In 2023, health insurers weren’t just playing it safe. They embraced innovation, tackling critical issues while reshaping the healthcare landscape. From crafting new partnerships to harnessing the power of AI, from prioritizing mental health to revolutionizing chronic disease management, these 15 bold moves showcase the industry’s commitment to a healthier future for all:
Blue Cross of North Carolina Launches New Apprenticeship Program
Blue Cross of North Carolina announced an apprenticeship program that helps connect individuals from the foster care system with employment opportunities at Blue Cross of North Carolina retail centers. In addition to employment opportunities, the program will connect apprentices with North Carolina community colleges. Blue Cross of North Carolina employees will serve as mentors to help them grow.
As unemployment continues at relatively low levels, insurers may struggle to hire and retain employees. Not only does the program help those entering foster care find meaningful employment and educational opportunities, but it also helps the health insurer identify talent and find its next generation of employees.
Gold Coast Health Plan Partners with Wellth Partnership
In October, Gold Coast Health Plan partnered with Wellth, a digital behavior change company. Wellth develops personalized behavioral change programs through daily interactions and incentives, helping members develop long-term healthy habits. Gold Coast Health Plan plans to roll out the program to 1,000 members to help them manage chronic conditions like diabetes and hypertension.
Gold Coast Health Plan is the first-of-its-kind program for a California Medi-Cal plan. Wellth has helped other health plans reduce inpatient and emergency department utilization while improving medication adherence.
Inland Empire Health Plan and Molina Healthcare of California Partner with BeMe Health to Improve Teen Mental Health
BeMe Health’s services will be available to teens in schools in two California counties thanks to a partnership with Inland Empire Health Plan and Molina Healthcare of California. BeMe offers an app with activities that support mental health, one-on-one coaching, clinical services, and crisis support. As a result of the partnership, more than 72,000 teens will have access to the platform.
Teen mental health is a health crisis, with 42% of high school students experiencing persistent feelings of sadness or hopelessness in 2021 and 22% seriously considering suicide. This collaborative effort, tailored to each school’s needs, addresses the urgent adolescent mental health crisis with the potential to save lives.
Blue Shield of California Announces Pharmacy Care Reimagined
Starting in 2025, Blue Shield of California will replace its incumbent pharmacy benefit manager (PBM) with five partners to create a best-of-breed approach. The new partners will each have a specific role in delivering pharmacy benefits:
- Amazon Pharmacy – Will provide fast and free prescription delivery with 24/7 access to pharmacists.
- Mark Cuban Cost Plus Drug Company – Will create a transparent pricing model.
- Abarca – Will pay prescription drug claims.
- Prime Therapeutics – Will manage negotiations with manufacturers.
- CVS Caremark – The incumbent pharmacy benefit manager (PBM) for Blue Shield of California will provide specialty pharmacy services.
The shift from one PBM to many, each with specialized expertise, has raised eyebrows across the healthcare spectrum. Blue Shield of California expects to save as much as $500 million in annual drug costs. The move from all-in-one to best-of-breed point solutions is a growing trend that insurers will likely replicate as they transition from all-in-one core admin systems to more feature-rich point solutions for claims administration, billing, and enrollment.
MVP Health Care Piloted Artificial Intelligence for 3 Use Cases
With the launch of generative artificial intelligence (AI) like ChatGPT, 2023 saw an explosion in the usage of AI. Health plans were not exempt. MVP Health Care announced that they had piloted the use of AI in three use cases:
- Condensing medical record data – The insurer is using AI to glean insights from member health records
- Hyper targeting – MVP used machine learning and advanced analytics to segment populations for health interventions
- Assessing risk adjustment in Medicare Advantage – Aiming to achieve five-star quality ratings, the company used AI to assess care gaps and evaluate its performance.
These use cases can save payers and providers time, improve member interactions, and help the insurer improve Medicare Advantage Star Ratings. As the AI tools continue to improve, more and more insurers will hop on the AI bandwagon and potentially revolutionize their business.
Point32Health Partners with Wellthy
Point32Health announced in late 2022 that fully insured commercial members would gain access to Wellthy’s digital tools that help individuals manage caregiver support. The partnership includes a care dashboard members can use for planning and other resources, access to care coordinators and care advisers, and access to a peer network to connect with those in a similar situation.
The average family caregiver spends 45 hours a week on unpaid care, which can lead many to leave their job. Additionally, caregivers report feeling isolated and unsupported. As a result, many insurers are turning to solutions like Wellthy to offer caregiver support tools.
Blue Shield of California Releases its Wellvolution Platform to Medi-Cal Members
Blue Shield of California rolled out its Wellvolution platform to Medi-Cal members in 2023. The platform includes:
- Headspace Health’s mental health solution,
- Virta Health’s diabetes reversal solution,
- Clickotine’s smoking cessation solution,
- And Betr Health’s weight loss solution.
