Aetna's two future businesses: Consumer health and ACOs

By Jonah Comstock
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iTriage PlayAetna CEO Mark Bertolini started his keynote at HIMSS here in Orlando, Florida with a simple fact: Aetna is doing well, but the healthcare system in general isn't. And for the latter problem, mobile is a big part of the solution.

"Inside my organization today, with record membership, our large staff of physicians, and record revenue, people would look at me and say 'Why would you want to change now?'" he said. "It's the perfect time to change. Because the solution we need is not found in how well Aetna does, it's in whether or not we meet the goal of healthier individuals that are more productive, economically viable, and satisfied."

Bertolini went over several troubling statistics. Healthcare premiums are growing at four times the rate of inflation, he said, leading to employees covering more and more of their own healthcare costs.

"Employees are paying 41 percent of the healthcare dollar," he said. "If the trend line continues, in another three to five years employees will be paying more than half. And when we reach that point, you'll have a very different customer sitting across from you talking about their costs, and how come it costs so much."

There are a number of ways to reduce cost, but Bertolini suggested one of the most effective is to focus on the biggest cost-drivers in healthcare: The chronically ill 5 percent of the population that consumes more than 40 percent of healthcare costs. Patient engagement can reduce readmissions for chronic disease and reduce those costs, but only if you can make the patient interested in engaging with you before it's too late.

"If you take someone through a dialogue about metabolic syndrome, about diet, the lack of exercise, the impact of metabolic syndrome, the fact that 60 percent over the next 20 years will get diabetes, you lose them," he said. "It's like Charlie Brown's mother - 'Wa wa wa wa wa.' So how do you make it work? You put it in the palm of their hand."

Dr. Harry Greenspun, Senior Advisor for Health Care Transformation and Technology at the Deloitte Center for Health Solutions, echoed Bertolini's sentiments in an interview with MobiHealthNews at HIMSS.

"We've done a good job of getting people who are interested more interested," he said. "And giving the interested people tools. And that's been great. But what we've left behind is a big chunk of the population that needs to be interested and it's not."

Both Bertolini and Greenspun suggested that mobile health technologies could bridge that gap by taking after other industries like retail, finance, or air travel, where a sufficiently easy mobile experience actually starts to change a consumer's expectation of their role in a transaction.

"Consumers judge the quality of their care not by their outcomes, but by their service experience," Greenspun said. "I know that when I order a mop from Amazon I get a text message telling me exactly where it is. So don't tell me you don't have the technology to tell me when my labs are done. The core things the consumer wants are everywhere. I would be happy to wait on gamification of my weight loss with my provider if I could do secure messaging with him or make an appointment with him from my phone."

Bertolini highlighted Aetna's iTriage mobile offering as an example of putting healthcare in the consumer's hands. He also talked about some other initiatives the company has underway to monitor patients with chronic disease and intervene before it becomes costly and life-threatening. The payor is partnering with Medtronic to use the data feed from pacemakers to figure out when a cardiac patient has put on extra water weight and is in increased danger of congestive heart failure. They're also working on a pilot with continuous glucose monitors to try to predict and prevent hypoglycemic events.

Although he spoke a lot about iTriage and Healthagen, Bertolini didn't mention the product that's been Aetna's headliner at other recent conferences like the mHealth Summit: Aetna CarePass. In addition to mobile, his talk focused on ways to align incentives in healthcare by focusing on quality and access of care rather than on cost, with the ultimate goal of reducing national healthcare spending. This includes creating private exchanges, where the consumer is more directly responsible for choosing a health plan, and the employer or the government's role is just to subsidize their choice.

"Aetna's going to have two businesses," he said, "one about ACOs and one about creating and thriving in consumer health experiences. Creatively destroying the current business model and making a new one can have a big impact on healthcare costs."