Payers ready for digital care, but obstacles remain

Close-up of hands tying laces on bright pink athletic shoes
Mobile devices are proving good incentives to get plan members moving. (Getty Images/bfk92)

Digital and mobile devices have the potential for preventing the development or progression of diseases and assist with diagnosis and treatment, but challenges remain.

In 2017, 24% of adults reported using wearable devices, according to a report on the role of mobile apps and wearable devices in healthcare, published in JAMA.

To capitalize on this trend, many health insurers are offering enrollees discounts on wearable devices or premiums for using mobile health devices. However, along with the benefits, author Robert W. Yeh, M.D., from the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center says that wearables could have unintended negative consequences.

In other countries, several insurance brands are incentivizing healthy digital habits. For example, South African company Discovery Limited combined health and life insurance to offer rewards for healthy behaviors exhibited on mobile devices. And in the United Kingdom, Discovery has combined mobile health devices with life and health insurance, which includes an Apple Watch Series 4 for a discounted price.

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And in the U.S., John Hancock introduced fitness-tracking into its life insurance policy in 2015. Rewards include gift cards for wearable fitness devices and discounts up to 15% on life insurance premiums. Similarly, UnitedHealthcare has partnered with Fitbit and Apple Watch to launch its Motion program, which offers monetary rewards. Participants can save more than $1,000 per year in their health savings account. In addition, Aetna, Qantas Assure and Oscar Health are some payers offering physical activity incentives into their policies.

The report gives three potential benefits to wearable and mobile devices: recording and monitoring personal health data; facilitating communication between the patient and members of their healthcare team; and providing reminders regarding appointments and medication.

And so far, several studies have proven that financial incentives get more use out of mobile devices. For example, in one clinical trial, some adults received financial ramifications for not meeting exercise goals, while others were given rewards for reaching goals. Over the 24-week period, the incentive group had significantly greater increases in mean daily steps.

The data coming directly from the payers also shows promise in digital adherence. In the Discovery Vitality Active Rewards Program in the U.S., U.K. and South Africa, participants in the active rewards program with an Apple Watch engaged in 34% more physical activity than participants in the active rewards program without an Apple Watch.

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However, Yeh also had some concerns with the widespread adoption of digital health products. For instance, if insurers collect data about poor health or lifestyle habits, payers could use this information to penalize patients with higher premiums or even deny insurance. Currently, there are no laws protecting digital health data when it comes to discriminating against pre-existing conditions.

Plus, as with any digital device, there is fear of inaccuracy of the data being collected. So, if a digital device has diagnostic capabilities, the wrong information could result in unnecessary treatment.

Other concerns with devices include the widening of the healthcare disparity gap, as low socioeconomic individuals engage less with electronic health products. And there is the debate over the privacy of the data that will be collected and may be at risk of being seen by third parties. Currently, data on these devices are not protected by the Health Insurance Portability and Accountability Act.

Still, most U.S. insurers are moving ahead with integrating technology into assessment, treatment and drug adherence programs. A new survey from America's Health Insurance Plans shows that consumers are generally in favor of technologies to help manage their health and most of those patients surveyed have access to virtual care programs, such as telehealth, through their current health insurance providers.

Of those studied, 94% of private plans and 92% of Medicare Advantage plans offer some type of virtual care services. And 93% of Medicaid managed care plans are currently using or considering offering telehealth services.

Looking at the breakdown of what plans are using their virtual care for, it seems that commercial plans are primarily using it for treatment of acute care, 80%, and behavioral health care, 84%, versus assessment and diagnosis, 77% and 73%, respectively. For Medicare Advantage plans, 91% of plans are overwhelmingly using virtual products for the treatment of acute care and behavioral health treatment. Finally, for Medicaid, 100% of plans are using virtual care to assess and diagnose pediatric patients, and another 92% are using it to assess and diagnose acute care.

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And what did each of the types of plans list as top priorities? Commercial plans, Medicare Advantage and Medicaid listed “increased patient engagement” as their top priorities. However, all plans see the impending challenges that exist to execution.

Both commercial (87%) and Medicaid managed care plans (91%) reported that engaging patients to use virtual care was a key challenge toward full adoption and integration, and Medicare Advantage said implementing the plans’ virtual care strategy (88%) and a regulatory landscape not conducive to offering virtual care services (70%) as the biggest barriers.

“Addressing challenges, such as patient engagement and the regulatory landscape, will be critical to maximizing the potential for virtual care as it is increasingly integrated into care delivery,” the survey concluded.

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