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Tag: Aetna

A Mystery Mission in LA: Aetna, Apple, and a Vision of Digital Health’s Future, Part 1

It was an invitation too intriguing to refuse: fly to LA to participate in a “top-secret mission” related to digital health. Instructions? Bring workout clothes. Don’t disclose your location. “We can’t say much. Just enough for you to quickly pack your bags, fly to California and participate in an exclusive Apple Watch from Aetna event – all expenses paid.” Generally, I’d file this type of message in the junk mail folder, but knowing that Apple takes secrecy seriously, I did some background sleuthing and decided it looked legit.

The mystery unfolded last week as I stepped into a black car at LAX with a secretive driver who joked that I and his other two passengers (who had received similar invites) would have to cover our faces as we drove through town. (Yikes!) When we arrived at a hip “concept” hotel I felt more at ease, and relaxed into enjoying the so-called mission with a glass of wine and some discussion of trends in the digital health industry. Over the course of a couple of days I was fortunate to join a group of new (and some old) friends to exchange ideas, take a challenging hike to the peak of Runyon Canyon Park, interact with Apple and Aetna execs, try out some new technologies, and get a glimpse of what both Aetna and Apple are envisioning for the future of digital health. I was assigned to one of several teams named after famous movies (in keeping with the Tinseltown theme) a personalized agenda, and some critical tools for the modern adventurer, including a bandana, water bottles, a phone charger, and, naturally, a selfie stick.

For about a year Aetna has used the Apple watch as part of an integrated wellness program available to its 50 thousand employees and those of several partner organizations it insures, such as Hartford HealthCare, which was represented among the participants in the mystery mission. Both companies are poised to expand the program.Continue reading…

Aetna’s Obamacare Surprise

Screen Shot 2016-08-21 at 10.41.37 AMDid Aetna just pull a nasty, Trump-like move and up the ante on the Obamacare debate in advance of the election and exchange open enrollment for 2017?

The allegation is that the company withdrew from 11 state insurance exchange marketplaces for 2017 after the Justice Department failed to heed Aetna’s warning that it would do so if Justice didn’t approve its $37 billion purchase of Humana.  The Justice Department announced last month that it was challenging that deal and Anthem’s proposed merger with Cigna, saying both deals threaten to sharply reduce competition in the health insurance marketplace.

A July 2016 letter from Aetna to Justice, unearthed by Huffington Post, contains the threat.   But in announcing its exchange pullback this past week, Aetna made no mention of the letter and insisted its action was prompted by existing and expected future financial losses in the exchanges.

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Let’s Have APIs for Those Provider Directories!

This was a comment I submitted submitted to this proposed set of regulations on health plans participating in the ACA. (Use ctrl-F to search “provider directory” within the page). HHS is proposing forcing insurers to make their provider directories more accurate and machine readable, and it would be great for consumers if that was made the case–especially if APIs (which means basically giving access for other computers to read them) were mandated–here’s why:

Subject–Immediately updated  provider directories machine readable via APIs should be mandated for health insurers.

Finding accurate information about providers is one of the hardest things for consumers to do while interacting with the health care system. While regulation cannot fix all of these issues, these proposed regulations in section  156.230 can greatly help, But they should be strengthened by requiring (under subsection 2) that health insurers immediately add new information about providers in their networks to a publicly available machine readable database accessible via a freely available API.

Currently companies trying to aid consumers in provider search and selection tell us that the information pertaining to which providers are in a particular network is the least accurate of all data they can receive. For consumers the biggest question for plan selection is trying to find out which provider is in their plan, and at the least this requires searching multiple websites. Worse, particular insurer’s plans can even have the same name but can have different networks (in one instance in our personal experience Aetna in New York state had two different plans with effectively the same name but different networks). This is essentially impenetrable for consumers and that is assuming that the information on the websites is accurate or timely–which it is often not.

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Dr. Aetna Will See You Now

The ever-blurring line between the practice of medicine and the business of profiting from unhealthy lifestyles was crossed again Wednesday, as Aetna announced a collaboration with two pharmaceutical companies to pitch their prescription weight loss drugs to selected Aetna members.

