Review: Major Health Insurance Industry Events in Q3 2016 (Part II)

As the third quarter of 2016 came to a close, foreign media outlet MobiHealthNews summarized the major news concerning healthcare providers, health insurance payers, and pharmaceutical companies during this period. Throughout the quarter, many health insurance companies were also in the headlines, indicating that payers are actively engaging in innovations within the digital health landscape. Even agencies such as the U.S. Centers for Medicare & Medicaid Services (CMS) made significant strides, extensively covering digital therapeutics. VCBeat (WeChat ID: vcbeat) provides you with a comprehensive review of the third-quarter health insurance news, detailed below.Due to the excessive length, it will be divided into three parts, with Part II covering medical insurance.

This July, the Centers for Medicare & Medicaid Services (CMS) proposed rule changes to expand the Diabetes Prevention Program (DPP), which took effect on January 1, 2018. In March, CMS confirmed that modifications, including the expansion of coverage to encompass digital versions of the program, would reduce net Medicare spending. In early October, CMS formally announced the new regulatory changes, marking a substantial step toward implementing reimbursable DPP initiatives. These changes will improve Medicare reimbursement for clinicians who invest time and resources in delivering more coordinated, patient-centered care. They will also better align with contemporary practices in primary care, care coordination and planning, mental health care, and the management of cognitive impairments such as Alzheimer’s disease. Furthermore, these changes will further advance the transformation of U.S. Medicare, better prioritize key areas, and reward physicians who deliver high-quality medical care through the Quality Payment Program.

CMS also announced the 14 regions and states that will participate in the new primary care model, “Comprehensive Primary Care Plus” (CPC+). Announced this April, the initiative is a multi-payer, five-year family medicine model scheduled to launch on January 1, 2017. CPC+ is a public-private partnership that enables medical practices of varying sizes, structures, and ownership types to receive incentive grants through an Advanced Alternative Payment Model under the “Quality Payment Program.” CMS estimates that up to 5,000 primary care practices (serving approximately 3.5 million beneficiaries) may participate in the program. CPC+ aims to help primary care practices deliver the most appropriate care to patients and improve health outcomes. Healthcare organizations in the 14 selected regions may apply to join the program by September 15.

Aetna Announces Largest Digital Health Insurance Program Among Private Insurers. Starting this fall, Aetna will integrate Apple’s consumer technology products with its analytics-based health and care management programs through an iOS-exclusive medical initiative. Initially, the company will offer Apple Watches to its large employer groups and individual members at a subsidized cost during the open enrollment period.

Aetna will also provide free Apple Watches to nearly 50,000 employees participating in the company’s health reimbursement plan. This initiative fully demonstrates a broad shift among health insurers toward reimbursing consumer digital health products, such as video consultations and even smartphones. Aetna’s iOS-exclusive health app aims to streamline the healthcare process through its built-in features, including medication reminders; integration with Apple Wallet, allowing consumers to check their insurance deductible status and pay bills at any time; personalized onboarding for medical plans; information and decision support; and medical guidance for consumers triggered by health events (such as new diagnoses), among other functionalities.

Humana, which may soon become a subsidiary of Aetna, has been actively seeking out various startups to integrate into its health product portfolio. In the third quarter, Humana began offering real-time online mindfulness training programs to employers through the health provider eMindful, aiming to improve the well-being of Ge Huiyuan’s employees and reduce preventable risk factors for chronic diseases. eMindful’s evidence-based mindfulness training programs last 8 to 16 weeks and cover a wide range of topics. Employees can participate in eMindful’s online lecture sessions via company computers, mobile devices, or in group settings. Participants can listen to expert guidance, engage in dialogue and interaction with instructors, and communicate seamlessly with fellow participants.

Finally, Oscar, a company that entered the health insurance market relatively late and is renowned for its technological expertise, announced its withdrawal from two markets. The company will cease offering individual health insurance plans under the Affordable Care Act in the Dallas–Fort Worth area of Texas and in New Jersey as of January 1, 2017.

At the end of the third quarter, Cigna, a health insurance company, announced a significant upgrade to its telehealth offerings. The company has been providing MDLive services to its members since 2013 and is now adding AmWell’s services under the brand name “AmWell for Cigna.” Starting next January, Cigna will introduce behavioral health video consultation services through AmWell. This service will serve as the standard telehealth option for most of Cigna’s employer-sponsored health plans and will also be available in many of its individual health insurance plans. In addition to expanding telehealth coverage within its health plans, Cigna also provides reimbursement for contracted telehealth providers specializing in behavioral health care.

Several Blue Cross Blue Shield (BCBS) health insurers in the United States also announced initiatives in the digital health sector during the third quarter. Sharecare, a healthcare engagement platform, formed a joint venture with Guidewell, whose subsidiaries include Florida Blue, the largest health insurer in Florida.

The yet-to-be-named joint venture will combine Guidewell’s member data and expertise with Sharecare’s digital health tools to create an all-in-one health plan application, initially piloted for members of Blue Cross and Blue Shield of Florida. This product integrates all applications and web-based products that Sharecare has built and acquired over the years—such as the symptom checker AskMD, the RealAge health risk assessment, and its companion stress management app—into a single comprehensive application, scheduled for launch in early next year. With Sharecare’s involvement and drive, the two companies will begin developing additional tools to connect patients, health plans, and providers, while fully leveraging health plan claims data.

Furthermore, Excellus BlueCross BlueShield, a health insurer in New York State, has partnered with Boston-based Wellframe to integrate Wellframe’s mobile platform into its care improvement teams. This partnership will serve the entire patient population, with a particular emphasis on enhancing care for high-risk individuals. By encouraging patients to interact with the application as frequently as possible each day, tailored to their individual conditions, the initiative aims to ultimately reduce the time care coordinators spend managing each patient.

The company also partners with the telehealth provider LiveHealth Online to offer non-emergency, Spanish-language video consultations with physicians to California residents enrolled in Anthem Blue Cross health insurance. LiveHealth Online began offering online physician consultations via its website in 2012 and launched mobile consultation services a year later. However, due to California’s unique linguistic demographics, many Spanish-only speakers were unable to access these services. Consequently, the partnership with Anthem significantly expands LiveHealth Online’s potential user base in California.

The company also implemented several minor initiatives in the third quarter. First, it updated its Health4Me application to engage more patients in health insurance plan decision-making and enhance the convenience of accessing healthcare services through the app. Second, the company partnered with Vida, a health coaching startup, on data disclosure. Vida reported that the collaboration has already shown initial success, helping 1,000 patients with high BMI across three states reduce their weight and blood pressure.

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Review: Major Events in the Medical Supplier Industry in Q3 2016 (Part I)