More and more, insurers are trying to help members get fit, slim down, and eat better. But for one of this century's most pernicious health problems, some find they need data-driven frameworks to target interventions and gauge their effectiveness.
As Aetna sets a moderate footprint in public exchanges (in 18 markets) and offers tailored accountable care networks to full-risk and self-funded employers, the insurer is also trying to improve and expand its portfolio of health coaching and personalized wellness -- especially for metabolic syndrome.
A collection of excess abdominal fat, high triglycerides, hypertension and pre-diabetic high blood sugar, metabolic syndrome can lead to diabetes and heart disease. By some estimates, at least 80 million Americans meet the criteria for the condition.
Metabolic syndrome and its downstream impacts -- acute and specialty care for heart attacks, strokes, diabetes and complications -- have been seen in claims trends for a while, and today "the problem appears to be only getting worse," said Adam Scott, managing director of Aetna's Innovation Labs, which is overseeing pilot projects for identifying members most at risk and intervening through lifestyle changes.
Analyzing claims, lab and biometric data from 37,000 large group members, with a platform from GNS Healthcare, Aetna was able to predict the risk that a member would develop metabolic syndrome in one year with 88 percent accuracy. (Without the biometric data, the predictability index was 80 percent.)
Identifying those most at risk was the first challenge. Now Aetna is trying to refine its wellness, intervention and health coaching programs and test the potential success and scalability of new pilots -- to see, for instance, if personalization, while accounting for genetics and behavior, can yield better results in the war on sedentarism and junk food.
Personalization and motivation
One pilot is testing a genetic- and personality-driven lifestyle improvement program on 500 of Aetna's own, most at-risk employees. They're being given online health surveys and genetic tests -- measuring genes linked with obesity, appetite, and behavior -- and then receiving personalized coaching on healthy eating and exercise from the Toronto, Canada-based company Newtopia.
Among the genes Newtopia's wellness program screens for is DRD2, a gene that partly controls dopamine regulation and that some research has linked to addictive behavior like overeating. With high expressions of the gene, it's like people aren't getting the "stop function" to let them know they're full, said Jeffrey Ruby, Newtopia's founder and CEO. Knowing they have expressions of that gene and others can "help people understand it's not their fault necessarily" that they have overeating problems, said Ruby, a former COO at the Cleveland Clinic Canada.
The company also tries to guide its coaching based on personality, with questions like: "How ready are they to change, what kind of motivations do they have, and what kind of personality type do they have?" For instance, do they benefit from short informational sessions, or are they long-form learners best fit for longer coaching sessions.
Aetna may expand the metabolic prediction program and open it up to more group customers and members in the future. For now, the company is following the results of the Newtopia partnership, other pilots and its existing lifestyle coaching programs, measuring how "individuals engage with programs" to "figure out whether or not to offer them at a scale," said Scott.
What is known so far about metabolic syndrome interventions is that improving waist circumference (i.e. losing belly fat) and reducing average blood sugar have yielded the largest benefits in subsequent risks and costs, said Scott.
As a whole, metabolic syndrome is a huge opportunity to improve the health of "people who have a poor quality of life," Scott said.
Indeed, the problem of metabolic syndrome has the potential to wreak so much havoc -- based on the 80 million Americans thought to have the condition -- that other insurers are trying to tackle it.
Since 2010, Cigna has had an intensive metabolic syndrome program as part of its employer wellness portfolio, offering weekly online or in-person group counseling sessions hosted by a clinician who tries to help insurance members understand the relationship between disease, diet and exercise.
UnitedHealthcare has been developing data analytics to identify patients with metabolic syndrome and other factors that may suggest a coming onset of diabetes, and has been building out its portfolio of consumer-facing wellness technologies along with the traditional employer-based wellness programs.