In-Depth: Recent digital health moves by payers, health insurers

By Brian Dolan
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An October report from the Psilos Group suggested that payors now need to figure out how to better serve individuals, not just as end users but as customers. In the last six months, we've seen payors doing just that, with almost every major payor upgrading its apps to bring added features to their members and other consumers, or potential members. A number of payors partnered with Samsung to leverage its new digital health platform, and a couple of others are rumored to be in talks about Apple HealthKit integrations. Though some may be moving quietly, payers are moving toward better consumer engagement via mobile devices.

What follows is a round-up of moves by the larger and smaller health insurance companies over the last six months, plus an update on government payers like CMS and the VA, and some brief updates on both price transparency and employee wellness. 

Aetna

A lot of people reacted to the shutdown of Aetna CarePass with doom and gloom predictions for mobile health, and for payers' digital consumer engagement strategies. But Aetna itself shrugged off the loss as an experiment that didn't work out, one the company would continue to learn from going forward -- and has continued to work on digital strategies since.

In November, just a few short months after news broke about CarePass, Aetna bought Chicago-based bswift, which offers a technology platform that powers health insurance exchanges, for approximately $400 million. The company, which has about 380 employees, will remain a separate business within Aetna led by its current team. The acquisition bolsters Aetna's competitiveness in the post-Affordable Care Act world of private exchanges.

That same month, Aetna was one of a number of healthcare companies that signed on to be involved with Samsung's Digital Health platform. The details of that partnership are still unclear.

In terms of its apps, Aetna has continued to expand its portfolio. Back in January 2014, the company launched a new app called "Resources for Living" that helps users to manage stress and anxiety, moderate work-life balance, and track their moods. For Aetna members, the app also recommends services they might be eligible for that could help them out.

And Aetna's flagship app, Aetna Mobile, continues to be updated, offering services similar to iTriage but specifically for Aetna members. Around the same time that iTriage added price estimator features for procedures, for example, Aetna Mobile added a similar payment estimator.

Aetna just recently announced a remote patient monitoring and patient engagement pilot with Newtopia. Newtopia will offer its health engagement platform to some of Aetna’s largest employer customers. The platform uses genetic testing and lifestyle assessments to create personalized nutrition, exercise and behavior management plans for users. Newtopia then supports users with online coaching via mobile devices, social networks, and wearable device integration.

And, in the wake of a disastrous data breach at Anthem, Aetna was the highest scorer on a survey about email security at healthcare companies. This survey, from email company Agari, was reported at length by Fortune. Aetna scored a perfect 100 percent. The average for the healthcare sector? 17 percent.

And Aetna has big plans for the future. In a December interview, iTriage president Jim Greiner told MobiHealthNews that a major iTriage redesign is planned for 2015, and the company is going to try to crack virtual visits.

"We believe there’s a huge amount of opportunity to crack virtual visits, which no one really has yet," he said. "I know there’s a bunch of startups, old ones and a bunch of new ones that are doing that, but we think we can play a role in helping people do that. If you look at the stats, very few people even understand what telemedicine is.”

Humana

Compared to some of its competitors, Humana's digital health year has a been a little quiet. But the company has continued to develop and innovate its apps and hasn't missed the boat on partnerships with consumer electronics giants Apple and Samsung.

In August, the company finally added a mobile component to its HumanaVitality employee wellness offering. In addition to tracking health and fitness metrics, select members can use the app, available on iOS and Android devices, to take health assessments, challenge coworkers to health-related competitions, and read information on staying healthy. Since then they've continued to add new features including, just this month, the ability to buy Amazon Gift Cards in the app with "Vitality Bucks," a currency users rack up by being healthy.

Humana has three other apps: its member app, its consumer app MyHumana, and RightSource, an app for managing and refilling prescriptions that launched in July of last year. In January, RightSource updated to add medication reminders, and to give users credit for taking their medication on time.

The Humana for Members app has been adding updates as well: In November, Humana gave users the option to link their Humana for Members and HumanaVitality accounts; in December they added a single sign-on for all Humana apps; and in January it added functionality to help users track their weight and blood pressure.