Because Medicaid populations are more likely to report mental illnesses or have substance use disorders than those privately insured, offering a collection of well-being apps to Medi-Cal members was worth the effort. Nearly 400 members had signed up within a month of launch, highlighting the desire for Medi-Cal members to access the Wellvolution collection of apps.
Blue Cross and Blue Shield of Texas Expanded its Behavioral Health Network
Like Blue Shield of California, Blue Cross and Blue Shield of Texas (BCBSTX) also improved behavioral health access. BCBSTX focused on expanding its provider network. Members can now access nearly 4,000 in-network behavioral health providers through Headway.
The network expansion enables members to receive care two to three times faster. Headway can also improve outcomes, indicating that 76% of BCBSTX members see an improvement in the first 30 days. The network expansion is one of many initiatives designed to improve mental health.
CVS Health Invests in Virtual Care, Primary Care
Though the pandemic is over, investments in virtual care have not ceased. This year, CVS invested $25 million in Array Behavioral Care, a provider of telepsychiatry services. CVS also led a series D funding round for Carbon Health, an in-person and virtual health organization, and will use some of the funds to pilot the operating model inside some CVS Health locations.
After buying Aetna in 2018, CVS has been building a fully integrated healthcare company. Investments in virtual and primary care will help the company grow its virtual care and primary care infrastructure.
Highmark Health and Kinsa Partner to Predict Disease Outbreaks
Highmark Health partnered with Kinsa to deploy the company’s data analytics technology to predict utilization trends and disease outbreaks. Kinsa combines data from numerous sources – including its smart thermometers – to track and forecast how disease spreads. Highmark Health owns the Allegheny Health Network health system and will initially deploy the technology to track staffing and bed capacity.
The partnership with Kinsa likely makes Highmark Health a more efficient, resilient, and customer-centric organization by enabling the health system to plan and prepare for illness outbreaks. That concept can also be expanded to the operational unit, helping it better predict outbreaks and staff its health insurance operations.
Longevity Health Plan Partners With SingFit for its ISNP Offerings
Longevity Health Plan became the first institutionalized special needs plan (ISNP) to offer SingFit, a music health platform for those struggling with cognitive and mental health conditions, to members. SingFit can help nursing home residents remember memories associated with songs and conversational prompts after group and one-on-one sessions.
Studies have shown that music therapy can positively impact cognitive function, reduce depression and anxiety, and improve social interaction for people with cognitive and mental health issues. Offering SingFit could lead to better overall health outcomes for Longevity Health members, potentially reducing healthcare costs in the long run.
Blue Cross and Blue Shield of Oklahoma Partners with National Fitness Campaign on Outdoor Fitness Courts
Blue Cross and Blue Shield of Oklahoma partnered with the National Fitness Campaign to construct outdoor fitness sites in public locations. The fitness sites are designed to deliver seven-minute bodyweight workouts for anyone and can also host outdoor workout classes. Free digital classes are available through an app.
Healthy members lead to decreased health expenses, which is why many health plans – like BCBSOK – invest in community-based fitness programs in their service areas.
SCAN Group and CareOregon Wipe Out Medical Debt
SCAN Group and CareOregon donated $345,000 to RIP Medical Debt to eliminate millions in medical debt. The donation will impact those at or below 400% of the federal poverty level or those whose debt represents more than 5% or more of household income. The donation was the first of its kind by a health plan.
The health plans – who merged to form HealthRight Group – hope to highlight the impact that high healthcare costs – and subsequent debt – can have on consumers. The organizations hope their donation inspires other health plans to launch similar initiatives.
Blue Cross and Blue Shield of Oklahoma Launches A Mobile Pharmacy Benefit App
BCBSOK launched a new mobile app, MyBlueRXOK, that enables members to manage their pharmacy benefits. Among the activities members can complete in the app:
- Find available lower-cost drug options.
- Compare drug costs at different pharmacies.
- Manage prescription drug care for their dependents.
- Get reminders when it’s time to refill a prescription.
- Access information about prescription drugs, including medication details, claims history, coverage, clinical review approvals, and refills.
- Search for and contact in-network pharmacies.
Insurers continue to iterate and improve their mobile applications to improve the member experience while providing on-demand information. These apps help members better navigate a complicated healthcare system but also help limit the resources insurers invest in their customer service teams.
Aetna Partners with Oshi Health to Help Members with Chronic Digestive Conditions
This spring, Aetna announced a partnership with Oshi Health to offer Oshi’s solutions for chronic digestive conditions to commercial members. Patients can connect with specialized providers via telehealth visits, access symptom-tracking tools, and access instant messaging services. Oshi has helped more than 90% of members gain control over their symptoms while achieving $6,724 per patient in GI-related costs.
Oshi’s integrated multidisciplinary care model has shown promising results in managing chronic digestive conditions, with patients achieving symptom control and cost savings over traditional care. The Oshi partnership could lead to lower healthcare costs for Aetna in the long run. Plus, the collaboration uses a value-based payment model that financially incentivizes Oshi to deliver effective care and manage costs, aligning with the broader shift toward value-based care. Aetna could use it as a model for future partnerships.
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