Health

The insurer’s confusion over digital health benefits is creating a new startup market

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Digital healthcare company Collective Health on Tuesday launched an initiative to help self-employed employers navigate the sea of ​​digital healthcare companies they could partner with.

Collective hopes its Premier Partner program will help self-employed employers select, integrate and evaluate digital healthcare companies. Lance Larson, director of digital, Nine startups have agreed to share their data with Collective Health, which will combine their information with data from claims to determine employee engagement, utilization, financial return. investment and the impact of the clinical outcomes of digital health care partnerships. Collective Health acts as the plan administrator for about 60 self-employed employees, including some of Health Care Service Corp.’s clients.

The startups included in this program address some of the most common and costly conditions that companies face, and include behavioral companies Lyra, Modern Health and Ginger; musculoskeletal startup Hinge Health; fertility benefit services Fertility and Carrot Pruning; AccessHope cancer care company; and virtual assistance and diabetes management companies 98point6 and Teladoc with Livongo services. By sharing their data, these companies can use Collective Health’s research to hopefully enter the slow-moving insurance market.

“In the first half of 2021, we had about the same digital investment in health care that we had all of 2020, so we’re on track to double that,” Larson said. “It’s a bunch of new solutions. Cutting rum is a big part of this program.”

Digital healthcare companies will already invest $ 14.9 billion by 2021, a sum already greater than what the industry has collected for the entire year 2020 – which itself represents a record year for investment in the company.

Employer customers are behind much of this growth, with four U.S. companies in 10 saying they believe digital health benefits will help them retain staff and 68% report that they plan to increase investment in digital health for the next five years, according to a recent Mercer report. Meanwhile, insurers tend to be more cautious about online decisions regarding digital health, said Ari Gottlieb, chief at A2 Strategy Research.

“I think employers are more affected by the angle of convention and the fact that they can promote that to employees,” Gottlieb said. “Employers tend to be a little more advanced and willing to innovate and experiment with things than the fully insured population.”

The payment models used by employers and insurers may also vary.

For employers, 54% of sculpted telehealth contracts are based on capitation rights based on pure subscriptions, with no additional fees rising with high utilization, according to a survey published by investment bank Credit Suisse at the end of last year. But for insurers, Gottlieb said most operate on service-rate agreements, since they do not pose the challenge of allocating common risk arrangements, where insurers have to figure out how to distribute the cost savings. between several partners. But recently, Gottlieb said he has seen growth in some settings “based on light value” with digital health startups.

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“A lot of these value-based contracts aren’t really value-based contracts, they’re more common risks with some upside,” Gottlieb said. “I think the question, though, becomes, is that really based on value?”

Lili Brillstein, former director of UnitedHealth Group and Horizon Blue Cross and Blue Shield of New Jersey. These shared savings are generally shared between the specialist provider and the digital health care provider, he said. For providers who offer more consistent care, they can receive a coordination fee per member per month with any health savings realized, Brillstein said.

“Many [digital health companies] are anxious to take risks, I think some fly to the blind, “said Brillstein, who runs BCollaborative-based consultancy.” I think it’s dangerous. I tell them, “Find out what you’re doing, and make sure it works before you take any risks.” Now is a good time to fail, since most of the models are retroactive to the floor, no one is hurt. ”

Ultimately, Brillstein said the confusion among insurers over how to associate and integrate startups into their operations is likely to lead to consolidation in digital health. A Mercom report found that 136 companies were acquired by June 2021, which is the latest since the data analytics firm began tracking digital health in 2010. Attribution challenges can also create a high market share. for claims administrators like Change Healthcare — in Nashville, Ten. based company that was acquired by Optum for $ 13 billion in one of the largest offerings to date. The Department of Justice is reviewing this acquisition.

“Insurers find it difficult to follow hundreds of different vendors that track hundreds of different disease states,” he said.

Award contracts often represent the core of value-based contracts, said Adam Block, head of Charm Economics. He said he has seen contracts with 30 pages of boiler language, and then two pages of language that essentially describe what the insurers ’claims management algorithms stipulate – like, if a patient sees a primary care provider a year, then the primary care provider will receive a fee per member per month.

Young companies can stand out in the crowd by focusing on the ROIs that insurers can achieve through partnerships, and the best customer experience, quality metric adherence and clinical outcomes they can offer, Block said. Industry associations such as the Alliance of Community Health Plans and Association for Community Affiliated Health Plans offer lists of preferred vendors that insurers use as well.

“You have a lot of cooks in the kitchen,” Block said. “Everyone tries to manage patient care and every digital health app tries to only manage a part of the patient. That leaves the insurer to manage the entire patient.”


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