In-Depth: Payer news and moves at HIMSS 2014

By Brian Dolan
Mark Bertolini, CEO, Aetna Mark Bertolini, CEO, Aetna | Photo Credit: HIMSS 2014 Event Staff

By Jonah Comstock

There may not have been a lot of news from payers (or health insurance companies) at HIMSS 2014 in Orlando, Florida, but their presence was definitely felt. Aetna CEO Mark Bertolini's keynote address laid out the stakes well: healthcare costs are rising markedly, and it's everyone's job to try to keep them down. That's why the theme of HIMSS this year seemed to be, in EY's Dr. Bill Fera's words, the "migration path to accountable care." Both Aetna and Cigna discussed some of their plans surrounding ACOs and provider partnerships, and UnitedHealth and others made moves too.

Aetna sharpens strategy, changes at its Healthagen unit

In Bertolini's keynote, he alluded to focusing on two core businesses: consumer health and accountable care. Other indications suggest that this strategy is in the midst of being implemented and it might include some changes at Healthagen.

Bertolini's talk was notably sponsored not by Aetna, but by Healthagen, an Aetna business unit that until recently was something of an incubator for Aetna acquisitions and spin-off businesses. Healthagen's name was also emblazoned on Aetna's booth on the HIMSS show floor, with only two Aetna properties represented there: clinical data exchange company Medicity and Aetna Accountable Care Solutions.

Although Healthagen the brand was front and center, Healthagen's most well-known company, iTriage, was relegated to a distant corner of the show floor. Aetna CarePass, which has been Aetna's headline at most major events for the last year, wasn't mentioned in Bertolini's talk or present in the company's booth.

Even more intriguingly, InvolveCare, the Healthagen caregiver app that just launched last fall at Health 2.0, was nowhere in sight. Two days ago, InvolveCare posted a blog post on its site saying that the consumer app would be discontinued effective April 28th.

"InvolveCare is in the process of being integrated into another company’s service offering," the blog post reads. "As a result, the consumer-facing app will become unavailable to accommodate the new company's servicing needs."

InvolveCareAetna acquired the Healthagen brand along with iTriage in 2011Just last year it re-purposed the brand to cover its health and technology offerings. Now it looks like it's repurposing the brand once more with a more streamlined mission -- one that may or may not include iTriage.

The payer-provider relationship in the age of accountable care

Fera, leader of EY's (formerly Ernst & Young) Health Care Provider Group, spoke with MobiHealthNews at HIMSS about how as providers take on more risk in accountable care, payers and providers find themselves both needing to reduce costs and improve care for the populations they manage. This requires two things: large datasets to understand population health, which payers have, and the trust of the patient, which providers have.

"I think historically, payers have had the advantage because they've had the information and they've always had the claim services," said Fera. "They understand risk stratification, they understand population health. The providers are trying to catch up to meet them to understand these shared risk arrangements. What payers have found is they cannot do care management alone. They've been trying to do case management and disease management in a vacuum and they've had real difficulty getting patients to engage. So if we took the strengths of the payers and the strengths of the providers to work in collaboration we should be able to advance everybody's goals, most importantly patients' goals."

So increasingly, as with Aetna's Accountable Care Solutions group, payers are working with providers to implement accountable care, integrating their own data with hospital data. Cigna Director of Clinical Integration Solutions Cameron Ough presented at an education session Monday about some of the challenges Cigna has had integrating with ACOs since it launched its Collaborative Accountable Care initiative in 2011. The payer currently has 86 collaborative accountable care initiatives under way.

Ough said that "if you’ve done one physician integration, you’ve done one physician integration," which is to say, the different data systems in place at hospitals and different physician preferences make it hard to scale procedures for integrating. Current hospital systems are designed to make it easy for physicians to extract data about a single patient and are not well suited to pulling data on multiple patients to do population management. Accountable Care depends on proactively reaching out to patients that need to be seen, not just following up with ones that are already coming in, and current systems aren't well built for that either.

"Historically, there's a lot of tension. I think there's genuine interest at this time for payers and providers to work together," Fera said. "I think they're all figuring out how to do that. If you look at Cigna, they have a multitude of pilots throughout the country trying to figure out what is the best model to collaborate, what really makes sense, which one are we going to codify and go to market with as a general model of working with providers. I think Aetna's in a similar boat. They have basically a consulting service around building these arrangements, they have some technology with Medicity that's their interoperability play."

Other payers, Fera suggested, are opting to buy provider organizations and "learn from the inside out what needs to be done". He pointed to UnitedHealth Group's purchase of Monarch HealthCare back in 2011 and their ACO pilot at the Tuscon Medical Center. He also mentioned Humana's 2012 acquisition of Metropolitan Health.

Humana also owns Certify Data Systems, which launched the latest version of population health management tool HealthLogix at HIMSS. HealthLogix is an interoperability play similar to Aetna's Medicity. And UnitedHealth Group also partnered last fall with Dignity Health, a hospital system, to launch Optum 360, a revenue cycle management company meant to help both accountable care and traditional fee-for-service health systems manage their spending.