Future of healthcare insurance - week 3

Bambi Francisco Roizen · October 8, 2019 · Short URL: https://vator.tv/n/4edb

Devoted Health makes Apple Watch a health benefit; Cigna expands MA; What is 'Grandkids on-demand'?

This is my weekly roundup of news around the topic we'll be focusing on at our upcoming Invent Health salon in November, hosted by Vator, HP and UCSF Health Hub. At the salon, we'll take a deep dive into one topic and look at it from a 360 degree view. This quarter's topic is: Future of Health Insurance.

At our last event, we focused on 'Reinventing the doctor.' These salons are intimate events, attracting 100-200 attendees (depending on where they're held - HP or UCSF) so all guests can interact with select speakers who jumpstart the conversation. The breakout of guests and speakers typically fall along these lines:

15-17% payers/providers

15% scientists/physicians

35% startups/innovators

25% investors

By spending three hours on one topic, we can explore many questions that we then summarize in our stories below. We hope these can help drive innovators to see the opportunities that lie ahead.

What drives healthcare costs down: cure or treatments? When we think about reinventing the doctor's role, one question raised was how much cost should come into the equation when pursuing treatments or cures. This question ignited a debate about expensive pursuing cures for specific people vs theoretically more cost-effective generalized treatments for a broad population. Another more sobering thought that came up was that more cures would result in more people living to an older age where they'd likely suffer more expensive illnesses.

Where healthcare tools fall short of satisfying patients Another part of reinventing the doctor is how their role changes as technology enables consumers to become more savvy about their health needs. At this point, the technology designed to navigate consumers to the right needs could be greatly improved, some speakers thought.

Now here's my roundup of interesting news and information from around the web as we prepare for our upcoming event focused on insurance.

Apple Watch insurance coverage

Devoted Health is one of the many startups targeting Medicare Advantage plans. MA plans cover over a third of Medicare patients, more than double in the past decade. The Waltham, MA-based startup, which has raised $362 million, said recently that it's the first Medicare Advantage plan to cover the Apple Watch as a benefit. The company will pay up to $150 for the watch, which can help modestly for the ones that can cost upwards of $700 for the latest Apple 5 Series, but can be pretty substantial for an Apple 3 Series, which is under $200. Devoted Health is one of the many startups targeting Medicare Advantage, along with Collective Health and 16 recent MA plan entrants. Apple is also working with other insurers to provide coverage for its watch, such as Aetna, where members can get a watch upfront for free and then pay it off by achieving health activities.

Read more on CNBC

Cigna expands Medicare Advantage offerings

The MA market is a hot market segment. Cigna this month said it's expanding MA plans to more states and counties. There will be some plans that have zero premiums, and no out-of-pocket costs, plus 89 percent of plans that have zero copays for primary care visits. Additionally, Cigna is reducing its premiums in 86 percent of its plans nationally. Most plans also include vision, dental and fitness centers at no additional cost. And for the first time, members will have access to their doctors via phone or digital device, like a computer or smart phone. Cigna is also unveiling benefits in "select" plans to address social determinants of health. Some of these benefits include - an air conditioner allowing (in some plans in Texas), transportation benefit to places of worship and grocery stores and adult care.

Expanding coverage: concierge and social determinants

Alignment Health Plan will start offering concierge services and social determinants as health benefits in 2020 to members who qualify. This means offering its members access to doctors via video or telephone anytime during the day or night. Its "ACCESS" program gives members a dedicated concierge team and a debit card to be used for qualified items, such as groceries at 50,000 retailers. As part of the insurers efforts to cover health factors outside of medical treatments or doctor's visits, Alignment's MA program will cover transportation to appointments, grocery benefits and companion care - what would be included as social determinants of health benefits. Uber and Lyft can be used to bring members to appointments. The companion component is called "Grandkids on-demand", where college students will be available to assist in non-medical tasks, like household chores. Alignment will leverage data and AI to identify and predict which patients need such care.

High deductibles are the problem

Bind On-demand founder and CEO Tony Miller penned a story about how rising deductibles are hurting the healthcare system. Indeed, he points out that 64 percent of patients say they've delayed or neglected care within the past year because of high expenses, according to 20/20 Research for CarePayment. He also points out that the average deductible is $3k, but most Americans don't have $400 in savings to cover medical costs, according to the Federal Reserve Board. Additionally, the Commonwealth Fund estimates that a quarter of insured employees are actually underinsured. In Tony's piece he advises employers to consider alternatives to high-deductible plans, encourage employees to take ownership of their health benefits and understand what's covered and what's not and do their own comparison shopping for the procedures or services they think they'll need. Tony is on a mission to dismantle high deductibles by allowing consumers to pay for insurance in more of an a la carte way. The service sits on top of United Healthcare's network.

Image sources: Mashable, NYTimes, PEHub, fstoppers

Bambi Francisco Roizen

Founder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.

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