Insurers are seeing massively higher usage of primary care triage apps and telehealth. The next step is the development of digital therapeutic platforms which extend touch with the patient beyond diagnosis. How? And who are the players in this new game?
Yesterday’s HBI-365 Big Picture panel discussion on payors and providers saw Aetna’s Sneh Khemka (VP of population health and v-health) and Cigna’s Carlos Araujo (its global provider contract lead) analysing the COVID-19 uptake in telehealth and their next steps. Cigna, in particular, is signalling that it wants to offer digital therapeutics, such as monitoring and coaching to patients with long-term chronic conditions. Here it’s entering a race alongside Optum, the services arm of UnitedHealth and Fresenius Helios, whose new digital chief, Jan Leister, we interview this week in HBI Deals+Insights about his ambitious plans.
In the fascinating HBI-365 Big Picture seminar, Aetna revealed that front-end digital/telehealth usage had more or less tripled to around the 15% mark worldwide. Cigna saw a fivefold increase in digital usage over COVID-19. Both say this will continue to accelerate to critical mass within three years, roughly three times faster than the decade forecast pre-COVID-19. Khemka didn’t baulk at the suggestion that this could mean 50-60% of insured customers online within three years.
But both signal that they want to maintain customer touch beyond primary care triage. This means investing in a digital therapeutics platform. Here Aetna may go down the route of partnering with digital healthcare start-ups and offering them a platform linked to Aetna. Cigna has launched a mental health service and is keen to extend this to other conditions. It is noticeable that both insurers say they are already seeing substantial savings from such an approach and also report very high levels of customer satisfaction with telehealth and apps. They go into specifics in the discussion, which is available in full to our 500+ HBI-365 delegates.
They are not the only people building a digital therapeutics platform. In our interview, Leister signalled that Helios is perfectly prepared to disrupt its existing rehabilitation business with digital interventions in many cases replacing face-to-face sessions. In practice, we think the winning digital therapeutic platforms will combine digital coaching, monitoring and telehealth with face-to-face sessions and hospital treatment. But Sneh Khemka at Aetna does think that the new approach should lead to much lower costs.
Building such a platform is a big bet. We’d expect the big quoted hospital groups – Ramsay, HCA, Fresenius Helios. possibly IHH and some Gulf players – to be developing this in competition with big and specialist health care insurers – UnitedHealth, Cigna, Aetna and probably Bupa. Large specialist players in long-term conditions such as dialysis are also developing digital platforms for specific conditions. As are the new generation of wellness operators such as Livongo whose entire raison d’etre is the development of such platforms.
The people who are likely to be left behind are national general hospital groups who treat a wide range of conditions and won’t be able to afford to invest enough, although there are exceptions such as Asklepios which has bought ten digital health outfits in the last 18 months. But most national chains could lose out badly, remaining factories serving out episodes of care to patients whose primary allegiance and time is spent on a digital platform owned by an insurer or competitor.
One thing is sure. Long-term there will be many losers and only a few winners.