Priority Health lists Omada and the National Diabetes Prevention Program as lifestyle change programs for members with prediabetes or at risk for diabetes.
Priority Health lists two lifestyle programs aimed at prevention: Omada for commercial members diagnosed with prediabetes, and the National Diabetes Prevention Program for members at risk for diabetes. This page is the Priority Health provider manual, so it is written for physicians and office staff and not for employers.
What the program is and what members do.
What the programs are
The carrier describes both as programs that help patients make healthy lifestyle changes, such as eating healthy, exercising and managing stress, with peer support. They appear as two separate entries on the page.
How members use them
The provider manual does not explain the format, schedule, length or how a member enrolls or is referred. We would ask the carrier for those details before describing the experience to employees.
What they cover and do not
The page describes lifestyle change support and says nothing about devices, costs, coaching ratios or results. We would not promise outcomes, and the carrier does not either.
Eligibility, funding and plan design.
Who the carrier says they are for
This page is the Priority Health provider manual, so it is written for physicians and office staff and not for employers. It states Omada is for all commercial members diagnosed with prediabetes, and that the National Diabetes Prevention Program is for employer group, Medicare and Medicaid members at risk for diabetes.
How they are funded or sold
The page does not say how either program is paid for or whether a group must opt in. Treat cost as an open question for Priority Health.
Where they fit in plan design
They sit upstream of diabetes treatment, for people identified as prediabetic or at risk. They would pair with a wellness or biometric screening effort that finds those members. They do not replace the diabetes programs the carrier lists for members who already have type 2 diabetes.
What to settle before relying on it.
Is Omada included for our group?
The page says commercial members with prediabetes. We would ask Priority Health to confirm in writing that the group has access and what it costs, if anything.
How does a member qualify?
The carrier names a prediabetes diagnosis for Omada and being at risk for the National program. We would ask what evidence is needed, such as an A1c result or a doctor referral, and who verifies it.
How are members found and referred?
The page does not say. We would ask whether the carrier identifies eligible members from claims and reaches out, or whether members must self-identify.
Common questions about this program.
Who can join Omada?
Priority Health says all commercial members diagnosed with prediabetes.
Who can join the National Diabetes Prevention Program?
The carrier says employer group, Medicare and Medicaid members at risk for diabetes.
Are the two programs the same?
The carrier uses identical descriptions for both, lifestyle change support with peer support, but lists them separately with different audiences. Ask the carrier how they differ in delivery.
Where these details come from.
This page summarizes what Priority Health publishes. Programs change, so confirm current details with the carrier before relying on them.
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