Taking a Personalized, Digital Approach to Wellness Programs

Blue Shield California (BSC) recently announced its new platform Wellvolution and in doing so it emphasized payers’ movement away from solely brick-and-mortar wellness programs to customizable, member-driven health solutions.

In 2016, wellness programs were an $8 billion industry with a projected growth of 7.8 percent per year. Employers were under the impression that by providing employees with access to wellness programs and incentivizing them to attend, healthcare costs would fall, productivity would rise, absenteeism would drop, and the company culture would thrive. 

However, since as early as 2013, the number of studies that demonstrate low return on investment has steadily accumulated. 

According to Angie Kalousek, director of markets, lifestyle medicine at Blue Shield California, relying solely on the traditional wellness program alone is outdated.

“When you go out and you look at the different payers that are out there and the different solutions that they're offering, there are a lot of one-size-fits-all in the market right now,” she told HealthPayerIntelligence.com.

Members want to be able to access their care as easily as they can access consumer products and they want their healthcare solutions to be customizable to fit their individual needs, Kalousek noted. In response to the trend towards healthcare consumerism, payers like Blue Shield California are turning to digital therapeutics.

Digital therapeutics are entering clinical settings at the request of both physicians and patients. A 2018 PwC survey found that 50 percent of consumers indicated they would be somewhat or very likely to try an FDA-approved app or online tool for treatment and 26 percent of physicians reported that a patient had inquired about a digital option. Seventy-seven percent of physicians also had recommended an app or digital program to a patient and 66 percent said that the app or digital program improved their experience.

As a result of the high demand for digital therapeutics, in 2017 and 2018, investors paid out $12.5 billion to digital health ventures. While funding grew in other areas by 67 percent as compared to 2013, contributions to digital health ventures increased by 230 percent in contrast to 2013 investment levels.

As a continuously evolving concept in the dynamic healthcare industry, digital therapeutics has become a broad-stroke term.

Kalousek clarified that, for Blue Shield California, digital therapeutics means offering members a platform that can address minor to major health concerns, from reducing stress to reversing type 2 diabetes. Their platform, developed in conjunction with Solera Health, is called Wellvolution.

“We can reach people in a scaled way through digital therapeutics and it allows them to receive the care that they need 24/7, at the time that they want it, when it's convenient for them, and still get really great care,” Kalousek explained.

When members join Wellvolution, they are asked a series of health-related questions that aim to address a wide range of health and wellness issues, including chronic disease management to personal health goals like establishing a sleep schedule, Kalousek explained. The platform then matches members to providers within BSC’s network of approximately 70 solutions.

“We are extremely conscious of not being paternalistic in this and saying, ‘This is the provider you need to work with.’ So while we do recommend a provider, we say, ‘Hey, if this one doesn't really sound great to you, you can also choose from another three or four that you might want to look at to see if they meet your needs in a better way,’" said Kalousek.

Once the member is matched and selects their provider, they are contacted by the provider to establish their care and wellness routine. Their care may be carried out in a number of ways, including at a brick-and-mortar facility, over the phone, or in their own home.

“One of the things that we're bringing to market is this idea of personalization and being able to choose a program that's really working for you,” Kalousek shared.

In the higher-acuity programs for chronic conditions such as diabetes, providers are contracted on a “pay-per-performance” basis. The providers’ contracts include milestones for performance, such as achieving a certain weight loss level, decreasing A1C, or diminishing hypertension.

For lower-acuity health issues or goals,BSC evaluates apps in the App Store and selects ones that receive high ratings and have proven outcomes, whether that feedback is anecdotal or clinical.

For the higher-acuity solutions, BSC observes each vendor to consider their past performance. Kalousek pointed to BSC’s partnerships with Better Therapeutics and Verta, both of which demonstrated A1C score reduction and even type 2 diabetes reversal.

“We're looking at a new age in the way that medicine is being delivered and I think that digital therapeutics is the wave of the future,” said Kalousek. “We're going into a place where people need to be able to access healthcare the same way that they access their consumer needs. That's what consumers are demanding. It’s important that health payers listen to that and begin to deliver solutions that work for the customer--not just them as a health payer.”