Unnerving mergers (US-UK); DoD’s EHR picked; EHRs & AMA

Blues feeling Blue about…The Anthem-Cigna merger, finalized last week (but yet to be approved by the US and likely the UK Governments as Cigna issues policies there), gives them bragging rights over the Aetna-Humana merger and Optum/United Healthcare in their covering of 53 million US lives as the largest US health insurer. Unnerved is the Blue Cross and Blue Shield Association, of which Anthem is a part of with the Anthem and Empire Blue Cross plans plus others in a total of 14 states. But Anthem also competes with ‘the Blues’ in 19 additional states where it markets under a non-Blue brand, Amerigroup, primarily for Medicare and Medicaid (state low-income coverage). Many of the Blues are non-profit or mutual insurers; many are partial or single-state, like Independence, Capital and Highmark (PA/DE/WV) in Pennsylvania and Horizon Blue Cross of New Jersey. Their stand-alone future, not bright since the ACA, now seem ever dimmer in this Editor’s long-time consideration and that of Bruce Japsen writing in Forbes. Also Morningstar considers Anthem’s overpaying and the LA Times overviews.

Walgreens Boots Alliance, another recent merger of quintessentially American and British drug store institutions, named as its interim CEO Stefano Pessina. He previously ran Alliance Boots prior to the merger and is the largest individual shareholder of WBA stock with approximately 140 million shares, so one cannot call it a surprise. At a youthful 73 (see video), one assumes he also takes plenty of Walgreens vitamins and uses Boots No 7 skin care. Forbes.

Updated: The big EHR news is the US Department of Defense announcing the award of its Defense Healthcare Management System Modernization contract this week. At 10 years and $11 billion, even giant EHRs went phalanxed with other giant government contractors to face DOD: Epic with IBM; Cerner with Leidos, Accenture and Intermountain Healthcare; Allscripts with Computer Sciences Corp. and Hewlett Packard. Certainly there will be ‘gravitational pull’ that affects healthcare organizations, but the open and unanswered question is if that pull will include the far nearer and immediately critical lack of interoperability with the Veterans Health Administration’s (VA) VistA EHR. The Magic 8 Ball reads: Hazy, try again later.  Leidos/Cerner announced as winners close of business Wednesday 29 July. 

In other EHR news, US doctors vented last week on how much they hate the @#$%^&* things to the American Medical Association‘s ‘town hall’ in Atlanta. Bloat, diminished effectiveness, error, getting in the way of care due to design by those without medical background presently prevail. The AMA’s Break the Red Tape campaign asks CMS to “postpone” finalizing Stage 3 Meaningful Use (MU) rules so that it can align with new payment/delivery models. Better yet, they should buy thousands of copies of Dr Robert Wachter’s book [TTA 16 Apr] and drop them on every policymaker’s desk there, with a thud. Health Data Management 

Kickstarting the 1st week of summer: news from all over

No deal yet between insurer giants. Cigna turned down a $53.8 billion bid from Anthem. According to Healthcare Finance, concerns ranged from corporate governance problems, their membership in the Blue Cross Blue Shield Association, the probable chairman’s (from the Anthem side) qualifications and data security (ahem!). Given that Anthem’s 60 million record breach was an inadvertent inside job [TTA 11 Feb], the last is perfectly understandable. But the door appears to be open for the emollient of additional money (to mix a metaphor). Extra: a tart take on this from the WSJ…..Jaguar is looking to increase driving safety by reading your brain waves to detect if you are distracted or daydreaming, via sensors embedded into the steering wheel. It’s based on technology used by NASA and the US bobsled team. They are also working on mood enhancing lighting and a predictive system to speed your interactions with the dashboard to minimize eyes off the road. But will these detect if you feel good to be bad, as their adverts say? Gizmag….The FT gets into digital health via business, profiling startups such as Lyra Health, Genomics England and Heartflow, as well as 23andme and Google X (including the glucose-detecting contact lens we profiled 18 months ago. Hat tips to Eric Topol and David Doherty (mHealth Insight) via Twitter….The NY Times looks at the dark side of ‘senior independence’ with a group of NYC homebound seniors, but other than tut-tutting the desire of older mainly limited income New Yorkers to remain in familiar surroundings, our ‘national celebration of independence’ (!) and not to be institutionalized (their words), the article doesn’t offer much in the way of solutions. And solutions are badly needed for the nearly 2 million over 65 who rarely or never leave their homes, because not all of them will be in assisted living. Hat tip to Joseph Coughlin of MIT AgeLab via Twitter…. But in Australia, they’re exploring ‘future proofing’ and ‘dignity enabling’ homes for an aging population to make them more livable and accessible, via landscaped ramps, larger bathrooms, and sensor rich floors that connect to gait tracking and analysis. Smart Homes 2.0. Sydney Morning Herald…..Neil Versel over at his new MedCityNews stand reports on Doctor On Demand‘s test of tablet-based medical kiosks adjacent to the pharmacy department at four Wegman’s grocery stores here in the Northeast. Is Weis Market far behind?….And Fitbit has a bit part in ‘Law and Order’…well, not the TV show in perpetual reruns, but in a real-life case in Lancaster County, Pennsylvania which is not all Amish farms, black carriages and the so-called Amish Mafia. The police used Fitbit activity data to determine that a local resident (and Fitbit wearer), who claimed she was raped by a stranger, staged the crime scene with overturned furniture, a knife, and a bottle of vodka in her home. ABC27 News via David Lee Scher.

