Omada Health has achieved what many digital health companies crave: continuous support from payers providing its product as a covered benefit.
On Wednesday, the San Francisco company that began life as a digital diabetes prevention solution for people at risk of developing type 2 diabetes, announced that Blue Cross Blue Shield of Minnesota would provide its separate diabetes management program for type 2 diabetes patients to self-insured employers that are customers of the health plan. The product will be available starting in January.
“Omada’s program for type 2 Diabetes provides an experience unlike anything else offered in health care today,” said Craig Samitt, president and CEO of BCBS of Minnesota, in a news release. “I am very pleased that so many of our members can now have access to a personalized program with professional coaching from Certified Diabetes Educators wherever and whenever they need it.”
Omada has several health plans that provide its virtual diabetes prevention product as a covered benefit to self-insured and fully-insured employers, including those employers that are customers of BCBS of Minnesota. While the type 2 diabetes disease management product is available to only self-insured customers of BCBS of Minnesota, there are plans to expand it to the insurer’s fully-insured customers, confirmed Sean Duffy, in response to emailed questions forwarded by a company representative.
Omada Health allows people to track their glucose
BCBS of Minnesota also invested an undisclosed amount in the San Francisco digital therapeutics company with which it has had a relationship since 2013. Earlier this year, Omada announced that it had raised $73 million in a Series D funding round. All in, Omada Health has raised $220 million to date.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“BCBSMN also becomes the sixth Omada commercial partner to decide to invest in the company after seeing Omada’s products, and operations, first-hand,” Duffy said in a statement. “This type of investment is a huge vote of confidence in our approach to digital care, and an endorsement of our program’s ability to engage and empower people while producing clinical and economic returns for employers.”
In the email, Duffy said that the Minnesota health plan has 2 million covered lives across its self-insured book of business. But he did not specify how many were managing type 2 diabetes and so stood to benefit from this program.
Interestingly, while Omada has found traction with employers, private payers and health systems, including Intermountain Healthcare, neither the diabetes prevention program product nor the type 2 diabetes management product has the blessing of Medicare. This despite the fact that the Centers for Diseases Control has fully recognized Omada’s virtual diabetes prevention program, not a mean feat requiring providing data continuously showing improved outcomes.
“CMS is currently evaluating several models that might provide reimbursement for a program like Omada’s,” Duffy said.
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