By LYGEIA RICCIARDI
Last week’s announcement by Aetna and Apple of their Attain “experience” designed to enable Aetna members to achieve better health using the Apple watch was the latest in a series of partnerships vying to shake up healthcare from an unconventional angle. Others include Amazon-Berkshire Hathaway-JP Morgan’s collaboration to reshape health insurance, and Uber and Lyft’s numerous partnerships with Sutter, CareMore Health, and other healthcare systems to address transportation challenges for patients.
The Heat is On
Big changes in healthcare—including the shift to value-based care, the growing influence of consumerism, and a recognition that health outcomes depend on a wide array of everyday life factors ranging from foods to moods—are forcing the old guard in healthcare to recalibrate. Healthcare provider organizations alone engaged in a record-breaking 115 mergers and acquisitions in 2017, and continued apace until now, with deals already announced in 2019 between Dignity Health and Catholic Health Initiatives (CHI), among others.
The most interesting partnerships, from my perspective, pair traditional healthcare players with non-traditional ones: it’s a recognition that something fundamental has to change, a point which hasn’t been lost on the 84% of the Fortune 50 companies that are already in healthcare, up from 76% in 2013. Everyone from tech giants to car manufacturers seems to gambling to some extent on healthcare. And why not, when the potential jackpot just keeps growing?
What’s In it for Patients and Consumers?
There’s no denying that healthcare needs radical fixing, so change is welcome—to a point. One key question to ask when evaluating any healthcare partnership is whether the incentives of the participants are aligned with each other—and with those of the consumer or patient.
Let’s take the Attain program which I saw launched by Aetna and Apple last week in Boston. Attain is a program for Aetna members who own an Apple watch. It uses health and activity data to set self-adjusting personal movement and other health activity goals for the user, who receives financial incentives such as coupons and gift cards for reaching his or her goals. A user can bring his or her own Apple watch or receive a new series 3 or 4 watch upfront and work toward paying it off via the program. It’s not possible to participate without an Apple watch or an Aetna membership.
What’s Apple getting out of Attain? Increased watch sales. Fair enough, it’s a hardware company. What’s Aetna getting out of it? Potentially healthier members, which translates into cost savings. Appropriately, Aetna is quite clear that none of the data generated through the program will be used for underwriting purposes. Though a risk remains that members could be gently nudged toward money-saving choices that might not necessarily align with the interests of their long-term health. What does the consumer get? Hopefully an engaging way to change everyday habits to move toward better health. As I wrote about this emerging partnership a year-and-a-half ago, I think it holds strong potential to positively reshape how our society thinks about health engagement generally.
On the cautionary side, I’d encourage Attain and the partners behind it to find ways to support users who lose their Aetna coverage and/or can’t afford to keep up with the latest model of Apple watch, particularly if they no longer receive incentives to do so. It’s also important to make sure the recent acquisition of Aetna by CVS is handled in a transparent, ethical way with respect to Attain. For example, the program could be used to reward users for filling prescriptions or purchasing health supplements exclusively through CVS, or alter behaviors in other ways which, particularly if they are not transparent, could be problematic.
On the plus side, the designers of the Attain “experience” appear to have bent over backwards to address privacy concerns, for example by using encryption, enabling choice about whether to share data, and eliminating the use of passwords, replacing them with a continuous risk-based authentication method which draws on geolocation and an assessment of 30 to 60 user attributes, such as the unique way a user holds his or her phone, to determine an appropriate level of access. If some these attributes were to become public, they would likely be less damaging than passwords or other traditional types of information used to prove identity, such as a mother’s maiden name.
As Harvard Professor Latanya Sweeney and others have demonstrated, privacy is particularly important in the case of activities that aggregate data from diverse sources—in this case claims data from Aetna, wearables data from the Apple watch, and phones. It is precisely in this kind of mashup that the greatest opportunities for creative use and misuse of data abound. For example, a public map released by a fitness app called Strava revealed the activities and locations of employees at a secret military base, inadvertently putting national security at risk.
Partnering for the Benefit of People
In an environment of rapid healthcare change, the ultimate compass for any healthcare partnership should be the extent to which it is genuinely helping individual patients or people—and those who care for them—to live their best lives. Protecting privacy is a necessary but not sufficient part of that picture. In the current landscape of misaligned financial incentives (which is, thankfully, evolving), it can be hard to simultaneously do good and do well, but let’s challenge old and new healthcare players alike to continue to find creative ways to win on both counts. And readers, please feel free to share any inspiring examples of successful partnerships you’ve seen.
Lygeia Ricciardi is the Chief Transformation Officer at Carium. She has helped to define the cutting edge of consumer engagement and digital health from both the public and private sectors.
Author’s statement: This post represents my personal opinions. While Aetna contributed to travel costs associated with my participation in the launch event for Attain, I was not required to write about the experience or to express a particular point of view about it.