The Power & Perils of Unconventional Healthcare Partnerships


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.

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14 replies »

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  3. Commercialization has started in healthcare. I feel that all these gadgets and technology is not reducing the expenses of the patients. The need of the hour is to bring awareness in the society.

  4. Prediction: Not one of these income generating “partnerships” will produce lower prices for patients.

  5. The Cooperative Extension Service for urban as well as rural farmers represents an institutional arena to connect the land-grant University based Colleges of Agriculture with the front lines of all farmers, county by county. The land-grant University-based, schools for agriculture were created by Congress in 1862 (Morrill Act) as revised in 1887 (Hatch Act).

  6. Hi Dr Palmer — Thanks for your comments. While I agree that patients need more support and guidance in their health and healthcare, I’m not convinced that only physicians can provide it to them effectively. Let’s harness information technology (including artificial intelligence) to fill some of the gaps and let MDs focus on higher order problem solving as well as empathy. In addition, other patients, nurses, pharmacists, coaches and family caregivers can help–MDs needn’t take on the full burden on their own.

  7. pjnelson — you raise some great points. I would love to see nothing more than a coordinated “moon shot” in health care. Too much of our national dialog has become partisan. We need to dream big and support, not oppose one another. Thanks for elevating the conversation… and please, help us figure out how to make it so!

  8. During the rush to capture market share with consolidation and economic dominance, our nation has no community originated and nationally coalesced strategy to manage an influenza pandemic or anticipate the future flooding of our oceanic coastal cities. Similarly, there is no means to assure that Primary Healthcare is equitably available and ecologically accessible, community by community. Furthermore, our nation’s high level of health spending requires a level of entitlement funding that accounts for more than 50% of our nation’s annual Federal deficit.

    The local, legitimate stakeholders are ready to act. An intense “shoot the moon” strategy, retooled for healthcare, will be required. With a locally fine-tuned strategy, nationally sanctioned and locally funded, we need to steadily control health spending to a growth level that is 0.5% less than annual economic growth for 10 years. We should challenge our nation’s behavioral economists to help structure our national health spending with a strategy for the industry to fix itself. The effort should be limited to a Federal expense of $1 per citizen per year and chartered by Congress with a sunset provision. It should be headquartered near our nation’s geographic population center that is located just west of Saint Louis.

    One more reminder. Our nation’s Cooperative Extension Service for agriculture was established by Congress in 1914. Our nation’s agriculture industry is the most efficient and effective among the world’s nations, by a wide margin. With the will to act, a similar process effort, retooled for healthcare, will be required. Many instances of collaboration and cooperation already exist in many communities. We only need to harvest that commitment to improve our nation’s HEALTH. The basic, county by county, model is soon 105 years old.

  9. Physicians are the only natural agents for patients. Patients need help in understanding premiums, bills from hospitals, charges from pharmacies, understanding shared costs such as co’s and deductibles, negotiating lower prices through large purchasing (oligopsony), obtaining information about clinical trials that may be applicable to their illness, obtaining accurate and timely diagnoses, negotiating length of stays with hospitals and nursing facilities, finding good doctors, not being hounded constantly about DNR agreements and things like POLST forms which always seem to lower costs for hospitals, understanding conflicts of interest in accountable care organizations…the list goes on and on where docs and patients should be working together.

    We need to figure out some way to do this job with, and for, our patients. The patients need allies and, alas, we are in need of some altruistic public relation exploits ourselves. Our professional organizations grow evermore self-centered and narcissistic and survival oriented themselves and are quite irrelevant here.

    This function should be bi-directional with patients and doctors both serving on policy committees. Im not sure whether money should be in here or not. It would be great if we could do this for our patients without money…but I am confused on this.

    Other stakeholders in health care have somewhat similar functions and groups. Eg insurers and plans use pharmacy benefit managers as intermediaries between manufacturers and patients. Hospitals and clinics use group purchasing organizations to obtain monopsony prices for medical supplies. The patients have been stuck pretty much on their own. It is time to fix this audacious vacancy.