Since 2015, Solera Health has contracted with health payers to help patients access diabetes prevention and management programs as a covered medical benefit.
The Phoenix-based startup serves as a liaison and integrator, connecting payers and patients with community, online and national organizations recognized by the CDC's National Diabetes Prevention Program. Solera manages patient enrollment for these DPP providers, using its own analytics model to identify "best fit" programs based on individual patient needs and preferences.
Solera saw how these DPP providers engaged patients beyond the traditional health system. However, it also recognized many community organizations didn't have the capacity to meet the compliance and privacy standards that health plans necessitate.
"Many of the DPPs, especially those that operate at the hyper-local level — community centers, churches, senior centers — while qualified to deliver the DPP curriculum, have limited bandwidth," explains Brenda Schmidt, CEO and founder of Solera.
To address these issues, Solera also takes on administrative functions for community organizations with limited resources. Ms. Schmidt says Solera serves as the "back office" for these programs, overseeing audits, electronic claims, fraud prevention and compliance with HIPAA and Health Information Trust Alliance certifications.
Ms. Schmidt spoke with Becker's Hospital Review about how Solera found its niche at the intersection of chronic disease prevention, personalized medicine and nonprofit collaboration.
Note: Responses have been lightly edited for length and clarity.
Question: What prompted you to found Solera?
Brenda Schmidt: We founded the company around the belief that health behavior change is personal and there is not a one-size-fits-all solution for chronic disease prevention. For example, a 30-year-old, primarily Spanish-speaking resident of Los Angeles with hypertension who is at risk for diabetes and prefers a digital provider will have a very different experience than a 65-year-old grandmother in Boca Raton, Fla., who prefers to attend a local community class.
The DPP providers are also extremely diverse — although they all deliver a CDC-approved diabetes prevention curriculum, the program is delivered in different ways. An important part of our model is connecting patients with the "best fit" DPP provider based on their unique needs and preferences. Our data has shown consumer choice drives sustained engagement and outcomes, and the DPPs will do well, and equally well, when patients are matched or guided to the program where they are most likely to succeed.
By helping community organizations and digital therapeutics providers integrate into the existing healthcare system, Solera has created a network of a new class of providers as an adjunct to primary care. Without burdening the DPP providers with administrative and regulatory requirements, Solera is freeing our partners up to concentrate on what they do best — delivering personalized lifestyle modification programs to help patients achieve their health goals to prevent chronic disease.
Q: What challenges has Solera faced since its launch in 2015? What are some of your goals for the company in the next year?
BS: Our first challenge was introducing a new market category. Solera is a precision prevention network and integrator, which was a new concept in the marketplace. Many organizations were used to a model where they selected the "best" prevention vendor based on a request for proposal process.
At Solera, we changed the paradigm and allowed them to offer choice with full transparency to provider performance, based on a common standard of performance benchmarks. Once a potential payer or employer client understands how our model works, they realize the tremendous value to payers, consumers, physicians and program providers.
Our second challenge has been managing exponential growth in a very short period of time. In 2016, Solera's focus was on building the team and technology infrastructure for scale, and gaining traction with health plan clients for the DPP as a covered preventive benefit. In 2017, our focus is on executing those contracts at scale. Since 2015, we've signed major healthcare payer contracts and we now have over 50 million covered lives.
In 2017, we are also preparing for Medicare DPP coverage in January 2018 and contracting with additional payers and employers. Finally, we are turning our attention to our product strategy and roadmap for how to best leverage Solera's technology platform and health plan contracts to successfully enter new markets.
Q: What advice do you have for other tech startups working to deploy products in the healthcare industry?
BS: It is critically important to understand how the money flows in healthcare and how your business model aligns with healthcare payment structures. Technology startups can burn through a lot of cash figuring out how they will get paid.
It is also important for technology startups to identify complementary partners who can leverage their relationships and products. It is difficult to gain traction as an island in healthcare.
Also, make sure that any proposed pilots have clear criteria for success and a plan for expansion if those success metrics are met. Technology startups sometimes get caught up in serial pilots and never have the opportunity to scale their business.