NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “Calif. Blues Plan Sees Promise in Diabetes Reversal Platform.”

By Lauren Flynn Kelly

Diabetes prevention and diabetes management are both key tenets of Medicare Advantage insurers’ approach to addressing this costly condition that impacts one in three Medicare enrollees. But one tech-savvy startup aims to popularize a third category — diabetes reversal — and early adopter Blue Shield of California says the program has achieved very desirable results in less than two years.

Utilizing a nutrition protocol combined with high frequency interaction with health coaches to achieve significant reductions in blood glucose levels — all done virtually — Virta Health has a mission of reversing type 2 diabetes in 100 million people by 2025.

“It is a highly individualized virtual care team that’s working with the member,” says Steve Hastings, health plan sales leader with Virta. As part of the nutrition protocol, coaches work with patients to figure out what they can eat in their own “food environment,” and interact with members based on their preference.

Blue Shield of California includes Virta as an optional benefit enhancement in its Wellvolution platform, which offers online and in-person programs for general wellbeing and disease reversal.

Blue Shield Senior Director of Lifestyle Medicine Angie Kalousek says Virta is one of Wellvolution’s highest-performing providers, and in the short time members have been engaging with the program, they have demonstrated improved outcomes and reported multiple positive side effects.

In aiming to get members “off the medications they’re sort of shackled to as diabetics, they’re not only tackling the cost of health care but they’re really improving the life of the member,” says Kalousek of Virta. For the members who have engaged with Virta, nearly 65% have achieved statistically significant clinical outcomes.

In a small study looking at prescription drug claims for 60 members using the Virta treatment platform, Blue Shield of California observed that 85% of members lost weight. In addition, more than half of members narrowed their diabetes medications down to one agent, and 30% discontinued their medications altogether.

Meanwhile, the insurer is starting to look at ways to measure the cost effectiveness of using such a program. Considering the estimated lifetime expense of treating a diabetic patient is $100,000, and Blue Shield can pay up to $3,900 per member to Virta — although most members achieve maintenance levels at a lower cost — “there’s an argument that there’s a lot of cost savings on the table,” says Kalousek.