This announcement crosses multiple lines, not just one. First, no insurer has ever announced that it would openly direct a specific class of members to use particular proprietary drugs. Disease management (DM) programs rarely recommend specific drugs, and certainly in the exceptionally rare instances when they do, the recommendations are not specific brand-name drugs (in this case, Arena’s Belviq and Vivus’s Qsymia).

Instead, DM focuses on improving compliance with existing drug regimens, and DM firms encourage members “talk to their doctor” about changing therapies. While DM companies shy away from directing patients to specific products, physicians and pharmacists have discretion to discuss the full range of covered generic and brand products with patients, in order to optimize therapy and close algorithm-identified care gaps.

Second, there are no generally accepted care algorithms (other than those created by the manufacturers of those products) for these two drugs in the treatment of obesity. So there is no “gap” to fill. If there were an accepted protocol, these drugs might be blockbusters but instead Belviq’s recent quarterly sales were an anemic $4.8-million, “well below even reduced Wall Street expectations,” while QSymia sales are “flailing” at $6.4-million for the same period.

Obese people and their physicians seem to be avoiding these drugs in droves. Regardless of what Aetna and the manufacturers believe about their effectiveness, or whatever promotional deal they’ve cut, market reaction is telling a different story, and unfortunately for Aetna, Vivus, and Arena we live in a market economy.

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State Insurance Exchange Blind Spots: Unknown Risks and Unintended Consequences

October 1st marks the first ever public exchange open enrollment season.  This means some of the speculation around consumer awareness and understanding, enrollment/uptake, premiums, and payer participation (not to mention the technical readiness of the exchanges) will finally subside and give way to a clearer picture of the PPACA’s initial success in mandating individual health coverage.

Despite this approaching level of clarity, however, several very significant “blind-spots” will continue to persist, principally for the health insurance carriers that choose to participate by offering PPACA compliant plans in the exchange.

This is due to the law’s guaranteed issue mandate prohibiting health carriers from denying coverage based on preexisting conditions.  As a result, the traditional enrollment process which consists of a comprehensive assessment of each applicant’s health status and risk cast against the backdrop of time-tested underwriting guidelines is completely thrown out.

What takes its place is an extremely limited data set (i.e., the member’s age, tobacco/smoking status, geographic region, and family size) from which carriers can determine pre-approved premiums and variability therein.  To use an analogy, health insurance companies no longer have a “bouncer at the door” turning people away, or a sign reading No shirt, No shoes, No service at the entrance.

In other words, everyone, regardless of their risk profile, must now be welcomed in with open arms and with very limited risk-adjusted rates.

This wouldn’t necessarily be a problem if the enrolling population comprised a well understood risk pool representing a true cross-section of the population.  The reality, however, is that a predominantly unknown and potentially unhealthy population will flood the individual health insurance marketplace in a two weeks just as most states quickly phase out their high-risk pre-existing condition pools and shift them into the exchanges.

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More Signs of Rate Shock and Awe

Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act (“Obamacare”).

Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine.

From Bloomberg:

Health insurance premiums may as much as double for some small businesses and individual buyers in the U.S. when the Affordable Care Act’s major provisions start in 2014, Aetna Inc. (AET)’s chief executive officer said.

While subsidies in the law will shield some people, other consumers who make too much for assistance are in for “premium rate shock,” Mark Bertolini, who runs the third-biggest U.S. health-insurance company, told analysts yesterday at a conference in New York. The prospect has spurred discussion of having Congress delay or phase in parts of the law, he said.

“We’ve shared it all with the people in Washington and I think it’s a big concern,” the CEO said. “We’re going to see some markets go up as much as as 100 percent.”

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Aetna’s Martha Wofford Talks Technology Development

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Matthew Holt spoke to Martha Wofford, head of Aetna’s CarePass platform, at the 2012 mHealth Summit in Washington, D.C. last week. Aetna CEO Mark Bertolini had just delivered a keynote and announced that his company will release the CarePass mobile app in March 2013. CarePass is a web portal where patients can connect data from their different personal applications. Here Holt speaks to Wofford about the development of Aetna’s technology offerings. He also asks her how much of an impact she thinks this tech can have on wasteful spending in the U.S. health care system.

