Aetna, one of the nation's largest health insurers, is embracing digital tools built around individuals in order to create a "new set of norms" for the U.S. health care system. Delivering the opening keynote at HIMSS14, Aetna CEO Mark Bertolini said the new model is about enabling consumers to interact with the system in a way that is simple and enables them to stay ahead of their health.
The Hartford, Conn.-based company in late 2011 acquired mobile health start-up Healthagen, the developer of iTriage, a popular medical diagnosis app designed to help consumers make health care decisions. The iTriage app has been downloaded more than 9.5 million times and is consistently rated in the top 5 health and fitness apps downloaded by iPhone and Android users.
"iTriage is about putting the health care system in your hand so it's there available for you and it's simple and it's easy--the quickest way to behavior change both for wellness and for chronically ill," Bertolini explained. "So, we're now creating a digital experience where people will not only be able to make their appointments and send their information back and forth to their doctor, but they will be able to find something they need when they want it on their terms, an experience we call WellMatch.
"Instead of offering employer-centric low tech products to our customers, we need to empower our customers to take control of their health care through connected digital tools," Bertolini said. IN one example, three years ago the insurer started utilizing Bluetooth technology combined with weight scales in a home-based program to monitor water weight gain in congestive heart failure patients, whose re-admissions can cost as much as $80,000. Bertolini said that the company reduced in one year congestive heart failure readmissions by 49 percent.
Over the next six to seven years, 75 million Americans will be "retail buyers" of health care, predicted Bertolini. "They'll come to the marketplace with their own money and either a subsidy from their employer or a subsidy from their government," he said. "It doesn't much matter. They'll be spending their money."
Bertolini said that Aetna's strategy includes connecting private exchanges here in the U.S. and abroad to accountable care organizations. At the same time, Aetna expects to lose money on the Affordable Care Act exchanges and the company's 2014 profit outlook is based on those expected losses Earlier this month, Bertolini, told CNBC that there is so much uncertainty about the Affordable Care Act that Aetna may be forced to double its rates or opt out of the program.
"I think in the end analysis, pulling out is always the last resort," he said during interview. "We don't like to do that because we disenfranchise customers and we disappoint customers, so we always look at that as a last resort, but that is an option that we will pursue if we need to if the program doesn't settle down."
An outspoken critic of the Affordable Care Act, Bertolini didn't mince words about the program at the HIMSS14 keynote. "What we've done with the Affordable Care Act is we've put--pick a number--2, 4 million people in the rat maze. We haven't done anything to improve their lot. And so, what we don't need to do is to put another 30 million people into the rat maze. We need to make sense of the rate maze and straighten the system out."
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