Finally, the MyHumana app recently added Spanish language support and a feature that lets the user take a picture with the phone's camera to verify a medical expense.

On the side of partnerships, Humana hasn't made too many big public announcements recently. But the company was included in the large list of 24 health companies working with Samsung, and Bloomberg reported that Humana was working with Apple Health as well. The Bloomberg report puts the deal in the context of employee wellness — the article is about employers giving insurance discounts to workers who track their daily steps with an activity tracker and can show they lost weight. That deal could put the recent Humana for Members update in some context.

UnitedHealth Group

UnitedHealth Group was also mentioned in Bloomberg's report as being in discussions with Apple about integrating HealthKit with some of its offerings. Other than that, the company's been a little quiet lately on the digital front, other than adding a lot of updates to its apps.

Earlier this month, the company announced some big updates to its Health4Me app, but it had actually been rolling those updates out gradually for some time. In the past year, it's added physical activity tracking, including connectivity to Fitbit devices, educational TV streaming of a channel called UHCTV, and payment capabilities integrated with claims and benefits information.

The latter, the in-app payment, works via InstaMed, which United had previously partnered with for its MyEasybook online appointment booking. The app also has price transparency features that have been in place for some time.

United's other app, Smart Patient, also added a number of updates in October, mostly to improve its health tracking features. They added triglyceride tracking to the apps calorie tracking feature and streamlined the process of tracking health values. 

Kaiser Permanente

Integrated delivery network Kaiser Permanente may not have launched many new digital health-focused offerings this year, but the payor-provider helped lead the digital health discussion and backed a seed fund.

In September Kaiser Permanente CEO Bernard Tyson spoke at an event in California. During his talk, he said there were three major trends driving changes in the healthcare system. Those include a shift to holistic, lifelong care; the rise of the patient as active healthcare consumer; and the decentralization of healthcare.

“Eventually, as we disrupt the healthcare system and as others on the outside get into healthcare, there is no question that the healthcare system is going to evolve from its current state of a ‘fix me’ system, to it’s future state as a total health system,” Tyson said. He added that right now, if you conceptually lay out the years of a person’s life from birth to death, most of our system’s spending on a person happens right before death. Creative opportunities lie in ways to “move and shift resources toward maximizing the healthy life years of individuals.”

Tyson also provided some concrete examples of steps Kaiser is taking to decentralize healthcare. He described this trend as “the move from ‘you go to a place for healthcare’ to healthcare being distributed to multiple areas in a person’s life,” and, as an example cited the 14 million online visits that were done through Kaiser last year.

A few months later, Kaiser Permanente Ventures contributed to Rock Health's third fund. Kaiser is a long time supporter of Rock Health, which transitioned from an accelerator to a seed fund in 2014.

Then in December, Christine Paige, senior vice president of marketing and digital services at Kaiser Foundation Health Plan, spoke about some of the lessons Kaiser has learned about the role it has to play in a customer’s life as a healthcare provider and payer. She said Kaiser Permanente now has 70 percent of its 9 million members as active users of its online and mobile offerings.

“One thing we’ve learned is that we’re not going to be in the health and wellness app business,” Paige said. “There’s a lot of people who do great work there, some who don’t do great work, but many who do, doing fitness apps and monitoring etc. And that’s really important and for some people it’s very, very powerful, it helps them get motivated to get done what they need to get done with their health. But for us, our sweet spot is in making access to the clinical part, the medical part much, much easier. And that’s a complement to what people do in their own life.”

Rather than try to have a presence in every area of consumer health and wellness, something other providers and payers have dabbled in, Kaiser has found success zeroing in on the patient-doctor relationship. In fact, Paige said, Kaiser’s “killer app” is secure email.

“Probably about 1 in 4 times people do that they don’t have to have an office visit,” she said. “And in a world where there’s more and more cost sharing, that’s a really great thing. I don’t have to drive, I don’t have to park, and I don’t have to pay whatever that office visit might have cost me.”