A ‘Game of Thrones’ analogy to potential health insurer mergers

The Wall Street Journal has likened the merger action pending among America’s largest insurers to the series ‘Game of Thrones’, said thrones occupied by Aetna, Cigna, Humana, UnitedHealthcare and Anthem. These more aptly remind this Editor of the final stages of airline deregulation, except that none are in a non-medieval bankruptcy court. Their actions reflects the payers’ urgent concerns that now is the time to reinforce a national presence, that revenues in a Obamacare environment (well, we’ll see the effect of that US Supreme Court subsidy decision due imminently) can do nothing but go down and that Medicare Advantage, commercial accounts, health system relationships (ACOs) and health IT systems are the place to be. What is missing: the fate of those independent, state and regional Blue Cross-Blue Shield (collectively, the ‘Blues’) which are not part of Anthem, many of which are ‘non-profit’ (note the quotes); the positive effect of competition on pricing and a fair consideration of the negative effects of monopoly. Ah, but there are no flung axes, regicide or poisonings to be found here. The real theme of ‘Game of Thrones’ is the effect of the powerful on the powerless (we the insured), which the WSJ writer doesn’t address…..Insurers Playing a Game of Thrones (if you hit a paywall, search on the title)

Aetna may ‘buy into’ more analytics, digital health

Rumors now mainstreamed into press surround Aetna’s apparent interest in fellow insurers Humana and Cigna. Forbes last Friday started the ball rolling with an article last Friday focusing on the main event driving insurance payer consolidation: the transition of Medicare from fee-for-service to value-based bundled payments and accountable care organization (ACO) models. Humana has substantial Medicare business and a foot in home care (SeniorBridge), but has innovated in digital health: partnerships (Healthsense, TTA 20 Dec 13), purchases (what remained of Healthrageous, TTA 16 Oct 13), employee wellness (Vitality) and app development. Cigna is a major insurer with corporate business, but has struggled a bit in the digital health arena with the flashy-but-flopped patient engagement platform GoYou. It’s piloted telehealth to reduce readmissions with Care Innovations [TTA 7 Oct 14]  and Coach by Cigna, a mobile health platform in conjunction with Samsung for the Galaxy S5 and S6 phones.

Aetna has had some success with working with ACOs, with 62 contracts covering about 1 million lives, but this Editor counts over 400 practice-based ACOs in the Medicare Shared Savings incentive program alone. Their experiment in consumer app aggregation, CarePass, came to a quiet end last August and Healthagen, their ’emerging businesses’ unit, has had some swerves in rationale including iTriage and even ActiveHealth Management, their long-time population health analytics arm. While digital health is part of it (see Mobihealthnews), (more…)

Hackermania running wild, 2015 edition

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”300″ /]

Do we need the Hulkster Running Wild against Hacking? It’s so heartwarming to see the mainstream press catch up to what your Editors have been whinging on for the past few years: that healthcare data is the Emperor With No Clothes. Here we have Reuters and the New York Times with a case of the vapors, seeking a fainting couch. Reuters dubs 2015 ‘The year of the healthcare hack’. The FBI is investigating the AnthemHealth breach, while their counterparts UnitedHealth, Cigna and Aetna are in full, breathless damage control mode. The Times at least delves into the possibility that it was at least partially instigated by China and the People’s Liberation Army (PLA) unit that trolls for intellectual property.

