By Ken Perez, vice president of healthcare policy, Omnicell, Inc.
“If at first you don’t succeed, try, try again.”
During the first half of 2017, two mergers, each pairing national health plans—Aetna with Humana and Anthem with Cigna, respectively—were blocked by two federal judges, both of whom concluded that the mergers would reduce competition in the health insurance market and, therefore, raise prices.
Departing from the horizontal merger approach, three national health insurers are now involved in proposed or possible vertical mergers. CVS Health announced its intent to acquire Aetna in December 2017; Cigna announced its plan to acquire pharmacy benefits manager Express Scripts in March 2018; and Walmart is reportedly in acquisition talks with Humana. Because of their size, the interesting value delivery chains they would create, and potential synergies, these corporate combinations have been described as disruptive and industry game-changers.
From a health policy standpoint, what has contributed to these mega-mergers?
First, the specter of a single-payer healthcare system—as most ardently promoted by Sen. Bernie Sanders (I-Vt.)—has been greatly diminished by the election of Republican Donald Trump as president in 2016, continued Republican majorities in both the House of Representatives and the Senate, and perhaps most saliently, the passage of the Tax Cuts and Jobs Act of 2017 (TCJA) in December 2017.
It is a truism in Washington, D.C. that taking back something that has been given to the public is hard, if not impossible. Since a single-payer healthcare system would clearly entail a major expansion of the federal government that would require not only the repeal of the TCJA’s tax breaks for individuals and corporations, but also the imposition of additional tax increases, it would appear to be a political impossibility for at least until 2021.
Second, Medicare Advantage (MA), Medicare’s managed care program, increasingly is where the action is for health plans. Congressional Republicans strongly support MA, and the program is gaining in popularity with Medicare beneficiaries. The Centers for Medicare and Medicaid Services projects that 20.4 million people will enroll in MA for 2018, an increase of 9 percent over 2017, about three times faster than the growth of the total Medicare enrollee population. More than a third (34 percent) of Medicare beneficiaries are enrolled in MA.
The proposed mega-mergers involving Aetna, Cigna and Humana secure control of significant shares of the Medicare population, including sizable shares of the MA enrollee pie.
Through grants, sponsorships and employee volunteerism, Aetna and the Aetna Foundation are working to help improve the health of children and adults and to make the healthcare system more equitable and effective. Garth Graham, M.D., M.P.H., is the current president of the Aetna Foundation and former deputy assistant secretary at the U.S. Department of Health and Human Services (HHS) during both the Bush and Obama administrations. Here he discusses some of the most pressing issues he’s seeing, as well as the Aetna Foundation.
People are using wearable technology and smartphone apps for just about everything these days. How do you see the Aetna Foundation’s commitment to technology playing a role in reshaping health?
Digital health technology provides a powerful tool to reach people with real-time health solutions that fit easily into their daily lives. In early 2014, the Aetna Foundation significantly expanded its commitment to digital health technology and mobile health solutions. Our $4 million, three-year commitment will help to implement and evaluate technology innovations that can help reach underserved communities with health solutions.
But does this technology really impact underserved groups?
People from all walks of life are increasingly relying on technology and we are increasingly seeing technology being utilized more among underserved communities, which offers an opportunity for direct education to individuals that have been hard to reach in the past. In fact, adults living in poverty account for 56% of cell phone-only households (CDC), making mobile technology a powerful equalizer for low-income communities. One example of our work is the Institute for eHealth Equity’s Text4Wellness program that focuses on reaching African American women ages 19 to 55 in Cleveland, Ohio. Women are a key audience because they not only make decisions about their own health, but are also more likely to be the decision-makers in their homes regarding food choices, meal preparation and wellness activities. Through programs like Text4Wellness, we are helping underserved communities access the tools that they already use daily to impact their health.
Garth Graham, M.D., M.P.H., specializing in cardiology, is the current president of the Aetna Foundation and former deputy assistant secretary at the U.S. Department of Health and Human Services (HHS) during both the Bush and Obama administrations. Here he discusses the Aetna Foundation, improving quality of care, how the health IT community continues to change, how can it best be used as a positive tool for better health outcomes, even at the individual level.
Tell me about the Aetna Foundation and your role within the organization? How does the Foundation impact healthcare community?
The Aetna Foundation is the philanthropic arm of Aetna, Inc. funding a number of activities across the country that promote thought-leadership and community-based impact as well as research around improving health outcomes. As the Foundation’s president, I oversee the philanthropic work, including grant-making strategies aimed at improving the health of people from underserved communities.