Cigna

In October, Cigna launched a digital health coaching program, called Cigna Health Matters. Cigna Health Matters offers mobile tools that feature social media engagement, gamification elements, and web-based incentives. The program is available to Cigna’s 14 million US members on employer health plans. The payor folded GoYou, an app sharing offering it announced in October 2013 into Health Matters.

The program begins with a gamified online health assessment. After completing the assessment and answering questions about the user’s BMI, cholesterol, and blood pressure, members are given a Health Matters Score. From there, as users work on improving their health, their score changes. The score also helps Cigna coaches and clinicians target the members that need the most help improving their health.

A month later, Cigna was named as one of Samsung's 24 digital health partners. Cigna's partnership with Samsung started as late as October 2013 when the two companies signed a multi-year agreement to develop health-focused features for Samsung’s wellness app, S Health, on Samsung’s major smart mobile devices.

Almost a year later, Samsung announced that the offering they co-created, called Coach by Cigna, would be available in the S Health app on Samsung Galaxy S5. Coach by Cigna creates a health improvement plan for a member by asking the member questions about exercise, nutrition, sleep, stress, and weight. The offering was made available to Samsung Galaxy S5 users in 36 countries and 26 languages.

And just last month, Cigna helped with a study conducted by health app intervention developer ORCAS that found a mobile intervention, called FitBack, that personalizes health content for the user is an effective tool to help patients improve their nonspecific lower back pain (NLBP). 

Blues

Various Blue Cross Blue Shield organizations across the country made digital health headlines in the past six months with notable hires, and new apps or app features for their members.

One of the best-known executives working in digital health, Dr. Sachin Jain, left his position as Merck’s Chief Medical Information and Innovation Officer and became the Chief Medical Officer of CareMore Health System, a subsidiary of Anthem. CareMore is an integrated care plan that combines a Medicare Advantage plan with 24 care centers around the country.

In August 2014, Blue Cross Blue Shield of Massachusetts added a mobile and online offering, called OneHealth, to bolster its mental health and behavioral health programs. OneHealth offers members 24/7 structured peer support, education, and tools to aide in the recovery from substance abuse, according to the health insurance company. The program uses social media and real-time tracking to monitor emotional states and to provide anonymous peer supports to help the member or their dependents stay sober.

Three other Blues: Independence Blue Cross, Florida Blue, and BlueCross BlueShield of Tennessee added new features to their signature apps.

As of last month, Independence Blue Cross's app, called IBX, now includes Blue Button, which helps patients get their medical records electronically. Patients can also view their spending account transactions from the app. In August, IBX added features that enable a user to change their primary care physician, view spending account balances, and request a new ID card.

In October 2014, Florida Blue redesigned its provider search function and updated its shopping UI for 2015 enrollment.

Finally, BlueCross BlueShield of Tennessee's app, called My Blue TN, added a "My Discounts" feature that members can use to get deals on everything from alternative medicine, like acupuncture and massage therapy, to fitness trackers, clothing, and gear.

In October, Highmark announced that starting in 2015, it would cover web-based dermatologist visits from Iagnosis, parent company of virtual visit skin care company DermatologistOnCall for its commercial members in Pennsylvania, West Virginia, and Delaware.

“We need to make sure our members get the right care in the right setting, and telemedicine is a key tool to help make that setting more patient-centered,” Highmark Senior Vice President and CMO Donald R. Fischer said at the time. “Telemedicine is a resource that is critical to transforming the delivery of health care. It ensures faster access to high-quality health care while also helping to control costs.”

DermatologistOnCall offers online, tablet, or smartphone-based consultations, although Highmark seems to only cover the web version. Patients who want to use the service first fill out a questionnaire that verifies whether or not their issue is appropriate for online care. Once he or she is confirmed as a viable patient, they set up a profile with demographic info and other basic facts.

