Solera

Summary

Solera matches individuals at risk for chronic disease, particularly diabetes, with recognized prevention programs. Solera uses an algorithm to connect qualifying patients with a program that is an ideal fit for them and for which they can receive coverage.^[1] Patients are connected to Solera by providers and health plans, based on recommendations or electronic medical record and claims data.^[2] Individuals can also engage independently with Solera through Solera4me.com, where they can take a “1-minute quiz” to assess their risk level for type 2 diabetes.^[3] Those above a certain risk threshold can then go through matching process. Patients are matched to programs based on the following preferences:^[4]

1.     Looking to prevent diabetes or lose weight?

2.     Online or in-person class?

3.     One-on-one or one-on-one and group support?

4.     Fixed or flexible schedule?

Patients can be matched to any program within the Solera Network, a collection of CDC-recognized Diabetes Prevention Programs (DPPs). The Network contains hundreds of community partners, many well-known weight-loss programs including Weight Watchers and Jenny Craig, and digital health programs including Lark, Noom, and Yes Health.^[5]

Additionally, Solera introduced the SoleraONE app in late 2016, powered by HealthSlate, a Solera Network partner.^[6] The app is meant to serve as a digital supplement to local, brick-and-mortar DPPs, aimed at increasing engagement and retention and improving the efficiency of in-person coaching. The app includes videos that participants can watch as make-up for lessons that they have missed. It also features a portal that is designed to make reviewing and providing feedback on nutrition and activity logs more efficient for lifestyle coaches.^[7] In this sense, SoleraONE is meant to make community DPPs more cost-efficient as well as more successful and engaging.

Solera operates on a value-based model of health; it tracks the progress and outcomes of enrollees and submits claims when these patients meet milestones. This model provides shared incentive, as neither Solera nor the partner DPPs in the network receives money unless outcomes are met.^[8] Solera does the work of submitting claims—and thus lightens this load for its partners—and it potentially gives partners access to patients covered by payers that might not be otherwise reached. The health plans also see the benefit of value-based care; they reimburse based on milestones and outcomes rather than services.

Analysis

Solera is an impressive example of a leading attempt to address several unmet, or at least under-met, needs in healthcare and prevention. It provides a basic form of personal “precision medicine,” matching individual patients to health solutions that are likely to be the best fit for their individual needs and circumstances. It works to reduce “gaps” that would otherwise appear when payers, providers, and patients don’t share knowledge of what types of prevention programs exist. Perhaps most importantly, Solera demonstrates how value-based care can incentivize the most important elements of care for all stakeholders. Payers, DPP partners in the Solera Network, and Solera itself all earn money based on milestones and outcomes like weight loss.

The characteristics that make Solera innovative and valuable also make it a successful model. Solera increases convenience for all stakeholders involved, as providers and patients who use Solera can easily identify the right prevention programs. DPPs in the Solera Network gain access to a larger patient population but don’t have to take on the work of filing claims. Payers reimburse based on demonstrated milestones, meaning they don’t need to pay for prevention services that cannot demonstrate impact. The “value-based” model provides value for all parties involved, including Solera. The personalization of “matching” also has the potential of long-term retention among people at risk for diabetes. In addition, the SoleraONE app indicates that Solera is dedicated to increasing convenience and efficiency for its partners, and improving engagement among DPP participants.

While we have yet to see any concrete information on whether Solera leads to actual cost-savings, Solera has started to show that it can affect diabetes prevention. Inclusion in the Solera Network is increasingly treated as a milestone for diabetes prevention programs, especially among digital programs. It is certainly not a guarantee that Solera can provide the highest level of personal precision medicine; after all, patients’ stated preferences may not necessarily reflect the option that will actually keep them engaged (e.g., patients who value a program’s convenience may end up in a less motivating program). Moreover, the SoleraONE app may inadvertently reduce engagement in some patients—making a missed session far less consequential, for instance. However, the concept of a combined digital and brick-and-mortar DPP certainly deserves attention in that it has the potential to provide the “best of both worlds” for participants.