Overall, at the Aetna Foundation we seek to impact the healthcare community by supporting research and organizations focused on improving the health and wellness of individuals throughout the United States.
How do you go about working to improve the health status and quality of care of the individual and community?
Our Digital Health Initiative is the most recent example of our efforts to fund both national and local programs that are striving to limit healthcare disparities among vulnerable populations, as well as increase positive health and wellness outcomes for individuals. Through this initiative, we are supporting technology that can empower individuals with the convenience and control to meet their personal health and wellness goals.
We hope that by arming individuals with the best possible tools to improve their health, we can ultimately build healthier communities.
Who would have thought that intelligent virtual assistants could be used as patient engagement tools? The same virtual assistants that live on websites you might traffic that help you find site details, search the site or ask more detailed questions about information contained on the site.
Apparently this is the exact line of thinking of the folks at Next IT, a company that develops virtual assistant technology. According to Victor Morrison, vice president of healthcare markets, virtual assistants are the “silver bullet” to the patient engagement quandary.
The Washington state-based technology firm currently supports several major companies including United and Alaska airlines, Gonzaga University, Amtrak and Aetna. Though it’s only current healthcare experience is on the payer side, the company entered into a partnership with a major pharmaceutical company a few weeks ago and is expected to bring a new virtual assistant “personality” to market in a few months, said Morrison.
Next IT has partnered with Aetna for three years, creating for the company through its Human Emulation Software, “Agent Ann,” a virtual assistant that lives on Aetna’s registration page of its website. There, Ann provides immediate assistance to new members visiting the site for the first time. Ann debuted in early 2010 when many new members were first beginning to use their plans, and “she” is available to members 24/7, making it easier to do business over the web.
Members are able to type in their questions, using their own natural language and get the information they need to continue registration. Results show that she’s having an impact.
According to Next IT’s website, more than half of people registering on the website for the first time engage with Ann, “Because Ann does such a good job walking members through registration, Aetna reported that during the fifth month after implementation, they saw a 29 percent reduction in calls to their member-service technical help desk.”
Because of Ann, Aetna is seeing a reduction in operating expenses while still providing the service that members expect.
Most impressive, though, is that half of all people registering on the Aetna site engage Ann. Even Aetna’s covered members using the member’s only site are able to use Ann to view claims, look up physicians for services and even estimate the amount a service will cost with a specific physician.
According to Morrison, the system used by Aetna will be considered somewhat light in relation to what Next IT has planned for the clinical setting. Specifically, it will be more proactive depending on a patient’s needs, he said.
“Interactive virtual assistants are the magic bullet for patient engagement,” Morrison said. “What we can do is create and interface with smart phone and smart devices.”
With the right interface, which can be created to incorporate voice activation, like what’s found in Siri, tools like virtual assistants that are employed by large and enterprise health systems may be able to create a link with a patient, to interact with and monitor activity on a regular basis and to engage them through a protected portal such as a patient portal.
Ultimately, tools like Aetna’s Ann, and the one used by the U.S. Army, which have personalities and back stories built into their profiles (designed to create trust with users, Morrison said) will be able to push information, reminders and updates to patients who sign up with the service to help them stay engaged with their caregivers.
“Once we understand the patient and we begin to engage, we can push information to them to push engagement,” said Morrison. “We’ll be able to ping them with a text message, and push medication reminders. We’ll even be able to ask them questions like ‘How are you feeling today.’”
Depending on the patient’s response, if after a certain number of non-positive responses, the assistant will be able to automatically schedule an appointment with a physician or manage some other pre-established message to the patient’s care provider to ensure the patient is being contacted to ensure proper care continuum.
But, the assistants’ interaction can be set up to be much more than pushing information; they can actually engage individual with medication reminders, for example, and provide guidance for recommended doses, where to take an injection (in situations where that is appropriate), and improve patient understanding of a procedure or medication.
Patients can set up reminders through their smart devices, schedule appointments and can rate their health experience and how they feel, which can help physicians begin to create a comprehensive patient case history.
Based on this, virtual assistants may contribute to a more engage patient population, especially if people are able to so easily interact with them as is showcased in the video. Where patient portals and other engagement strategies, like social media, may be lacking, this technology may, in fact, be the magic bullet Next IT believes it to be.