In September 2014, insurance company Health Care Service Corporation (HCSC), which offers insurance plans to residents of Illinois, Montana, New Mexico, Oklahoma and Texas, has made available its first wellness app for its members, called Centered. The app focuses on activity tracking and meditation.

Centered displays a daily summary of calories burned, miles walked, and time spent being active every day, but it also offers meditation sessions for users to complete every week that range from four to 19 minutes. The app sends users tips on how to have a successful meditation session and provide them with a history of meditation sessions completed. Before the session begins and afterwards, users can use the app to get their average relaxation rating.

An HCSC spokesperson told MobiHealthNews that the app was developed based on a study conducted by the Adler School of Professional Psychology and the University of Massachusetts Medical School. The study found that short meditation sessions lead to reduced stress levels and an increase in a user’s ability to focus.

HSCS also partnered with Healthbox for the accelerator's third Chicago-based class.

These were not the first digital health-related projects HCSC was involved in that year. In April, HCSC was part of a $7 million investment round in Healthbox Global Partners which has been the parent company of digital health accelerator Healthbox since 2013. It was the first time strategic investors invested in Healthbox’s parent company.

Then, in December, LifeWise Health Plan of Oregon announced plans to cover video visits to its members starting in 2015. While the plan will pay for video visits between patients and their providers, LifeWise also partnered with video visits company Teladoc to make its video visits service available to members.

Portland, Oregon-based LifeWise along with its partners Premera Blue Cross, Premera Blue Cross and Blue Shield of Alaska, and LifeWise Health Plan of Washington, cover more than 1.9 million people in those three states. All of LifeWise Health Plan of Oregon’s members, 52,000 people, will have access to these new benefits, but LifeWise’s partners will only cover the services for select members in Alaska and Washington.

Through the program, LifeWise’s members receive health-related services and information for diagnosis, prevention, health advice, disease management, and treatment remotely.

San Francisco-based digital health startup Wildflower Health partnered with health insurance company LifeMap Assurance to launch an app, called LifeMap Due Date Plus, for expectant parents with short term disability coverage. The app is available on iOS and Android devices. LifeMap's parent company Cambia is a part of the Blue Cross Blue Shield federation.

“LifeMap is an ancillary benefits provider meaning that they provide things like disability benefits, insurance benefits, and dental benefits to employers,” Wildflower CEO Leah Sparks told MobiHealthNews at the time. “And, what’s interesting about them is that — the number one reason for short term disability is typically maternity. So in the implementation we’re doing with LifeMap, it’s a little bit different than some of the other customers where we might focus on the medical intervention. It’s really about helping women navigate some of the things to do with taking time off work, tapping into their disability coverage, which is just as top of mind when women are navigating pregnancy as the healthcare piece. It’s a really nice and neat point of synergy between what we offer in Due Date Plus and what LifeMap offers.”

A handful of Blues also invested in other companies' digital health wares.

In September 2014, Florida Blue awarded researchers with affiliations to Johns Hopkins Medicine $100,000 to launch a study on how tracking devices and apps can help obese teenagers make healthier decisions.

The researchers visited a high school in Florida to begin recruiting the 50 teenagers it plans to sign up for the study, which includes the use of Fitbit tracking devices and the MyFitnessPal app. Study participants tracked their activity and sleep with the Fitbit device, while MyFitnessPal helped them track what they eat.

And just last month, West Conshohocken, Pennsylvania-based chronic care app developer CareCam Health Systems received a $2.4 million strategic investment from Independence Blue Cross Center for Health Care Innovation.

CareCam’s chronic care management offering, called vHealth, helps patients record videos of care management activities, like giving themselves a diabetic foot exam or using their glucometer. The service offers a facial detection process to verify that the correct patient is taking the video and performing care activities. All videos are sent to a “flashboard” that providers can use to view the videos and see trends in the patient’s self care. 

Oscar

In May, New York City-based health insurance startup Oscar raised $80 million at close to a $1 billion valuation for its individual-only insurance plan.

