Digital health-focused moves from payers throughout the last quarter ranged from partnership agreements and program launches to acquisitions and CMS coverage rulings. Several such headlines came from major players like Cigna, UnitedHealth Group, pharmacy benefit managers (PBMs) and various Blue Cross plans, and frequently involved digital health mainstays such as Livongo, Fitbit, Doctor on Demand and more. Read on below for a roundup of the stories MobiHealthNews wrote covering this market during Q2 2019.
Digital health dealmaking
First and foremost, insurers big and small continue to views digital health tools as a means toward improving care and cutting down unnecessary expenses. In Q2 2019, this mentality manifested in a number of deals between payers, digital startups and even some larger tech entities.
An example of the latter came at the very start of the quarter when Amazon announced and unveiled the first six HIPAA-compliant Alexa skills. Alongside those released by providers was a skill from Cigna that allowed employees enrolled in a plan to check in on their wellness program’s goals or other info, while PBM Express Scripts offered its own tool for members to track home deliveries of their treatments.
A few weeks later, Oscar Health would cut a deal with Cardiogram that would give members at risk for diabetes or atrial fibrillation access to the app maker’s disease detection.
Around this same time, telehealth company Doctor on Demand and Humana jointly launched a new virtual care model that would allow plan members to access in-network primary care doctors with no copay. And sticking to telehealth, Optima Health, the health plan division of Virginia integrated delivery system Sentara Healthcare, launched a collaboration with MDLive that is using telehealth to improve population health and quality measure scores. The arrangement is being viewed as a pilot, with changes in quality scores being continuously evaluated throughout the rollout. Additionally, Optima Health also announced plans to use Cardinal Analytx Solution’s health insight generation platform to help drive proactive care offers to members and patients.
In June, a joint venture between Independence Blue Cross and Comcast finally pulled the curtains back on its own unique virtual care support platform. Called Quil Health, the company’s new CEO described plans to build an app- and TV-based service that guides patients through pre-admission and post-discharge challenges, with the ultimate goal of reducing complications and their resulting costs for payers.
UnitedHealth Group put a cap in the quarter when news broke in late June that the payer had purchased online patient community portal PatientsLikeMe. While the terms of the deal were generally kept under wraps, the companies since made it clear that although the startup would become a part of UnitedHealth Group’s research arm, no sensitive patient information would be identified and supplied to the insurer.
PBMs gauging digital health
As healthcare begins to incorporate digital health tools and pharmas grow increasingly interested in digital therapeutics, some PBMs are laying the groundwork to support reimbursement for these novel therapies and products.
In particular, Express Scripts announced in May that it will be releasing a stand-alone formulary in 2020 that highlights vetted digital health tools for the pharmacy benefit management firm’s payer and consumer customers. With an initial focus on validating chronic disease prevention and management tools, the company sees this effort as a step toward establishing validity for these products and, subsequently, ensuring lower costs or reimbursement.
“We see a need to put mechanisms in place to help carefully manage these innovations, and are proud to lead again by being the first health services organization to establish a formulary of this nature,” Mark Bini, VP of innovation and member experience at Express Scripts, said in a statement. “This formulary will help ensure developers do right by payers and consumers, while increasing patient access to technology that can help improve their health.”
CVS Health followed suit in June with the rollout of Vendor Benefit Management, a new service that will help CVS Caremark PBM clients roll out and manage third-party health products.
According to the announcement, Vendor Benefit Management will help PBM clients access negotiated pricing, real-time and standardized member eligibility verification, easy billing and payment processing, and standardized result reports for supported vendors and products. Designed as an open platform that will support a range of vendors and products, CVS Health said it will be looking to smoking cessation and substance abuse support, medication adherence, care management and benefit navigation products as potential additions to the service down the road.
“The challenge is not just in developing [digital] products — we now have very effective products — but how do we distribute and gain reimbursements for those products in a very, very scalable way, in a way that allows not just the really early adopters to buy and then offer to their populations?” Big Health CEO Peter Hames, whose digital health product is the first to be included in the service, said. “What this partnership with CVS offers, specifically in the context of digital therapeutics, is a new pathway to facilitate that mainstream adoption of a digital therapeutic.”
CMS
This quarter started off on a contentious note for the US’ largest payer of healthcare services when Administrator Seema Verma, a well-documented opponent of single-payer healthcare, went on the record to say that “Medicare for All” and government-run healthcare is “the greatest threat to innovation” within the space.
“One of the things that troubles me in terms of how we go forward with technology and innovation and harness that to solve some of our most difficult problems is there has been a lot of discussion about government-run healthcare around 'Medicare for All,’” she said at the World Medical Innovation Forum in Boston. “I think those proposals are the greatest threat to innovation in healthcare. The reality is government has often been a barrier to innovation.”
These comments came around the same time that CMS finalized a ruling that expanded access to telehealth for Medicare Advantage patients.
“These changes will provide MA plans with the ability to offer expanded telehealth coverage to meet the needs of their patients,” the agency wrote in a press release. “Patients in MA plans have always been able to receive more telehealth services than those in Original Medicare, and with the final rule there is an even greater likelihood that these patients will have access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.”
But while CMS’ digital coverage expanded in one direction, a research letter penned in JAMA Internal Medicine in early May highlighted a key area in which the agency’s efforts fell short. According to the University of Michigan team, the Affordable Care Act-mandated Physician Compare website designed to provide patients with information about their doctors has fallen well short of its goal, likely due to the voluntary nature of its data collection strategy.
The quarter also saw some digitally-minded companies push their business deeper into the public reimbursement space. Livongo, for instance, was recognized as an enrolled provider for Medicare Advantage members in late April and now is offering its diabetes management product to certain members. Meanwhile Lyft has landed approval as a Medicaid provider in Arizona for its non-emergency medical transportation service, and intends to secure similar designations nationwide.
Personal health and wellness programs
Healthcare payer- and employer-sponsored wellness initiatives continue to account for a sizable portion of activity within the digital health sector.
Beyond some very substantial funding announcements Collective Health and Gympass — both of which market their platforms to benefit program managers — consumer tech firm Garmin inked a deal with Blue Cross Blue Shield Association’s wellness program Blue365. As part of the agreement, members may now buy a Garmin wearable at a reduced rate for use within the program.
In a similar vein, Fitbit and UnitedHealthcare are revitalizing their longstanding partnership with an update to the latter’s wellness-focused Motion Walking Program. Participants in the employer-sponsored program may use their Fitbit Charge 3 device to log daily activity and earn rewards, or obtain the device as a buy-up option. In addition, the companies announced that the Fitbit Inspire HR will also be available to program participants before the end of the year.
Fitbit, for its part, made this market a key focus of its quarterly earnings call, which recapped the company’s new welllness plan products the company’s long-term plans to increase revenue and partnerships with payers and employers.
Finally, Blue Shield of California closed out the quarter with the announcement that it would be relaunching its Wellvolution wellness platform. Now with help from Solera Health, the new version is a digital marketplace where members can search for apps or other tools that will help them achieve their personal health and wellness goals.
