Waltz Health makes push into Medicare Advantage, inks partnership with SCAN

Just a few short months after making a push into the payer space, digital health company Waltz Health is stepping into the Medicare market.

Waltz will make its Marketplace Search tool available to Medicare Advantage plans. This platform lowers members' prescription drug costs and offers payers or plan sponsors key details on adherence and utilization, the company said in an announcement.

The Marketplace Search tool deploys artificial intelligence to a "curated mix" of drug discounts that save patients and healthcare organizations on prescriptions.

Waltz Health CEO Mark Thierer told Fierce Healthcare that Medicare beneficiaries can often to be exposed to high costs, notably in the so-called "donut hole" that can leave members on the hook for the full cost of key drugs.

"We know that in Medicare Advantage, the biggest problem that they're dealing with, or one of one of the bigger problems is that these seniors who cannot afford drugs are moving into a dangerous place," he said. "It's kind of a guidance counselor holding the members' hands through the donut hole."

Waltz's first partner in this endeavor is California-based SCAN Health Plan. In the version of its platform tailored for Medicare, beneficiaries can access key information on prescription discounts when they enter a coverage gap, including the "donut hole."

Theirer said SCAN is using the Marketplace Search tool to supplement its base product, and the insurer is "excited" about the possibilities it opens up.

He added that partnering with SCAN is just the first step in this move to Medicare, and that the company is also in discussion with other payers about its technology. Given the growth potential—and expectations—in this space, plans are looking for additional ways to manage costs and improve the patient experience. That expanding membership base and the investment opportunities therein made Medicare the next attractive segment to explore, Thierer said.

"It's the fastest growing part of the population as it relates to health plan growth," he said. "By and large, most health plans are throwing a ton of weight and a ton of investment behind this space. And it's because if you can do a good job of engaging the patients and managing their healthcare costs, it's a profitable place to operate. "

Beyond Medicare, Waltz is building a specialty drug platform insurers can also tap into. The goal is to improve transparency and drive better patients outcomes as these pricey therapies account for a greater and greater portion of drug spend.

"The very next place we go beyond Medicare Advantage and the donut hole, is we go into specialty medications," Thierer said.