At a Boston event in November, Oscar co-founder Kevin Nazemi spoke with Bessemer Venture Partner’s Steve Kraus about how a focus on user experience — and a fortuitous market opportunity in the Affordable Care Act — helped catapult Oscar into the national spotlight. He also announced for the first time that the company will be expanding from just New York into New Jersey.

“We started the company because we, like everybody who’s insured, got our explanation of benefits and said ‘This is everything but an explanation’,” Nazemi said. “So we decided, why not do something about it? What if there was an insurance company that started with a blank slate and put the consumer first, building all the backend pieces, connected those in from the type of experience that we wanted?”

Kraus pointed out that other health insurers also offer telehealth, mobile apps, price comparison tools, and other features to help users access information. But Nazemi argued that there’s a nuance to true consumer focus. The proof in the pudding of true user-centricity, Nazemi argued, is not whether the insurer offers tools but whether people use them.

“If you took the list of the feature set we have and you put it against a major carrier, they checked a lot of the boxes, to be fair,” he said. “But then ask them what percent of the people visit your website or use those tools. And I can tell you proudly that over 90 percent of our members have a log-in. Over 70 percent have filled out a detailed health risk assessment. Because we didn’t frame it that way. We framed it around making the user experience customized, the way Facebook would.”

The following month, Oscar partnered with Misfit Wearables to get more of its members moving. As part of the deal, each Oscar member got a free Misfit Flash tracker and the opportunity to earn up to $20 a month in Amazon.com credit by meeting step goals. The two companies integrated their mobile apps as well. Oscar members can see the step and activity data from the Misfit Flash on Misfit’s app, but have to transmit that data to Oscar’s mobile app in order to get paid. Members earn one dollar per day that they meet their personalized fitness goals for a maximum of $20 per month.

Last month, Oscar announced that they planned to offer their service in California by 2016, according to a post from TechCrunch. The service has grown its member base from 16,000 in November 2014 to 30,000 at the end of January 2015.

Arches Health Plan

The following month, another payor, Arches Health Plan, devised a mobile app solution to the problem of convincing so-called “young invincibles” to sign up for health coverage: a gamified app they hope will educate users about the costs of being uninsured. Arches Health Plan is a Utah-based 27,000-member co-op health plan funded by provisions in the Affordable Care Act.

The app, called “Arches Saves Your Bacon” aims to give users an idea of how different behaviors affect their health risks and how much they can cost them. First, the user spins a wheel to generate six behaviors that range from mundane behaviors (binge-watching Netflix) to extreme sports (skiing or skateboarding) to just plain silly entries (one just says “BEES!!”, for instance).

Government payers

It's been a big couple of quarters for government payers as well, including Medicare, Medicaid, the VA, and even Healthcare.gov, which, while not a payer itself, has started to realize the value of mobile in getting people connected to health insurance. It added a new mobile-optimized section to its website in November.

CMS programs have been running telemedicine pilots and CMS itself is gradually warming to reimbursing those efforts, including remote patient monitoring and video visits. In fact, an Accenture report in January found that 19 out of 25 states that received CMS innovation grants are planning to use them for telehealth pilots. All of the states in the program said they were focusing on patient-centered medical homes and lower-cost labor models, but 19 states want to expand telehealth use and 15 want to offer more patient-facing digital tools, like patient portals.

In November, CMS released its final rule that will lead to changes in coverage under Medicare Part B. The rule, proposed in July, will expand the range of telehealth services that can be reimbursed under Medicare starting in 2015. CMS added telemedicine codes for an “annual wellness visit” including a personalized prevention plan of service — one code for the initial visit and another for subsequent visits. In the area of mental healthcare, CMS has added codes for psychoanalysis and family psychotherapy (which has two codes, one for family therapy with the patient present and one for family therapy with the patient absent). The next two codes are ones that therapists use to report sessions that go overtime or require additional time over the scheduled hour-long visit — these will now be eligible for reimbursement via telehealth.

