As we do every quarter, MobiHealthNews has rounded up our Q2 2016 coverage into a handful of longform stories. This section is on payer-related digital health news.
CMS and other government payer-related digital health news from Q2
The Center for Medicaid Services announced a new expanded initiative for bringing value-based repayment to primary care. The Comprehensive Primary Care Plus (CPC+) program, builds on the Comprehensive Primary Care program introduced in 2012, but will expand the program to a larger number of practices and includes some tweaks to the model.
CMS will also work with private payers to set up a system that can support 5,000 primary care practices in 20 different regions of the country. They’ll be set up in one of two tracks, both of which will receive some payment in the form of a monthly care management fee for each of their Medicare patients, and bonus payments for meeting certain performance measures. In Track 1, practices will continue to receive regular Medicare fee-for-service payments for covered services while Track 2 will use a hybrid fee-for-service/value-based model.
Soon after the announcement, some called out CMS for excluding ACOs from the initiative. CMS responded in kind by announcing via Twitter that CMS would change course and allow a limited number of ACOs, under the Medicare Shared Savings Program but not the Next Generation ACO program, to participate in CPC+. In addition to the tweet, CMS released an updated FAQ that detailed exactly how the change would work. The FAQ explained that only a maximum of 1,500 of the 5,000 CPC+ practices will be allowed to be ACOs. If more ACOs than that apply, they'll be subjected to a lottery. This is to ensure that a large influx of ACOs doesn't edge out other would-be participants in the model. The FAQ also explains how payments will work for practices that are both ACOs and CPC+, and that they will be responsible for both programs' quality reporting requirements.
In late April, CMS also released its 1,425-page Managed Care Final Rule, a long-awaited update to CMS bylaws which, according to CMS, “aligns key rules with those of other health insurance coverage programs, modernizes how states purchase managed care for beneficiaries, and strengthens the consumer experience and key consumer protections.”
In part, the rule opens the door for more telemedicine reimbursement. The rule passes to the states the duty of establishing “network adequacy standards”, or standards that ensure all Medicaid beneficiaries have reasonable access to all the types of care they might need. In the past, these standards required that services be accessible in-person, but, after it was suggested in public comments, CMS has amended the final rule to allow states to consider telemedicine options as well.
Digital launches from big payers
May marked six months since UnitedHealthCare’s launch of its Doctor on Demand and American Well’s video visit program. At the American Telemedicine Association conference in Minneapolis, representatives from all three companies reported on their experiences with the partnership and also shared some thoughts about the future of telemedicine.
Karen Scott, senior director of marketing, product and innovation at UnitedHealthcare shared some early data about the insurer’s experience with video visits. They’re expecting 20 million users by the end of the year. The majority of video visits on the platform have been for respiratory issues, she said — those accounted for more than 50 percent of visits, while no other single category accounted for more than 10 percent. The average video visit user was a 31-year-old female.
Also at the Minneapolis conference, American Well announced a new enterprise telehealth service called the Exchange, will allow payers and providers who use white-labelled American Well telehealth services to offer their care to one another.
Under the Exchange, participating insurer services will be able to negotiate directly with participating provider networks, allowing payers to give their patients access to a wider range of care providers, while health systems have the opportunity to see many new patients. The starting partners are Cleveland Clinic, Nemours Children’s Hospital in Florida, and LiveHealth Online, the American Well-powered telehealth system for Anthem Blue Cross Blue Shield. Notably, Cleveland Clinic has already begun to experiment with using telehealth to make its doctors more broadly available, partnering with CVS Minute Clinics via American Well earlier this year.
In June, Anthem Blue Cross, a BCBS plan that covers the state of California, became the first of several Anthem payers nationwide to launch a pilot with Kurbo Health to use its app and online coaching to help treat childhood obesity. The initial pilot includes 100 young patients and will last three months with the option to continue for an additional three months. Anthem is also working with San Benito Medical Associates, a local provider in the California county with the highest incidence of childhood obesity.
San Benito physicians selected pilot candidates out of the Anthem members in their patient population, focusing on children with BMIs in the 85th percentile. If parents agree to participate, they will download the Kurbo app, which offers weekly one-on-one digital coaching with a Kurbo coach, a manual entry food tracker that assigns colors (red, yellow, and green) to different foods so that children understand at a basic level which foods are healthy and unhealthy, and games that reinforce healthy choices. Providers will also be able to view data from the tracker portion in their own dashboard.
Highmark, a Blue Cross Blue Shield-affiliated payer, announced a collaboration with connected behavioral health company Quartet Health. Highmark will initially roll out the program for members in Western Pennsylvania. Through this partnership, Quartet will help primary care physicians pinpoint which patients may need behavioral health support. Primary care physicians can then use the service to refer patients using Quartet’s referral network. Members can use Quartet Health to communicate with a psychiatrist via video or phone, participate in online treatment programs to help manage conditions, view resources and health information to learn about cognitive conditions, and connect with peers.
CareFirst BlueCross BlueShield, a health insurer covering Maryland, Virginia, and Washington, DC announced the 10 organizations that it will support financially in launching or developing telemedicine initiatives. The insurer first announced the program which offers $3 million to non-profit organizations and government entities for "innovative programs using telemedicine to improve access to health care and increase efficiency", last fall.
Louisville, Kentucky-based insurance company Humana also made a strategic $5 million investment in connected diabetes management company Livongo.
Digital news from smaller health insurance companies
During MobiHealthNews’ first-ever event in June, private health insurance company Oscar Health presented an overview of its member engagement. Holly Bui, Oscar's General Manager for California, said the company’s step-tracking program has been a valuable method to keep members engaged with other offerings and helps keep a larger number of healthy people on the platform. Perhaps the most interesting insight in Bui’s talk was that collecting step data isn’t really about the data for Oscar, nor is it entirely about supporting the patient’s health, though that is one goal. It also creates a feeling of value for Oscar members who don’t actually make use of the health plan that much.
Also at the MobiHealthNews 2016 even in June, Portland, Oregon-based Zoom+ CEO and cofounder Dr. Dave Sanders talked about the challenges of creating a full stack health plan controlled by your phone. For the past decade or so, Zoom+ has been innovating around its network of clinics. The genesis of the company, Sanders said, was thinking about the millennial customer and their particular healthcare needs. Assessing those needs, he said, they realized the only way to serve that customer would be to provide “full stack” healthcare: to be the patients’ primary care provider, specialist care provider, and emergency room, all in one. And all that care would be mediated through, and when appropriate delivered through, the phone. As they developed the “full stack” experience, Sanders said, they realized they also needed to be their patient’s health insurer.
Connected toothbrush company Beam expanded into dental insurance and launched in California in April. Beam first launched a few years ago with a connected toothbrush offering, called Beam Brush, but has since expanded into offering large and small employer dental health insurance plans.
Employee health and wellness news from EEOC
The Equal Employment Opportunity Commission (EEOC) set limits on the monetary value of incentives that employers offer to employees and their spouses to convince them to contribute specific health information to a wellness program, according to the commission's final rules released in May. The rules take effect at the start of 2017. The final rules explain how employers that offer wellness programs that collect health information for employees and their spouses can comply with Title I of the Americans with Disabilities Act (ADA) and Title II of the Genetic Information Nondiscrimination Act (GINA).