The digital health-focused moves of payers in the past quarter ranged from partnership deals and program launches to acquisitions and CMS coverage decisions. Several of these headlines came from major players such as Cigna, UnitedHealth Group, Pharmacy Benefit Managers (PBMs) and various Blue Cross plans, and frequently involved digital health stalwarts such as Livongo, Fitbit, Doctor on Demand and more. Read below for a summary of the stories written by MobiHealthNews covering this market in the second quarter of 2019.
Digital health negotiation
First, insurers large and small continue to view digital health tools as a way to improve care and reduce unnecessary spending. In Q2 2019, this mindset manifested itself in a number of agreements 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 top six. HIPAA Compliant Alexa Skills. Along with those published by vendors, there was a skill from Cigna that allowed employees enrolled in a plan to check their wellness program goals or other information, while PBM Express Scripts offered its own tool to customers. members to track home deliveries of their treatments.
Few weeks later, Oscar Health to enter into deal with Cardiogram this would give members at risk for diabetes or atrial fibrillation access to disease detection from the app manufacturer.
Around the same time, a telehealth company Doctor on demand and Humana jointly launched a new virtual care model that would allow plan members to access primary care network physicians without a co-payment. And sticking to telehealth, Optima Health, the health plans division of Virginia Sentara Healthcare’s integrated delivery system, has launched a collaboration with MDLive which uses telehealth to improve population health and quality measurement scores. The arrangement is considered a pilot project, with changes in quality scores being assessed continuously throughout the deployment. In addition, Optima Health also has plans announced use Cardinal Analytx Solution’s health information generation platform to help deliver proactive care offerings to members and patients.
In June, a joint venture between Independence Blue Cross and Comcast finally pulled the curtains on its own unique virtual care support platform. Called Quil Health, the company’s new CEO described his intention to create an app and television-based service that guides patients through pre-admission and post-discharge challenges, with the ultimate goal of reducing complications and costs that result for payers.
UnitedHealth Group topped the quarter when news broke in late June that the payer had purchased the PatientsLikeMe online patient community portal. While the terms of the deal were generally kept under wraps, the companies have since made it clear that even though the startup would be part of the research arm of UnitedHealth Group, no sensitive patient information would be identified and provided to the insurer. .
PBMs measuring digital health
As healthcare begins to integrate digital health tools and pharmaceutical companies grow more interested in digital therapies, some PBMs are paving the way to support reimbursement for these new therapies and products.
In particular, Express Scripts announced in May the release a stand-alone form in 2020 that highlights approved digital health tools for the pharmacy benefit management company’s pay and consumer clients. By focusing initially on validating tools for chronic disease prevention and management, the company sees this effort as a step towards establishing the validity of these products and, subsequently, reducing costs or reimbursement.
“We see the need to put mechanisms in place to help carefully manage these innovations, and we are proud to lead again as the first health services organization to establish a form of this nature,” Mark Bini, vice -President of innovation and member experience at Express Scripts, said in a statement. “This form will help ensure developers are doing the right thing to payers and consumers, while increasing patients’ access to technology that can help improve their health. “
CVS Health followed suit in June with the deployment of Supplier benefit management, a new service that will help CVS Caremark PBM customers deploy and manage third-party healthcare products.
According to the announcement, Supplier Benefit Management will help PBM customers access negotiated pricing, real-time and standardized member eligibility verification, easy billing and payment processing, and standardized results 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 look to help with smoking and substance abuse, medication adherence, management of care. and benefit navigation products as potential additions to service on the road.
“The challenge is not only to develop [digital] products – we now have very effective products – but how do we distribute and get refunds for these products in a very, very scalable way, in a way that not only allows really early adopters to buy and then propose 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, particularly in the context of digital therapeutics, is a new avenue to facilitate this widespread adoption of digital therapy.”
This quarter started on a controversial note for the largest health-care payer in the United States when Administrator Seema Verma, a well-documented opponent of single-payer health care, publicly declared that “Medicare for All” and government-run health care is “the biggest threat to innovation” in the space.
“One of the things that concerns me about how we move forward with technology and innovation and how we are harnessing that to solve some of our most difficult problems is that there is had a lot of talk about government-run healthcare around “Medicare for All,” ”she told the World Medical Innovation Forum in Boston. “I think these proposals are the biggest threat to innovation in healthcare. The reality is that government has often been a barrier to innovation.
These comments came around the same time that CMS finalized a decision that expanded telehealth access for Medicare Advantage patients.
“These changes will give MA plans the ability to offer expanded telehealth coverage to meet the needs of their patients,” the agency wrote in a press release. “Patients on MAID plans have always been able to receive more telehealth services than those from Original Medicare, and with the final rule, it is even more likely 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 as CMS’s digital coverage has expanded in one direction, a research letter written in JAMA Internal Medicine in early May highlighted a key area where the agency’s efforts have failed. According to the University of Michigan team, the Affordable Care Act-mandated physician comparison website is designed to provide patients with information about their physicians. is well below its target, possibly due to the voluntary nature of its data collection strategy.
The quarter also saw some digitally minded companies push their businesses deeper into the public reimbursement space. Livongo, for example, was recognized as a registered supplier for Medicare Advantage members at the end of April and now offers its diabetes management product to select members. Meanwhile Lyft got approval as a Medicaid provider in Arizona for its non-emergency medical transportation service, and intends to achieve similar designations nationwide.
Personal health and wellness programs
Wellness initiatives funded by healthcare payers and employers continue to represent a significant portion of activity in the digital health sector.
Beyond a few very substantial funding announcements Collective health and Gym Pass – who both market their platforms for the benefit of program managers – consumer tech company Garmin has signed an agreement with the Blue365 wellness program of the Blue Cross Blue Shield Association. As part of the agreement, members can now purchase a Garmin wearable device at a reduced rate for use in the program.
In the same vein, Fitbit and UnitedHealthcare revitalize their long-standing partnership with an update to the latter Wellness walking program. Employer-sponsored program participants can use their Fitbit Charge 3 device to record daily activities and earn rewards, or get the device as a purchase option. Additionally, the companies have announced that the Fitbit Inspire HR will also be available to program participants before the end of the year.
Fitbit, for its part, has made this market a key focus of its call for quarterly results, which recapitulated the company’s new wellness plan products, the company’s long-term plans to increase revenue, and partnerships with payers and employers.
Finally, Blue Shield of California closed the quarter by announcing that it would be relaunches its Wellvolution well-being platform. Now, with the help of Solera Health, the new release is a digital marketplace where members can search for apps or other tools that will help them achieve their personal health and wellness goals.