In recent months remote monitoring trials were launched for both Medicare and Medicaid patients. In August, Microsoft launched a major mobile health pilot along with mobile service provider TracFone Wireless and the Health Choice Network, a Miami-based company that manages a 17-state health IT network for community health centers. In the pilot, 100 Medicaid patients with type 1 and 2 diabetes were equipped with smartphones containing both health management tools and traditional smartphone features.

In September, Verizon teamed up with smartphone health monitoring startup Ginger.io in a pilot conceived and run by Centerstone Research Institute to create a mobile health intervention for high-cost Medicaid patients.  Patients were equipped with smartphones, with connectivity supplied by Verizon and various health tracking applications, that they could use to contact a support team. The support team included a consultant, an on-call nurse and a supervising licensed therapist, as well as a wellness coach. Ginger.io tracked participants’ phone use passively and also sent them daily survey questions about their mental wellbeing.

Finally in October, Cigna-Healthspring, a subsidiary of Newtown, Massachusetts-based payor Cigna that specializes in Medicare plans, expanded its congestive heart failure remote patient monitoring program in partnership with Intel-GE Care Innovations. The two organizations first piloted the program with 50 patients in Tennessee. These members, who had been recently admitted to the hospital for CHF complications, received a tablet on which they could track their health for at least 90 days. During this time, they also interacted via digital devices with a Cigna-Healthspring nurse practitioner, tracked their health metrics, and completed a program that educated them on how to manage their congestive heart failure at home.

The US Department of Veterans Affairs also made news recently related to telehealth, and reimbursement news. The VA announced that 690,000 US veterans received care in the 2014 fiscal year via telehealth, with 2 million telehealth visits scheduled. That means that 12 percent of all veterans enrolled in VA programs received telehealth care of some kind in 2014. And the VA also made some internal rules changes that allow them to reimburse healthcare providers for specific wearable sensors.

The change the VA has made is to introduce a new mandatory template for providers to use when negotiating contracts with the vendors that sell prosthetic limbs and custom orthotics for injured veterans. Part of the impetus is to keep the costs down by giving VA medical centers across the country a consistent idea of what they should be paying for various systems. But, for the first time, the contract also allows providers to be reimbursed for monitoring devices that can, in turn, deliver data on the effectiveness of prosthetic devices and how much patients are using them. 

Price Transparency

Price transparency has been big business in digital health for a while, as evidenced by Castlight Health's IPO. But lately even more steps have been taken toward making the cost of healthcare more decipherable to consumers, some by payers and some by other stakeholders.

In October, a Massachusetts law went into effect requiring health insurers to make realtime cost information publicly available, an unprecedented move. As WBUR reported at the time, the initiative has already started to shine light on some galling price discrepancies for procedures like MRIs, surgeries, and lab tests (for instance, an MRI in Boston ranges from $614 to $1,800 with no discernible difference in the test).

That same month physician rating platform Vitals acquired price transparency service Compass Healthcare Advisers. This acquisition will combine Vitals’ rating system with Compass Healthcare Advisers’ price transparency system so that consumers can consider both options when choosing a provider. Compass Healthcare Advisers offered their price transparency tool through health plans and employers. When members use Compass Healthcare Advisers’ offering to save money, they receive monetary rewards from the program.

Vitals planned to roll the service out to its payer customers, not its direct-to-consumer users, at least at first. Aetna's iTriage, on the other hand, tapped Healthcare Bluebook to add price transparency to its app. According to the app’s iTunes description, as of the latest update “members of select insurance carriers can see estimated cost of care for procedures.” An “Average Cost” tab has been added to the Procedures section of the app, but currently bears a “check back soon” message that says Aetna will tap Healthcare Bluebook for pricing information. It’s possible some Aetna members are already seeing price data on the app.

Currently United and Aetna offer some kind of price transparency tools to users via mobile devices. Health insurance upstart Oscar, which focuses on consumer engagement to bring in young members, also offers price comparison tools.

Employee Wellness

While this report mostly focused on health insurance companies' activities, employers are often payors, too. Here's a brief roundup of employee wellness program news from the past few months.

Recently a few organizations published metrics about consumers' views on employee wellness offerings.

