Round-up: Health insurance, payer-related digital health news from Q1 2016

By MHN Staff
02:46 pm

As we do every quarter, MobiHealthNews has rounded up our Q1 2016 coverage into a handful of longform stories. This section is on payer-related digital health news. Skip ahead using these links to read Q1 roundups focused on providers, pharma, M&A and funding.

Public payers

HS Secretary Sylvia Burwell announced at the tail end of the quarter that Medicare will cover the Diabetes Prevention Program, including digital versions like Omada Health’s. This marks the first time a preventative model from a CMS Innovation Center has been expanded into the Medicare program.

HHS reported that, based on pilot studies, participants in the program lost an average of 5 percent of their body weight, 80 percent attended at least four weekly sessions, and, compared to Medicare beneficiaries outside the program, the DPP would save about $2,650 per enrollee.

Earlier in the year, The Centers for Medicare and Medicaid Services came out with a final rule yesterday that would require face-to-face visits prior to home health services for Medicaid patients, a rule that already exists for Medicare patients. But, the rule also includes a parenthetical allowing those "face-to-face" visits to be conducted via telehealth.

A month later, a bipartisan group of US Senators led by Brian Schatz (D-HI) introduced new telemedicine legislation that would move to waive restrictions on Medicare telehealth coverage that many consider antiquated or arbitrary. In addition to a coalition of six senators and three representatives, the bill has the support of the American Medical Association, the American Telemedicine Association, and a number of other industry groups, health systems, and tech vendors.

And in March Sense Health, a texting software company focused on Medicaid care managers, signed a deal with Coordinated Behavioral Care’s (CBC) Health Home, a nonprofit that oversees more than 50 Medicaid care management agencies in New York City.

The American Telemedicine Association (ATA) released the latest edition of its telemedicine state-by-state score card reports this quarter. As always, there’s good news and bad news. In the area of coverage and reimbursement, 11 states and the District of Columbia saw their grades improve since September 2014, when ATA released the first editions of these reports, and only two saw their grades decline. But in the area of physician practice standards and licensure, 11 states saw their grades lowered while just six improved. Nevada was the only state to improve in both categories.

Private payers

UnitedHealthcare partnered with Qualcomm subsidiary Qualcomm Life to launch a new mobile-enabled wellness program, called UnitedHealthcare Motion. The program is designed for UnitedHealthcare members and their covered spouses who are enrolled in high-deductible health plans.

Aetna subsidiary iTriage quietly launched a new version of its app, called iTriage Essentials, for iOS and Android platforms. The app is a redesigned, stripped down version of iTriage designed to serve as a testing ground for the company, though it will likely eventually replace the original iTriage app.

The following month, Aetna merged iTriage with its cost transparency business, WellMatch, to form one team. The move follows layoffs across four Aetna businesses, an iTriage spokesperson confirmed to MobiHealthNews. The iTriage app, which has been downloaded more than 15 million times, helps consumers connect with the right care provider via a symptom navigator.

Pharma company Novartis signed deals with two major health plans, Cigna and Aetna, to pay for its new heart failure drug Entresto based on outcomes. The deals are among the first publicly announced examples of outcomes-based drug pricing. While Novartis discussed using digital health devices as part of its planned Entresto rollout last year, reports about the new payer deals have not mentioned the prospect of including digital health tools in the mix.

Louisville, Kentucky-based health insurer Humana announced it was joining Propeller Health's Air Louisville public-private partnership. The project, launched in March 2015 in collaboration with the City of Louisville and funded by a Robert Wood Johnson Foundation grant, aims to connect sensors to 2,000 asthma inhalers and share that data, in aggregate, with city officials so it can be used to improve public health.

Meanwhile, population health company Transcend Insights, a health tech subsidiary of Humana, launched three digital tools to help health organizations transition patients from episodic care to proactive care. In addition to this announcement, Transcend Insights announced that its first pilot customer, Hardin Memorial Health.

A few Blues made news too:

Independence Blue Cross, which serves 2.5 million customers in the Philadelphia area and another 7.5 million across the country said it would offer telemedicine to its members in two ways — both through a partnership with MDLive and through whatever telemedicine offerings their primary care physician provides. 

Seattle, Washington-based EveryMove shifted its business strategy and announced a new product that helps health plans with member engagement and behavior change, called Tandem. The company also announced its first customer for Tandem, Premera Blue Cross.

Cambia Health Solutions, a Portland, Oregon-based health insurance company, shut down its mobile payment startup Wellero after two years. With only about 1,100 users on the app despite it being deployed at 700 health plans, it appears the service just failed to get traction.

Employer news

The Equal Employment Opportunity Commission (EEOC), itself a government body, has sued three different companies in the last two years on behalf of employees required to submit to screenings or face higher premiums if they decline. Earlier this year, a judge ruled against EEOC, following a 2011 Florida precedent. The court said that a safe harbor provision in the ADA protects employers who are “establishing, sponsoring, observing, or administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks”.

Piggybacking on a Wall Street Journal story about how Castlight Health uses health data to drive healthcare savings for employers, The New York Times editorial board called for federal protections that would prevent employers from hiring or firing based on an employee's health data. The Times points out that as it stands right now, health data collected by employers is in a grey area. It isn't protected by HIPAA, which strictly controls how a patient's doctor or hospital -- or any business associate they share personal health data with -- can use patient health data. 

Boston Medical Center added a mobile-enabled sleep tracking program from London-based company Big Health to its benefits package. Since launching the program in December more than 1,000 of Boston Medical Center’s 5,800 employees, about 17 percent of its staff, have started to use the app. Boston Medical Center currently has a one-year contract with Big Health.


The percentage of Humana employees in a low-risk range for chronic conditions, who were also engaged in HumanaVitality, the payer’s employee wellness offering, increased by 24.4 percent, according to The HumanaVitality Impact Study. The study is a retrospective of healthcare usage and claims data for 8,000 members over three years. Humana only included members who were with the program for at least a full year, and excluded members with high cost claims, or more than $100,000 per year.

WebMD partnered with Verizon to offer digital health coaching to 1,100 of Verizon's employees in a recent pilot. The program led to weight loss for 73 percent of participants. Verizon employees were invited to participate after taking a health assessment if they had a BMI over 30 or a blood glucose level above a certain threshold. The program included one-on-one coaching over the phone and digital coaching via an app, which allowed employees to set goals and work toward them through various baby steps. At the end of 12 months, 800 of the 1,100 participants had lost weight.

A survey of 213 employers sponsored by Xerox Human Resource Services and the National Business Group on Health (NBGH) found 50 percent of employers use mobile apps to engage their employees in their health. NBGH added that there was significant growth in this category compared to its 2013 survey where only about 16 percent of employers said they were using mobile to engage users.

According to a recently published 2014 survey of 1,557 US physicians, there’s a big disconnect between support for telehealth and actual use of telehealth technologies. While 78 percent of respondents believed that telehealth improved access to care, only 15 percent actually reported using telehealth services in the past 12 months.

And later in the quarter, a Fitbit survey of 200 CEOs that run companies with between 1,000 and 10,000 employees found that 88 percent of respondents already offer employees some kind of wellness program. When asked whether a social event or a wellness program would more effectively reduce stress in their workforce, 80 percent of CEOs said a wellness program and just 20 percent said an event.

Read on for Q1 2016 digital health news about providers, pharma, funding, and M&A.


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