This quarter, news about payers was dominated by two kinds of stories: high-profile digital health partnerships for health plans and legislative efforts on the government payer side. Read on for our roundup of payer news from Q2 2017.
Large health insurer news
On the digital health side, we didn't hear quite as much from health insurers this quarter as we normally do, but there were some interesting partnerships and developments.
In an effort to reduce the number of missed or delayed doctor’s appointments that are attributed to a lack of dependable transportation options, Blue Cross Blue Shield Association teamed up with ride-sharing company Lyft in a nationwide partnership to provide patients with reliable rides. The San Francisco-based ride-sharing company proactively reached out to BCBS, and the service will begin rolling out over the next few months at no cost to patients. Prior to launching the service, BCBS will work to incorporate Lyft’s platform into a yet-to-be-determined delivery model, and it will function as a service carried out on BCBS’s behalf.
Cigna expanded its collaboration with Omada Health, offering the digital chronic condition prevention program at no cost to members with prediabetes as well as those with an elevated risk for conditions such as heart disease and hypertension. Cigna first evaluated Omada’s digital program in 2015, and has plans to expand availability over time.
And UnitedHealthcare teamed up with Adelade, marking the startup's first accountable care program for Medicare Advantage plan members, more than 15,000 of whom could participate in the new initiative. Aledade – which was founded three years ago by former National Coordinator for Health IT Dr. Farzad Mostashari – will work with UnitedHealthcare in Arkansas to put technology and clinical best practices to work enhancing care coordination and promoting more team-based patient care.
Over in the UK, London-based BioBeats signed a distribution agreement with European health insurer AXA PPP that will put its app, Hear and Now, into the hands of tens of thousands of employees at companies like JP Morgan and KPMC. "Hear and Now" is designed to help employees cope with work stress. It monitors a user’s heart rate and respiration while providing the user with mindful breathing exercises to complete.
Finally, an undisclosed large health plan in Texas, serving more than 200,000 Medicaid members, launched the MyVitalData app from Vital Data Technology, a patient engagement and care coordination app that gives users access to medical information such as immunizations, medications, lab results and health plan details, as well as tools to find the right care.
Smaller startup health plans were also in the news this quarter -- some for positive developments and some not so much.
News broke this quarter that the FBI is looking into allegations of fraud health plan Zoom+ may have committed in effort to avoid losing money from required risk adjustment payments. Allegedly, Zoom+ retroactively falsified medical claims to get out of the an Affordable Care Act-mandated requirement that decrees health plans with healthy members must pay into a pool to offset the high costs attributed to their sicker members.
Health insurance startup Oscar Health had a very active quarter. The startup introduced a virtual clinical dashboard that displays multiple steps of an Oscar member’s medical journey, with the goal being to offer a more readable profile of their health; laid out its strategy for expanding into additional states; and announced a partnership with the the Cleveland Clinic to offer co-branded health insurance in Ohio.
The quarter included some discouraging indications for value-based care as digital health startup Twine Health pivoted from working with risk-sharing hospitals to focusing on employee populations.
"Their risk-based contracts are just not risky enough," Twine Health CEO John O. Moore told Babyforyou.net.ua. "They don’t have enough of an incentive to really do what, in parallel, we were seeing our workplace health providers do. So we said ‘there’s a dramatic difference in uptake here of Twine in these workplace health providers and ACOs, so we’re going to put all our effort into the workplace health providers.’”
Another company that made news in the corporate wellness space this quarter was Fitbit, which reorganized its business to better focus on employee wellness. In May, the company merged Fitbit Group Health and Fitbit Digital Health into a single entity called Fitbit Health Solutions.
“We are integrating because of increasing traction in the healthcare space,” Amy McDonough, who previously served as the vice president of Group Health and will now hold the position of senior vice president of Fitbit Health Solutions, told Babyforyou.net.ua. “Our charge as Fitbit Health Solutions is to take on a more significant role in helping not only employers, but also health plans, and health systems address the ongoing challenges of health engagement, prevention and care management.”
Much of the quarter's payer-related news involved the Centers for Medicare and Medicaid Services (CMS) and the changing reimbursement landscape for digital health and telemedicine.
In April, the Senators Cory Gardner (R-Colorado) and Gary Peters (D-Missouri) introduced the Telehealth Innovation and Improvement Act, which require the Center for Medicare and Medicaid Innovation (CMMI) to “test the effect of including telehealth services in Medicare health care delivery reform models.” The bill would require the Department of Health and Human Services to allow eligible hospitals to test telehealth services through CMMI.
Another bipartisan bill, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, was introduced in May. The bill primarily works to waive restrictions around Medicare telehealth coverage that many consider outdated or arbitrary. Along with the Senators, it also has the support of the American Medical Association, the American Telemedicine Association, and the Alliance for Connected Care along with many industry groups, health systems and tech vendors.
Yet another bill, the Creating High Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017 (CHRONIC), aims to hone in on Medicare payment reform in order to expand telemedicine services for chronic disease management and at-home care coordination. This bill was also introduced in April.
All three bills are currently being considered by the finance committee.
In other CMS news, Silicon Valley company Able Health, which helps providers navigate complex payment programs, was approved by CMS as a MIPS Qualified Registry under the Merit-based Incentive Payment System. This will allow the company to submit data to CMS, which will help provider customers to more easily track their performance and secure reimbursement.
Finally, the Center for Connected Health Policy released the fifth edition of its State Telehealth Laws and Reimbursement Policies Report. The report found that 48 states and Washington, D.C., provide reimbursement for some form of live video in Medicaid fee-for-service. Specifically, 13 states reimburse for store-and-forward delivered services in Medicaid; states that only provide reimbursement for teleradiology were not counted in this number. Twenty-two states reimburse in Medicaid for remote patient monitoring.