Via all of this 12 months’s tumultuous ups and downs, one pattern that has remained unstoppable – and has even accelerated – is the healthcare sector’s adoption of know-how.
For years, MobiHealthNews has lined the payer area because it regularly pushes additional into the world of digital well being, and 2020 proved no totally different. From conventional insurers embracing know-how to huge expansions of telehealth, to revolutionary insurtech firms hitting the general public market, this roundup goes deep into how payers are turning in the direction of tech amid a altering world. Learn on for a recap of payer digital well being information from 2020.
Insurers upping their know-how recreation
HIMSS20 Digital
As a lot of this 12 months was spent navigating totally different stay-at-home and social distancing mandates, many turned in the direction of know-how as a solution to obtain healthcare. Because of this, even essentially the most conventional healthcare insurers upped their tech-game this 12 months.
The 12 months noticed UnitedHealth Group wanting in the direction of the digital pharmacy area with its acquisition of Divvydose, value an estimated $300 million. The deal provides UnitedHealth Group entry to the digital pharmacy’s capabilities, which embrace prescription shipments.
In September, Medicare began covering Abbott’s FreeStyle Libre 2 built-in steady glucose monitoring (CGM) system. The protection for Abbott’s newest CGM got here within the midst of the COVID-19 public well being disaster the place self-monitoring and distant affected person monitoring instruments are serving to cut back pointless medical visits or avoidable exposures.
Centene Company, a managed care enterprise, boosted its services by buying unstructured affected person information analytics firm Apixio. The platform finds and compiles affected person information from doctor notes, medical charts and different medical paperwork. Buying Apixio’s enterprise and the platform permits the managed care firm to deploy the know-how throughout its total enterprise, probably optimizing care and lowering administrative prices for a large quantity of sufferers.
Others, like Anthem, joined research initiatives to check how digital instruments can enhance well being outcomes. The insurer joined Apple, the College of California, Irvine, and software program firm CareEvolution to launch a two-year, 900-participant research investigating how digital instruments may help sufferers management their bronchial asthma and cut back hospital utilization.
The rise of insurtech
As many payers added know-how to their enterprise fashions, others integrated know-how from the beginning.
The Medicare Benefit insurer Alignment Healthcare depends on its tech platform in two key methods: by way of an “on-demand concierge” system, the place senior members can converse to a care coordinator 24/7 through telephone, and thru the Alignment Digital Software platform that collects affected person information and factors to shifts in a member’s care wants. The corporate closed a $135 million Collection C funding spherical this 12 months.
Alphabet’s life science subsidiary Verily jumped into the health insurance space this 12 months with the launch of Coefficient Insurance coverage Firm. The tech-enabled payer is backed by Swiss Re Company Options and can mix Verily’s {hardware}, software program and information science and Swiss Re Company’s distribution mannequin.
The 12 months additionally noticed two main insurtech firms go public.
Clover Health was first, because it turned publicly traded by way of a merger with particular function acquisition firm (SPAC) Social Capital Hedosophia Holdings Corp. III. Together with providing well being plans, its platform, the Clover Assistant, combines well being information with machine studying to offer physicians with affected person insights on the level of care.
Following two huge funding rounds, this 12 months value $225 million and $140 million, the medical health insurance know-how firm Oscar filed to go public in December. Oscar affords direct-to-consumer well being plans that search out and information members towards optimum and cost-effective care choices – which might embrace the 24/7 digital care companies provided by Oscar itself, named Physician on Name.
Telehealth is right here to remain
Whereas telehealth will not be new, it had its second within the solar this 12 months because of the COVID-19 pandemic. By the tip of March, telehealth utilization elevated 154% in comparison with the identical time interval in 2019, based on the Centers for Disease Control and Prevention.
At the start of August, President Trump signed an government order to make the non permanent telehealth flexibility given underneath the general public well being emergency permanent.
Because of this, payers of all varieties hopped onto the telehealth practice this 12 months.
In March, Blue Shield of California briefly waived out-of-pocket prices for all business plan members utilizing Teladoc Well being’s companies.
