San Francisco startup Omada Health is expanding its prevention efforts beyond pre-diabetics, targeting adults — and their employers or health plans — who are at risk for cardiovascular disease, a significant driver of cost and adverse outcomes.
Founded in 2012, Omada has worked with the likes of Kaiser Permanente and workforces from Stanford Healthcare and Costco to prevent type 2 diabetes, using web and mobile engagement and counseling efforts based on guidelines from the National Diabetes Prevention Program, which is led by the CDC.
It’s looking to do the same with cardiovascular health, with the expansion rooted in the important but little-discussed guidelines from the U.S. Preventive Services Task Force – essentially the Consumer Reports of preventive care – that came out last August and take effect by 2016.
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“A health payer can choose how they want to react to the guidelines,” Omada Health CEO Sean Duffy said. “However, it really adds to our value – we can take it to them, and they have to think about it by law.”
The Affordable Care Act requires coverage of anything with an “A” or “B” rating from the Task Force within a year’s time. For the cardiovascular guidelines, the Task Force issued a “B” rating, meaning “there is a high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
Health plans are already thinking about how to adopt the guidelines before the next enrollment season for plans in 2016, and Omada hopes to position itself as a go-to resource well in advance of that, Duffy said.
“We’re already having health plans reach out to us,” he said. “We want to be a one-stop shop to implement the recommendations.”
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The recommendations may sound somewhat wonkish, but they are a key piece of the puzzle for how health plans and self-insured employers go about targeting the costly cardiovascular conditions and those who are at risk of developing them, according to Duffy.
As with it’s pre-diabetes program, called Prevent, the efforts with cardiovascular health indicators – hypertension, high cholesterol, metabolic syndrome and the like – are aimed at individuals with high-risk, not those who already have a chronic disease.
Omada has long said it wanted to expand into other areas beyond diabetes, but the issuance from the Task Force prompted the company to act faster than it had initially anticipated, Duffy said.
“This recommendation forced us to do something we wanted to do quicker,” he said. “This will surface on the to-do list of all the major health plans.”
Omada looks to help large employers and health plans save money by preventing chronic disease in the first place, and the latest cardiovascular efforts could go a long way in helping spur more healthful behavior, Duffy said.
“From a clinical standpoint, it has has the potential to create a real tipping point over 2015 as it relates to how the country tries to tackle obesity,” he said of the guidelines.
All of Omada’s compensation is “at-risk,” meaning it’s outcome-based for clients.
Omada has raised $30 million in funding from Andreessen Horowitz, Kaiser Permanente Venture, the California Healthcare Foundation and others.
USPSTF Recommendations from Omada Health on Vimeo.
