This quarter the payer space continues to push digital initiatives. In the last few months CMS announced that home health organizations could get Medicare reimbursement for remote monitoring. Meanwhile, private insurers charge on with digital health programs geared to tackle chronic conditions, mental health and overall wellness.
Read on for a roundup of Q4 payer news. Check out Q1, Q2, and Q3 payer roundups for this year’s overviews.
The government as payer
Outside of ongoing debates on the legality of the Affordable Care Act, this quarter saw a fair amount of news regarding CMS and other government sources affecting the payer markets.
Chief among these was word that CMS would begin allowing home health agencies to report the cost of remote patient monitoring for reimbursement under Medicare. The finalized ruling, to be implemented in 2020, also came with other clarifications from the agency regarding payment and safety standards for qualified home infusion therapy suppliers; a reduction in administrative responsibilities for certifying physicians; and the planned implementation of a new case-mix system focused on patient need over care volume. Just a few weeks earlier, some physicians questioned whether the administration’s proposed plans to reimburse doctors for five-minute “check-in” calls will have a positive effect on care and costs.
Meanwhile, FCC Chairman Ajit Pai provided an update on the FCC’s efforts toward promoting rural telehealth programs. Whereas funding requests outstripped the rural healthcare program’s spending cap in 2017, Pai said that the FCC expects all requests in 2018 to be fully funded thanks to a spending cap increase of $400 million to $571 million.
"Unfortunately in 2017, demand for this program outstripped the spending cap for the program … and that’s hardly a surprise when you consider that the program was established in 1997 over 20 years ago, during the days of dial-up — I’m sure you all remember those AOL CD-ROMs and the whirring of those modems — and the funding limit for this rural healthcare program had never been increased, not even for inflation,” Pai said at the Connected Health Conference in Boston. ”"This reflects what the funding would be had the cap been adjusted for inflation all these years, [and] we’re also adjusting for inflation going forward, allowing the program to scale as advances progress. We are also allowing any unused funds to roll forward to future years.”
From the legislative side, Q4 saw the passing and eventual signing of theSupport for Patients and Communities Act, a bipartisan bill that, among other things, expanded opioid-specific telemedicine services and modified provisions regarding electronic prescriptions and post-surgical pain management.
Further down in the bill, the telemedicine portion spelled out that states will be able to seek federal reimbursement under Medicaid for telemedicine services of substance abuse disorders including medication-assisted treatment, counseling, medication management and medication adherence. The legislation specifically targets people in high-risk groups including American Indians and Alaska Natives, adults under 40, individuals with a history of non-fatal overdoses and individuals with co-occurring serious mental illness and substance use disorder.
“We will work to strengthen vulnerable families and communities, and we will help to build and grow a stronger, healthier and drug-free society,” President Donald Trump said in a statement.
Wellness programs
The small handful of benefits program news in Q4 was kicked off with an announcement that Performance Lab Technologies and Vivametrica would be jointly launching a activity data tracking service for life insurance companies. Called EngageRate, the service looks to better engage life insurance policy holders with their health by offering personalized artificial intelligence coaching and activity tracking. It also helps insurance companies track and validate their underwriting services.
Around this same time, life insurer John Hancock announced that it would be giving all of its members access to Vitality, a behavior-changing rewards platform that is combined with a wearable. Members will have the ability to opt into two plans. The first is Vitality Go, which gives members access to fitness and nutrition resources and and personalized health goals, and gives users discounts at brand outlets when they reach their activity goals. The second, Vitality Plus, costs users $2 a month, and offers consumers incentives like costs savings of up to 15 percent on annual premiums for healthy habits.
Mid-November saw UnitedHealthcare’s “Motion” incentive program expand to include Apple Watches among its laundry list of compatible devices. Further, program participants who consistently log their activity with the device can pay off the full price of the watch within roughly six months.
Just a few days later, Peerfit would unveil a direct-to-consumer version of its digital platform for fitness benefits. Rather than offering employees redeemable fitness class credits through a paying employer, users can now choose the number of class credits they would like to receive through a pay-as-you-go subscription service. The service currently provides access to gyms and fitness studios across 46 states.
Payer driven digital health initiatives
Payers continue to kick off digital health initiatives this quarter. The programs target a myriad of issues from helping lonely seniors to improving air quality.
During the enrollment season UnitedHealthcare announced updates to a slew of digital resources designed to provide employers insight on their employees’ health, as well as encourage those employees to better apply their health benefits.
These include: Health Plan Manager, an interactive analytics tool for self-funded health plans; Digital Onboarding, an online plan enrollment system; PreCheck MyScript, a tool integrated into existing EHR platforms that allows patients and providers to view medication costs; and Personalized Claims Videos, a system that offers bespoke video explanations of benefits and medical bills.