Uninsured residents of Massachusetts had been given access to free COVID-19 telehealth visits by way of a deal between Physician on Demand and the Commonwealth. The deal adopted not lengthy after the telehealth supplier and MassHealth, the state’s Medicaid and Kids’s Well being Insurance coverage Program administrator, agreed to an identical COVID-19 association for its 1.eight million plan members.
Humana beefed up its telehealth choices by investing in and partnering with the house call and telemedicine platform Heal. Not solely did the deal present Heal’s house healthcare companies to Humana members, however the $100 million funding helped push the platform into new markets together with Chicago, Charlotte and Houston.
Transferring in the direction of worth
Early in 2020, the Division of Well being and Human Companies released its final rules on interoperability, data blocking and affected person entry. The foundations implement a number of provisions from the 21st Century Cures Act, together with these to forestall data blocking and different anticompetitive behaviors amongst suppliers, well being data exchanges, and well being IT builders, and together with the institution of a Affected person Entry API.
Due to the time and a focus required by the COVID-19 pandemic, the Workplace of the Nationwide Coordinator for Well being IT announced in October that HHS would lengthen the time frames for necessities associated to the information-blocking guidelines for healthcare suppliers and HIEs, and the situations and upkeep of certification (CoC/MoC) for know-how builders. The brand new information blocking applicability date is now April 5, 2021 – whereas new necessities round standardized API performance have been pushed out to New 12 months’s Eve 2022.
That is all part of a bigger pattern round making a extra value-based healthcare system that places the affected person on the middle of the care journey. Many well being leaders agree that value-based care is efficient in creating higher outcomes and lowering healthcare prices, however the query stays how worth is finest carried out.
One technique from the insurance coverage startup Sidecar Health focuses on worth transparency and decreased funds primarily based on self-pay service charges. It has an app that enables customers to customise their annual protection quantity and choices and features a worth comparability software for viewing totally different companies from native suppliers. The corporate raised $20 million this 12 months to help firm development.
UnitedHealth Group took a distinct method this 12 months by starting a pilot program the place it offers members with a Dexcom G6 CGM to assist them handle their Sort 2 diabetes at no extra value. This system additionally incentivizes the members it enrolls to proceed wholesome behaviors with rewards akin to reward playing cards or money.
Elsewhere, the São Paolo-based health tech startup Sami transitioned into medical health insurance this 12 months with a give attention to value-based care. Sami raised $15.5 million this 12 months because it hopes to take its method to offer care at worth throughout the globe.
The Facilities for Medicare and Medicaid Companies are working to make it simpler to create value-based drug buying agreements with a final rule it passed in December.
The brand new rule will incentivize producers to arrange value-based buying preparations, as a result of drug pricing shall be pushed by the worth of the drug to particular person sufferers, CMS stated. It additionally permits for negotiations round drug costs to be primarily based on evidence-based outcomes to make sure that if the drug will not be efficient, the payer will not be held accountable for the total worth.
Supporting behavioral well being
With the entire uncertainty of this 12 months, many handled antagonistic psychological well being situations associated to COVID-19. Throughout late June of this 12 months, 40% of U.S. adults reported fighting psychological well being or substance abuse, based on the CDC.
“One of many issues that’s occurred in 2020 is COVID-19, and this has introduced into a better profile the necessity to get companies, and technology-based companies, to folks,” Helen Christensen, director and chief scientist on the Black Canine Institute, stated throughout a WISH 2020 panel in November.
To assist get these psychological well being companies into the fingers of people that want them, well being plans have been partnering with behavioral well being tech firms.
Aetna Worldwide introduced in Might that it was partnering with Wysa, an AI-powered chatbot and psychological wellbeing app. Via Wysa, all Aetna Worldwide members and their staff have free entry to 24/7 text-based help designed to assist them navigate a variety of psychological well-being challenges at their very own tempo, together with anxiousness, stress, motivation and confidence.
To assist combat the social isolation many seniors really feel due to the pandemic, SCAN Health Plan and Rally Health teamed up to present SCAN’s senior members entry to the Rally platform. Inside the platform, customers can obtain details about easy methods to handle a continual situation, methods to enhance psychological well-being, help in setting well being objectives by giving rewards and get entry to a web-based social neighborhood the place they will work together with friends and share experiences.