A recent poll conducted by Survey Sampling International found that 71 percent of consumers want their employer or health plan to offer a program or a set of guidelines that helps them manage their health. The survey was commissioned by San Francisco-based HealthMine, which offers employers and health plans a white-label health improvement program for web and mobile devices.

Another 75 percent of consumers want their health plan or employer to offer incentives to help them improve their health.

In another survey, conducted a few months earlier, by the National Business Group on Health, 48 percent of employers will make telehealth services available to employees, in states where it’s legal, in 2015. Within this group, 33 percent of employers plan to offer these services without incentives or penalties and 15 percent plan to offer the services with incentives and penalties.

Additionally, in 2015, 84 percent of employers surveyed said they plan to offer disease management tools, but the survey didn’t explain what kinds of tools would be offered. Another 71 percent said they want to offer price transparency tools and 71 percent said they plan to offer decision support tools.

In September 2014, CEOs from nine large US companies -- healthcare and otherwise -- released a 130-page report detailing a number of ways the private sector can help reduce the country’s rising healthcare costs, including explaining a lot of the work their own companies are already doing. The group, named the CEO Council on Health and Innovation, was formed by the Bipartisan Policy Center.

Five CEOs from the council participated in a panel discussion to launch the document: Aetna’s Mark Bertolini, Verizon’s Lowell McAdam, Bank Of America’s Brian Moynahan, Nant Health’s Dr. Patrick Soon-Shiong, and Muhtar Kent, CEO of the Coca Cola company. Representatives of the other companies (Johnson & Johnson, McKinsey Company, Blue Cross Blue Shield, and Walgreens) also attended.

The report outlines three major areas where large employers can improve healthcare: they can focus on improving the health and wellness of individuals through their own employee wellness programs, they can improve the health of communities by working with local organizations, and they can improve the healthcare system by pushing their employees into provider organizations that offer value-based care, and supporting new care delivery technologies like telemedicine and mobile medication adherence tools.

Safeway Health president Dr. Kent Bradley also discussed employee wellness earlier this year at an event.

Safeway Health entered the health market in an unusual way. In 2010, the grocery store chain Safeway was getting so much attention for its novel approaches to employee wellness that the company spun off Safeway Health, a wholly owned subsidiary that now offers services and platforms to other employers to improve health at their own companies.

Bradley spoke about how healthcare data has arrived, but the challenge now for stakeholders, especially employers, is to figure out how to use that data meaningfully.

“Safeway did our own introspection and came up with what I call it the ‘triple insight’ from an employer perspective,” he said. “And from an employer perspective, those insights were healthcare costs were concentrated [in] a small percentage of the population; behavior was a key cause of conditions and therefore we needed a focus on lifestyle and behavior and that incentives, when properly designed, could, in fact, drive behavior change and improve health. And then the third was that, we had this understanding that we needed to have a marketplace and individuals had to be empowered and be able to make thoughtful decisions around their healthcare like they would other things in life.”

While employers are turning more and more to preventative wellness programs to keep down their employee’s eventual healthcare costs, including biometric screenings to determine early risk factors, making these screenings mandatory may be a violation of the employee's privacy.

In October, the Chicago-based Equal Employment Opportunity Commission (EEOC) filed a lawsuit against Honeywell, which alleges that Honeywell’s employee wellness program can cost employees up to $4,000 in surcharges and lost HSA funds — $2,000 of which is referred to as a “tobacco surcharge” — if they and their spouse refuse to undergo a biometric screening that includes a blood test. They say that this violates both the Americans with Disabilities Act and the Genetic Information Nondisclosure Act. (Although genetic testing is not involved in Honeywell’s program, the EEOC claims that requiring spouses to be tested constitutes an unlawful demand for family medical history.)

This month, a report in The Hill quoted a senator as saying that the EEOC would be publishing new guidelines for employee wellness programs “very shortly”. One of the core debates about employer-sponsored wellness programs is what exactly constitutes a “voluntary” program.