levels along with all the test strips they require to use the meter. While Virta’s preference is for patients to use these devices, if a patient prefers to use their own, they have the ability to do so.

Omada ships out a cellular connected scale that is specifically configured to that member’s Omada account. The member will not be able to configure their own digital scale to their Omada account. The same is true for Omada’s cellular connected blood glucose meter.

What kind of communication will I receive as a provider from these programs?

With member consent, providers will be notified by fax when their patient enrolls in Virta. Virta providers will send any results or recommendations to the member’s PCP or endocrinologist including labs and medication recommendations, so you will know how they are doing. Virta functions as a specialist, focusing on reversal of diabetes. However, Virta's providers do not replace the PCP relationship, and advocate for members to seek care regularly for health maintenance and medical conditions outside Virta’s scope of practice.

Virta sends regular updates to you on progress, labs and medication changes. Virta provides fax updates to you at enrollment, 14, 30, 60 days, and every 30 days thereafter, as well as an update if the patient is released from the Virta treatment. Progress reports will include:

  • Results from labs tests: A1c, lipid panel, glucose, weight, other T2D info (labs ordered every 6 months and included in PCP monthly fax report)2
  • Comparison to prior values
  • Rx changes (send at a regular cadence rather than every time a change is made to reduce burden of updates)

Members may also consent to have Virta providers directly engage with you to discuss all recommendations, keeping you in the loop to best manage their care.

With Omada, you will continue to manage your patients as you have before, as Omada does not provide adjustments to their medical treatment plan. You remain at the center of your patient’s medical home. Omada fills in the gaps between PCP visits and reinforces the member’s treatment plan. Omada helps the member to be actively involved in their care and adhere to their treatment plan on a day-to-day basis. Ask your patients how Omada is helping them manage their diabetes during their regularly scheduled visits.

Please note, Omada will not know the member’s PCP unless the member tells them. However, Virta will know who the member’s PCP is, as this is part of the application process.

What else should I know as a provider?

You play a key role in helping your patients with prediabetes reduce their risk of developing diabetes, as well as in helping those patients who already have diabetes successfully manage the disorder by spreading the word about this new benefit and encouraging your interested patients to go to the program sites for more information.

Virta and Omada are offering a medical service to members who participate. As a result, they are providers and will submit a monthly claim for each participant who engages with the program. These claims will not result in cost sharing with the member.

While patients may only participate in one program at a time, they do have the option to switch if they become eligible for an alternate program.

What if I have more questions?

For more information, contact your Provider Engagement Consultant or the Provider Service team at 866.688.2242.

1Members will not be able participate until the launch dates.

2If a patient has labs done through their PCP or health plan, Virta can access those in lieu of ordering additional labs.