Health plans

Health plans and wellness apps

Florida Blue and Blue Shield of California are among insurers that organize and provide free access to wellness apps for their members.

As consumers embrace wellness apps to help them do everything from reduce stress to improve their sleep, some health insurers are supporting the trend, offering members free access to select apps designed to improve health and well-being. “People are looking for an easy way to improve,” says Anne Hoverson, vice president of digital transformation at Florida Blue, which seeks to “arrange the right thing at the right time” for its members.

The first health and wellness apps were launched more than a decade ago, and even today, “most don’t do much,” says Bryce Williams, vice president of MindBody Medicine for Blue Shield of California. “They’re just kind of a transient experience for most people.”

But some apps can play a vital role in limb care, he adds. “We felt that the field had matured enough that this was a very good opportunity that could help our members.”

The California insurer has a special website called Wellvolution that offers tools to help members do things like manage diabetes, lose weight and deal with mental health issues. The abundance of wellness apps can create what behavioral economists call overchoice: people freeze up when faced with too many options. Blue Shield of California ensures that all applications on the Wellvolution website have been clinically validated and found to be effective in real-world conditions, according to Williams. The company launched Wellvolution in 2008 and began “experimenting” with apps in 2010, Williams says. Now, members who visit the site can discuss health issues and the insurer will offer them apps and other tools to help them achieve their goals. Health plan members do not pay extra for the programs. They can be connected to apps such as Ginger, which provides online mental health care; WW (formerly Weight Watchers) for weight loss; Clickotine to quit smoking; and Virta Health to manage diabetes. In an email to Managed Healthcare Frameworke®, Blue Shield of California said that all of Wellvolution’s payment models are pay-for-performance. In Ginger’s case, the health plan says it pays on a milestone basis, and the milestones include engagement, sustained engagement, and clinical outcomes based on common mental health scoring tools.

Florida Blue launched a new section of its website last year where members can report health concerns and be connected to appropriate care. Plan members have free access to meQuilibrium, an app designed to reduce stress and build resilience using cognitive behavioral therapy at a time when many Americans are struggling with the mental toll of the pandemic. of COVID-19. A Florida Blue member with diabetes can access Livongo for Diabetes, which monitors blood glucose readings through a connected device. Members can receive automated “nudges” to help them stay on track or can chat with a Care Coach or Diabetes Educator. The Livongo for Diabetes website says it’s a $75 per month benefit paid for by an employer or health plan.

Why now?

As demographics changed and younger people, more inclined to use apps, began to sign up for medical coverage, Florida Blue began to increase its app offerings, Hoverson says. Meanwhile, app development, including wellness apps, has exploded. Wellness apps also respond to the high value people place on convenience. There are no appointments, no travel time, no waiting room. An app “is always there for you, always in the palm of your hand,” Williams says. The pandemic has also been a factor, propelling a major shift towards virtual care and familiarity with digital healthcare delivery. The pandemic, says Hoverson, “has knocked down a lot of barriers.”

This growing demand for virtual care has also fueled a wave of investment across the digital health sector, which includes apps. Noom, the weight loss program and app that uses cognitive-behavioral techniques, made the biggest digital health investment in 2021, bringing in $540 million, according to Rock Health, a capital fund -risk that focuses on digital health.

Overall, venture capital funding for digital health start-ups soared to $29.1 billion last year, a new all-time high, according to Rock Health, and about double investment funding. in 2020. 2021 money went to 729 transactions, with the average transaction reaching nearly $40. million. Digital health start-ups in the fitness and wellness sector attracted $4.3 billion in funding last year, according to Rock.

One issue with health and wellness apps is covering their cost. Some are available free to consumers, many charge a monthly subscription fee, and others are only available to health plan members.

Digital health company Big Health tackled the problem by working with a Pharmacy Benefit Manager (PBM). Big Health promotes its apps, which use cognitive-behavioral techniques, as non-drug alternatives to insomnia and anxiety. The company says its apps – Sleepio for insomnia and Daylight for anxiety – have undergone clinical studies, including 13 randomized clinical trials.

The company works with CVS Caremark, the PBM arm of the pharmaceutical giant. “By paving the way for the ability to bill through PBM, employers and health plans can easily add Big Health to their formulary and pay for their usage through a drug claim, the same way they pay for drugs,” Big Health co-founder and CEO Peter Hames said in an email. A person can only access a Big Health app if their employer has registered them.

App Concerns

Big Health and a few other companies are trying to break away from the pack by claiming that their apps have passed clinical trials. But in a recent opinion piece in JAMA, David Simon, Ph.D., a research fellow at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, and his Harvard colleagues discussed the lack of regulation of many wellness products, including including consumer apps that people use to assess their health status. The FDA tends to focus on the risk a product might pose to consumers, they noted. The agency distinguishes between devices that diagnose disease and ailments or claim to cure, treat or prevent disease and those intended for general use and wellness. “Even though some general wellness products may be ‘devices,’ the FDA will not regulate such products if they merely promote a healthy lifestyle or help reduce the risk of certain chronic diseases based on ‘accepted interventions,’ the authors wrote.

Simon said in an interview that one of his concerns is whether consumers who use wellness apps are “aware that they are not intended to diagnose disease.” There are also questions about the reliability of the information generated by wellness apps and what doctors can or should do with that information.

As for regulation, “the FDA can’t be out there policing the tens of thousands of apps that are out there” with the agency’s limited resources, Simon said.

Health plans benefit

By offering apps, health plans hope to increase connection and engagement with members.

For Florida Blue members, the apps can be used to more effectively manage chronic conditions, Hoverson says. “The better they are, the healthier they are,” which can reduce emergency room visits and hospital admissions while lowering costs for the insurer.

Williams of California’s Blue Shield agrees. He says offering the apps “improves the lives of those we serve. By improving health, everything else (business side) will take care of itself.