Our Readers, savvy to your Editors’ warnings since at least 2010, were aware that the drumbeat accelerated this past summer. (more…)

Aetna’s CarePass passing into history

Another Aetna Healthagen initiative is shutting its virtual doors–the much-touted CarePass aggregator for mobile health apps. Available to both Aetna and non-Aetna members, it incorporated leading apps such as Fitbit, Jawbone, Withings, MapMyFitness and BodyMedia. A dimming of its consumer/mobile health star which burned so brightly from late 2012 through last year was evident at this year’s HIMSS. CarePass was nowhere to be seen, and the iTriage patient engagement tool was off in the shadows [TTA 28 Feb]. From its redone website, Healthagen is increasingly concentrated on core areas for payers: ACOs, clinical decision support, data management and health information exchanges. MobiHealthNews broke the exclusive including Aetna’s confirmation and also the quiet departure of two CarePass executives from the company which took place earlier this summer. (more…)

Is the ‘last mile’ of app certification efficacy metrics?

News and announcements around app certification definitely were hot topics in the past week or so, but are they more heat than light? Do these certifications adequately address efficacy? Stephanie Baum, in her follow-up to the Happtique kerfuffle in MedCityNews, opens up the discussion with the proposition: “It seems like there needs to be some way to prove that apps actually help people.” Bradley Merrill Thompson of Epstein Becker & Green points out “It’s certainly useful to know that an app works from a software perspective reliably, but it is even more valuable to know that the app can actually improve health.” While Happtique certification standards have a gap here, this Editor would point out that they were evolved nearly two years ago when the reporting/analysis needed for this was largely not available. Newer programs such as Johns Hopkins’ mHealth Evidence and the new IMS Health AppScript [TTA 15 Dec] can dip into the ‘big data’ pool far more effectively. Will Happtique be able to address this, or leave the ‘last mile’ to others? And what is the real and quantifiable demand for app certification anyway? Health app prescribing by physicians is a question mark in this Editor’s observation; the larger market may be health plans and programs such as Partners HealthCare’s Wellocracy, Cigna’s GoYou  and Aetna’s CarePass.

Two health app directories/curation sites debut, contrastingly

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/10/CignaGOYOU_Judging_720x426.jpg” thumb_width=”175″ /]Health app curation and directory listing is becoming a popular space with Cigna’s GoYou Marketplace, launched at Health 2.0 this week, and start-up MobileHealthMarketplace.com. Cigna’s move is clearly designed to counter Aetna’s CarePass, which is a more broadly centered consumer platform [TTA 12 July]. GoYou will include not only health monitoring/wellness apps but also lifestyle/money management with a strong social (rating/sharing) overlay. Developed with SocialWellth, the latter’s Las Vegas location must account for the blindingly bright, about-as-far-as-you-can-get-from-insurance graphics (despite the Cigna logo), to the point where the approach becomes New Age kitschy: “We want to inspire you to be  (more…)

Telemedicine breaking through with payers? (US)

Cigna, the tenth largest insurer in the US, jumped this week on the virtual consult wagon train with earlier pioneers UnitedHealthcare (#1), WellPoint (#2) and Aetna (#5).  Cigna is partnering with MDLive to offer online video, telephone or e-mail consultations with doctors for non-urgent care as an option for self-insured employers nationwide starting 1 July for plans effective 1 January 2014. MDLive will send, via Cigna, summaries of telehealth visits to patients’ physicians. Cigna’s present telemedicine partner, McKesson’s RelayHealth, will remain for virtual consults with the patient’s own physician. Among payers, the widest coverage appears to be UnitedHealthcare with NowClinic in 22 states; WellPoint offers American Well only in California and Ohio while Aetna is piloting with Teladoc in Texas and Florida. (Just in time to buzz through ATA 2013!) InformationWeek Healthcare