Through all of this year’s tumultuous ups and downs, one trend that has remained unstoppable – and has even accelerated – is the healthcare sector’s adoption of technology.
For years, MobiHealthNews has covered the payer space as it continually pushes further into the world of digital health, and 2020 proved no different. From traditional insurers embracing technology to massive expansions of telehealth, to innovative insurtech companies hitting the public market, this roundup goes deep into how payers are turning towards tech amid a changing world. Read on for a recap of payer digital health news from 2020.
Insurers upping their technology game
As much of this year was spent navigating different stay-at-home and social distancing mandates, many turned towards technology as a way to receive healthcare. As a result, even the most traditional healthcare insurers upped their tech-game this year.
The year saw UnitedHealth Group looking towards the digital pharmacy space with its acquisition of Divvydose, worth an estimated $300 million. The deal gives UnitedHealth Group access to the virtual pharmacy's capabilities, which include prescription shipments.
In September, Medicare began covering Abbott’s FreeStyle Libre 2 integrated continuous glucose monitoring (CGM) system. The coverage for Abbott’s latest CGM came in the midst of the COVID-19 public health crisis where self-monitoring and remote patient monitoring tools are helping reduce unnecessary medical visits or avoidable exposures.
Centene Corporation, a managed care enterprise, boosted its services by acquiring unstructured patient data analytics company Apixio. The platform finds and compiles patient data from physician notes, medical charts and other clinical documents. Acquiring Apixio's business and the platform allows the managed care company to deploy the technology across its entire enterprise, potentially optimizing care and reducing administrative costs for a massive volume of patients.
Others, like Anthem, joined research initiatives to study how digital tools can improve health outcomes. The insurer joined Apple, the University of California, Irvine, and software company CareEvolution to launch a two-year, 900-participant study investigating how digital tools can help patients control their asthma and reduce hospital utilization.
The rise of insurtech
As many payers added technology to their business models, others incorporated technology from the start.
The Medicare Advantage insurer Alignment Healthcare relies on its tech platform in two key ways: through an “on-demand concierge” system, where senior members can speak to a care coordinator 24/7 via phone, and through the Alignment Virtual Application platform that collects patient data and points to shifts in a member’s care needs. The company closed a $135 million Series C funding round this year.
Alphabet’s life science subsidiary Verily jumped into the health insurance space this year with the launch of Coefficient Insurance Company. The tech-enabled payer is backed by Swiss Re Corporate Solutions and will combine Verily’s hardware, software and data science and Swiss Re Corporate’s distribution model.
The year also saw two major insurtech companies go public.
Clover Health was first, as it became publicly traded through a merger with special purpose acquisition company (SPAC) Social Capital Hedosophia Holdings Corp. III. Along with offering health plans, its platform, the Clover Assistant, combines health data with machine learning to provide physicians with patient insights at the point of care.
Following two massive funding rounds, this year worth $225 million and $140 million, the health insurance technology company Oscar filed to go public in December. Oscar offers direct-to-consumer health plans that seek out and guide members toward optimal and cost-effective care options – which can include the 24/7 virtual care services offered by Oscar itself, named Doctor on Call.
Telehealth is here to stay
While telehealth is not new, it had its moment in the sun this year as a result of the COVID-19 pandemic. By the end of March, telehealth usage increased 154% compared to the same time period in 2019, according to the Centers for Disease Control and Prevention.
At the beginning of August, President Trump signed an executive order to make the temporary telehealth flexibility given under the public health emergency permanent.
As a result, payers of all varieties hopped onto the telehealth train this year.
In March, Blue Shield of California temporarily waived out-of-pocket costs for all commercial plan members using Teladoc Health's services.
Uninsured residents of Massachusetts were given access to free COVID-19 telehealth visits through a deal between Doctor on Demand and the Commonwealth. The deal followed not long after the telehealth provider and MassHealth, the state's Medicaid and Children's Health Insurance Program administrator, agreed to a similar COVID-19 arrangement for its 1.8 million plan members.
Humana beefed up its telehealth offerings by investing in and partnering with the house call and telemedicine platform Heal. Not only did the deal provide Heal’s home healthcare services to Humana members, but the $100 million investment helped push the platform into new markets including Chicago, Charlotte and Houston.
Moving towards value
Early in 2020, the Department of Health and Human Services released its final rules on interoperability, information blocking and patient access. The rules implement several provisions from the 21st Century Cures Act, including those to prevent information blocking and other anticompetitive behaviors among providers, health information exchanges, and health IT developers, and including the establishment of a Patient Access API.
Because of the time and attention required by the COVID-19 pandemic, the Office of the National Coordinator for Health IT announced in October that HHS would extend the time frames for requirements related to the information-blocking rules for healthcare providers and HIEs, and the conditions and maintenance of certification (CoC/MoC) for technology developers. The new info blocking applicability date is now April 5, 2021 – while new requirements around standardized API functionality have been pushed out to New Year's Eve 2022.
This is all a part of a larger trend around creating a more value-based healthcare system that puts the patient at the center of the care journey. Many health leaders agree that value-based care is effective in creating better outcomes and reducing healthcare costs, but the question remains how value is best implemented.
One strategy from the insurance startup Sidecar Health focuses on price transparency and reduced payments based on self-pay service rates. It has an app that allows users to customize their annual coverage amount and options and includes a price comparison tool for viewing different services from local providers. The company raised $20 million this year to support company growth.
UnitedHealth Group took a different approach this year by beginning a pilot program where it provides members with a Dexcom G6 CGM to help them manage their Type 2 diabetes at no additional cost. The program also incentivizes the members it enrolls to continue healthy behaviors with rewards such as gift cards or cash.
Elsewhere, the São Paolo-based health tech startup Sami transitioned into health insurance this year with a focus on value-based care. Sami raised $15.5 million this year as it hopes to take its approach to provide care at value across the globe.
The Centers for Medicare and Medicaid Services are working to make it easier to create value-based drug purchasing agreements with a final rule it passed in December.
The new rule will incentivize manufacturers to set up value-based purchasing arrangements, because drug pricing will be driven by the value of the drug to individual patients, CMS said. It also allows for negotiations around drug prices to be based on evidence-based outcomes to ensure that if the drug is not effective, the payer is not held accountable for the full price.
Supporting behavioral health
With all of the uncertainty of this year, many dealt with adverse mental health conditions related to COVID-19. During late June of this year, 40% of U.S. adults reported struggling with mental health or substance abuse, according to the CDC.
“One of the things that’s happened in 2020 is COVID-19, and this has brought into a higher profile the need to get services, and technology-based services, to people,” Helen Christensen, director and chief scientist at the Black Dog Institute, said during a WISH 2020 panel in November.
To help get those mental health services into the hands of people who need them, health plans have been partnering with behavioral health tech companies.
Aetna International announced in May that it was partnering with Wysa, an AI-powered chatbot and mental wellbeing app. Through Wysa, all Aetna International members and their employees have free access to 24/7 text-based support designed to help them navigate a range of mental well-being challenges at their own pace, including anxiety, stress, motivation and confidence.
To help fight the social isolation many seniors feel because of the pandemic, SCAN Health Plan and Rally Health teamed up to give SCAN’s senior members access to the Rally platform. Within the platform, users can receive information about how to manage a chronic condition, ways to improve mental well-being, assistance in setting health goals by giving rewards and get access to an online social community where they can interact with peers and share experiences.