Meanwhile in Asia Pacific news, China’s leading one-stop healthcare ecosystem platform, Ping An Good Doctor announced in November a Memorandum of Understanding (MoU)with Bangkok Dusit Medical Service (BDMS), the largest healthcare network in Thailand. The two medical service giants will integrate and exchange their experienced medical resources online and offline, and provide one-stop healthcare services for millions of Chinese patients.
Looking to the mental health space,Cigna has teamed up with Happify Health and Prevail in order to give clients new digital platforms designed to tackle stress, anxiety and depression. In January 2019, the payer plans to roll Happify and iPrevail into its Cigna Total Behavioral Health program.
Happify helps users maintain well-being and targets preventing diagnosable mental health conditions, according to a statement. Users can access activities and games as well as medication apps.
Meanwhile, Humana is looking to offer more options to seniors living in isolation. Papa, a startup that schedules companion visits for lonely seniors, has teamed up with Humana to support those covered under Medicare Advantage. The Florida-based startup trains and provides college-aged assistants to meet and spend time with seniors in their home, and bills itself as a “grandkids on demand” service.
“At Humana, we know if we truly want to impact the health of our Medicare Advantage members, we need to look at the whole person, and that includes the social determinants of health, like loneliness and social isolation,” Humana Central and North Florida Medicare President Deb Galloway said in a statement.
Some payers are looking at chronic conditions. Onduo, a Verily-Sanofi joint venture focused on digitally-driven diabetes management, is looking to further protect its members from foot ulcers and limb loss. Orpyx Medical Technologies’ diabetic foot ulcer sensors for its members.
Thanks to a newly announced deal struck between the companies, Orpyx Medical Technologies’ FDA-cleared SurroSense Rx system will be available to “select members” of Onduo’s diabetes management program in 2019. The system consists of a thin sensor that is placed in a patient’s shoes and a wirelessly connected smartwatch, which displays readings and alerts to the user when dangerous pressure levels are detected.
Payers have also become involved with public health initiatives. In October Blue Shield of California Foundation awarded a $250,000 grant to SmartAirLA — a public-private partnership between the City of Los Angeles, its department of public health, digital inhaler maker Adherium, and others — to improve air quality and reduce the burden of asthma in the city. To do so, the group will be providing asthmatic, underserved LA children with Adherium’s connected Bluetooth inhalers.
"This project puts the internet-of-things in the hands of the people who need it the most, underserved children who are literally, struggling for breath," Peter Long, president and CEO of the Blue Shield of California Foundation, said in a statement. "And it will help their communities advocate for a healthier environment with a powerful new dataset.”
The business side
At this year’s Connected Health Conference in Boston, Dr. Harold L. Paz, EVP and chief medical officer for Aetna discussed the company’s new mobile strategy and lessons learned from the past. Aetna looked to be ahead of the game when it acquired Healthagen, maker of the iTriage app, back in 2011. However, the following years saw the insurance company’s mobile and digital initiatives flounder (see the 2014 collapse of CarePass), and just this year Aetna quietly shuttered iTriage itself in preparation of an Aetna Health flagship mobile app.
Paz said that the payer’s early acquisition wasn’t entirely for nought. Rather, bringing on Healthagen’s talent and trying different strategies led to the company’s latest digital strategy: a single, patient-facing app that takes a long-term approach to healthcare navigation and provision.
Digital has also been playing into UnitedHealth Group’s offerings. UnitedHealth Group finished the third quarter strong, reporting a 12 percent year-over-year revenue growth totaling $56.6 billion. This finish prompted the company to raise its 2018 net earnings outlook to approximately $12.10 per share, up from the $11.80 to $12.05 range.
CEO David Wichmann highlighted the company’s use of information, technology and clinical insights as reasons for the success.
During the call he pointed out consumer-facing services like its on-demand healthcare and Colorado Doctors Plan offerings helped contribute to the company’s earnings. In particular he went on to discuss the digital health platform Rally, which was acquired by UnitedHealth Group in 2014and helps users manage their health plans by providing tools to help them understand upfront health costs or schedule appointments.
Meanwhile in hiring news, Udi Manber, a veteran of Amazon, Yahoo and, most recently, Google, has been tapped by Anthem, CNBC reports. Specifically, Manber will be building and leading a team focused on artificial intelligence applications, signifying an increasing interest in the technology for the large health insurer.
Manber held the title of vice president of engineering at Google and was largely responsible for its various search engine offerings. After nearly a decade, he left the tech giant to join the National Institutes of Health.