Health 2.0’s Berlin Code-a-thon, Sponsored by Aetna International Spurs Creation of New Mobile Apps to Improve Health

On the weekend before the third annual “Health 2.0 Europe” conference, Health 2.0 and the international arm of Aetna (NYSE: AET), the global health solutions company, invited the best developers, designers, health experts and health tech entrepreneurs to compete for € 10.000 in prizes at Health 2.0’s Berlin Code-a-thon, Sponsored by Aetna International. Their challenge was to develop innovative mobile apps to promote health and wellness across the globe.

The event kicked off on November 3 with the participants pitching their mobile app ideas to attract the other developers to their projects. Then, the real work began—small groups spent the next 29 hours transforming their concepts into working prototypes. On the evening of November 4, a panel of expert judges that included representatives from Aetna International and Health 2.0 announced the best of the best.

The winning app was “Jog of War,” created by four talented developers and founders of start-ups from Slovenia, Macedonia, Finland and Colombia. The app is designed to motivate people to be more active outdoors by encouraging them to run through their cities, and in so doing, “conquer” territories. The app tracks the jogger’s positions and marks the corresponding areas of the city in a map. Other joggers who run in the same area can reclaim the territory by running through it themselves. Once a territory is occupied, rewards and discounts from local businesses will be unlocked to the users.

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Health 2.0 Code-a-thon – SF Winners

The San Francisco teams only had 2 days to create a solution and 3 minutes to present. It was a high-stakes, high-pressure event. If known the challenges it was entered for are in parentheses. AT&T, Aetna, Healthline, Food Essentials and athenhealth all offered separate challenges and prizes for this codeathon.

DIG*IT Mobile (AT&T): This app tried to use the “desire engine” concept to develop a medication adherence app specifically for patients with HIV. The app includes a news feed, a way to compare yourself to other people like you, easy contact buttons for providers and a quick health summary. Patients can see a graph of their lab values and their medication compliance, as well as a graph for adherence. Each day the app asks if a patient has taken their medication, as well as providing alerts that tell them to take their meds. The med component showed their pills and when their prescriptions are due. They plan to incorporate crowd-sourcing information later.

DocSays (Aetna & Healthline): This team took on the challenge of improving hospital discharge outcomes. Patients are overloaded with information at the time of discharge. Their app, titled Doc Says, gives them automatic reminders about everything from activity levels, foods, medication to reminders for appointments. It can also work on an SMS system, so it doesn’t have to be smart-phone based. Options on the screen include defining all doctors instructions as tasks. The steps are broken down so that “pick up your lisinopril” is a separate task from the more generic “take your medicine.”

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A Tale of Two Keynotes: Futurist Joe Flower and Aetna’s Mark Bertolini

This year at Health 2.0′s Annual Conference, two speakers split stage time during the opening keynote. Joe Flower, a health futurist, and Mark Bertolini, CEO of health insurer Aetna, don’t have a whole lot in common professionally. But in their talks they both made clear that they hold two beliefs in common: the United States health care system needs to react to the country’s cost crisis, and efforts to address health care costs will happen independently from federal reform.

Flower spoke first, laying out the tenets of what he calls the Next Health Care. For such an optimistic speech, it was filled with negatives. Flower went through step by step, talking about what the nation isn’t doing right now, who’s not invested in better care, and why all health care systems can’t just become Kaisers.

Though the talk certainly wasn’t meant to praise health care for all it does right, it was meant to point out the promise that the health care system could be on the brink of.

“Health care is undergoing fundamental economic changes,” Flower said. “These changes are driving us to what may well be better and cheaper health care for everyone.”

The Affordable Care Act isn’t what’s propelling those changes, according to Flower. It’s other factors including an aging population, the sheer cost of care in the U.S., and technological capability that we’ve never seen until now.

Chronic disease accounts for 70 to 75% of all health care costs, Flower said. And as many Americans know, obesity is a huge contributor to those costs. The maps looked at the projection of obesity rates in the U.S. over time, and as the slides passed it looked like the country was being eaten by the disease.

“Now, some of the best hopes for that future, honestly, we see right here at Health 2.0. But we are not there yet,” Flower said.
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