RED HOT Contributors

 

Roundup: all the digital health payer-related news from the first quarter of 2017

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Payer moves in digital health in the first quarter mainly fell into one of two categories: employee wellness initiatives and reimbursement moves. The only major piece of payer news that didn’t fit into one or the other category was Humana’s partnering with digital health startup Quartet to bring mental health services to underserved communities in New Orleans.

Employee Wellness

Early in the quarter we saw an update to UnitedHealthcare’s wellness program Motion, an employer-sponsored wellness program powered by Qualcomm Life’s 2net platform that launched in March 2016. UnitedHealthcare began offering Fitbit’s Charge 2 to to employees to track activity metrics via a customized integration with Motion’s Frequency, Intensity and Tenacity (F.I.T.) program. Using the device, participants can track progress on their daily goals and earn financial incentives that can be applied towards their healthcare plan.

With the integration of the Fitbit Charge 2, participants can earn up to $4 per day in credits by achieving one or more of their goals on each arm of the F.I.T program. All together, participants can earn up to $1,500 in Health Savings Account or Health Reimbursement Account credits per year.

That same month Health Savings Account provider HSA Health Plan partnered with Boston-based Wellable, an employer wellness company, to offer an incentive program to its members. Wellable’s digital, customizable wellness platform is built around wearable devices and mobile apps, and through the partnership, HSA Health Plan members will be offered a Garmin vivoki. If they take at least 8,000 steps per day on 20 or more days in the month, employees can earn $20, which will be deposited directly into their HSA accounts.

Later in the quarter Collective Health, an employee benefits platform that raised more than $100 million in VC funding in 2015, launched a new product called CareX that’s designed to help employees navigate all the options their health plan provides. CareX integrates into Collective Health’s existing platform. For employers who have elected to offer point solutions, CareX will run an algorithm using data from claims, as well as from searches on its member portal and past communications with its member advocates, to identify employees who would benefit from particular benefits. Then using a combination of digital tools and human care navigators (the exact approach varies by employer), CareX reaches out to employees and presents them with their options.

At HIMSS, Cigna and Microsoft showed off a digital health game using Microsoft’s Hololens called BioBall that could serve as a new way to do health screenings. To play, users first meet with a trained BioBall expert – Cigna representatives who register the users and take their blood pressure – then they step into a hologram-filled chamber of sorts and the bowling ball-sized device and a VR glasses come into play. As users try to capture images that are flashed across the HoloLens screen, the BioBall measures their pulse, BMI, movement and speed. At the end of the one-minute game, users immediately receive their health numbers on the lenses as well as an email offering suggestions on how to improve. The device won’t be making its way into homes or doctor’s offices, but will be featured at Cigna-sponsored public events throughout the United States.

On the regulatory side, a district judge struck down an AARP lawsuit, meaning that the Equal Employment Opportunity Commission (EEOC)’s rules to set limits on the monetary value of incentives employers can offer to employees in wellness programs will still stand. Judge John Bates ruled that the AARP couldn’t show that any of its members would suffer “irreparable harm” if the EEOC rules went into effect January 1, 2017. Both agencies will now develop evidence for the court to explore the legal merits of the rules and AARP’s argument against them, but the court indicated that it was unlikely AARP will be successful in its argument.

Reimbursement

The biggest reimbursement news of the quarter came in January when the Centers for Medicare and Medicaid announced that certain therapeutic continuous blood glucose meters (CGMs) would be considered durable medical equipment and therefore eligible for coverage. As of now only the Dexcom G5 Mobile meets all of CMS’s requirements. CMS issued the billing codes for CGM reimbursement in March.

Other interesting reimbursement news came from private insurers. Chronic disease prevention and management company Solera Health partnered with Blue Shield of California to offer Diabetes Prevention Programs (DPPs) to commercial health plan members. Blue Shield members can access the Solera program –  which offers both digital and in-person programs through a network of 1,000 CDC-recognized DPPs, – at no extra cost through Wellvolution, Blue Shield’s wellness solution that provides tools and resources to encourage healthy lifestyle behavior.

Diabetes management company DarioHealth announced partnerships that will allow customers in the United States who use the company’s digital diabetes monitoring system to have their products reimbursed by insurance. All third party insurers were not named, but the company said it had signed alliance agreements with partners across the country who will be able verify insurance coverage and bill insurance for members using the Dario blood glucose monitoring system, which consists of a pocket-sized device that includes a glucose meter, disposable test strip cartridge, a lancing device and a companion smartphone app. So far, the company has shared that Aetna and various Blue Cross Blue Shield members have been able to have their Dario systems covered.

Finally, UK provider network IPRS Health launched the virtual physical therapy platform from Physitrack to their customers under global insurer QBE, allowing patients to use app-based physiotherapy in lieu of some in-person sessions. The QBE deal is a big one for Physitrack, which was founded in 2012 and has enjoyed considerable success across Europe, Australia, New Zealand and the United States. QBE is the first private payer in the UK to start offering the virtual physical therapy service, but Physitrack hopes it will open the door for other large payers to follow.

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