The big health payer news last week was that Aetna was mulling the acquisition of one or more of its competitors: particularly Humana or Cigna. A recent Forbes analysis suggested that such a move would be a result of changes to payment models in healthcare. But Humana, Cigna, and Aetna have all been important players in the digital health. So what might a merged Aetna-Cigna or Aetna-Humana company's digital health offerings look like?
Aetna's biggest digital health footprint is its iTriage app, which the company acquired in 2011. iTriage has evolved from just a symptom navigator, physician and hospital finder app to include price transparency tools, health education and literacy tools, prescription management tools, and -- soon -- maybe even video visits with physicians. And other Aetna apps do even more: Aetna Mobile has many of iTriage's features, plus it allows Aetna members to access information about their insurance, and Aetna's Resources for Living app helps users to manage stress and anxiety, moderate work-life balance, and track their moods.
All in all, Aetna is trying to offer a comprehensive suite for helping members -- and others -- manage their health. But they're less focused on preventative measures like promoting good diet and exercise. This is likely by design -- Aetna's CarePass platform, which the company shut down last year, had this functionality, drawing in data from other devices and apps to promote activity for users.
Both Humana and Cigna have focused their health tracking efforts on this kind of tracking.
Last August, Humana finally added a mobile component to its employee wellness offering, HumanaVitality. In addition to tracking health and fitness metrics, members can use the app, available on iOS and Android devices, to take health assessments, challenge coworkers to health-related competitions, and read information on staying healthy. Since then they’ve continued to add new features including the ability to buy Amazon Gift Cards in the app with “Vitality Bucks,” a currency users rack up by being healthy.
Meanwhile Humana's Cue, a new app designed just for the Apple Watch, regularly reminds users to do little health-conscious things like standing up, drinking water, or straightening their postures. Humana also has a member app similar to Aetna's, a consumer app called MyHumana, an app for care managers called CareMatch, and RightSource, a prescription management app.
Cigna's efforts include Cigna Health Matters, a program for members and Coach by Cigna, a collaboration with Samsung. With Cigna Health Matters, after completing the assessment and answering questions about the user’s BMI, cholesterol, and blood pressure, members are given a Health Matters Score. From there, as users work on improving their health, their score changes. The score also helps Cigna coaches and clinicians target the members that need the most help improving their health.
Meanwhile, Coach by Cigna, which is available to users of the Samsung Galaxy S5 and Galaxy S6 smartphones, creates a health improvement plan for a user by asking the member questions about exercise, nutrition, sleep, stress, and weight. The latest version uses “psychology of lateral assessment” to determine the user’s personality type, wants and needs, as well as preferences, so that Cigna can profile the user more accurately.
The big question when it comes to Aetna, these rumored acquisitions, and digital health, is whether, if Aetna buys Cigna or Humana, it will be interested in trying again with a preventative health, lifestyle play like HumanaVitality or Cigna Health Matters. The company already decried its own CarePass attempt as a failed experiment, so it seems unlikely, but acquiring Cigna or Humana and then killing those programs would leave a lot of value on the table, not to mention upsetting users.
Most likely, Aetna will focus its preventative health efforts on employee populations, rather than trying to make them available to everyone like it did with CarePass. Aetna has shown just recently that it's still looking at employee health, it announced a remote patient monitoring and patient engagement pilot with Newtopia. Newtopia will offer its health engagement platform to some of Aetna’s largest employer customers. The platform uses genetic testing and lifestyle assessments to create personalized nutrition, exercise and behavior management plans for users. Newtopia then supports users with online coaching via mobile devices, social networks, and wearable device integration. Either HumanaVitality or Cigna Health Matters could be operated in the same vein.
Beyond that, Aetna continues to run pilots that focus on ACOs and remote patient monitoring. At HIMSS in 2014, Aetna CEO Mark Bertolini talked about some initiatives the company has underway to monitor patients with chronic disease and intervene before it becomes costly and life-threatening. The payer was partnering with Medtronic to use the data feed from pacemakers to figure out when a cardiac patient has put on extra water weight and is in increased danger of congestive heart failure. They were also working on a pilot with continuous glucose monitors to try to predict and prevent hypoglycemic events.
Humana CEO Bruce Broussard spoke at the most recent HIMSS event, and his sentiments weren't far off from Bertolini's a year earlier: the healthcare system, including payors, needs to become more patient-focused, especially when it comes to the most expensive healthcare customers with multiple chronic diseases. Expect that to be the focus of any payer consolidation, with digital health and wellness tools acting as an important enabler.
