To not only survive in but also successfully adapt to a reformed healthcare marketplace, insurers are taking varied diversification paths -- some of them betting against history.
"It's a journey," said Charles Saunders, MD, CEO of Aetna's Healthagen, at a panel at the AHIP Operations and Technology Forum. "There are unknowns, and there will be winners and losers along the way."
Aetna is one of several insurers diving deep into health information technology, along with the likes of another giant, UnitedHealth Group.
Aetna's Healthagen is looking to serve consumers, employers, providers and also other payers, with a portfolio of software and mobile apps in analytics, population health, care management and consumer self-service, including ActiveHealth Management for providers, the health information exchange Medicity, and the symptom checker iTriage.
Healthagen was "created to align with the future of healthcare" and has become "a crucible of innovation for Aetna," said Saunders, who previously directed San Francisco General Hospital's managed care program and also worked at WebMD and had stints in private equity.
Part of that future, per Aetna's strategy, includes inking accountable care partnerships with providers, and offering them Healthagen products for predictive modeling, analytics, care coordination and quality reporting. Today, Aetna has more than 25 commercial accountable care contracts, along with 75 Medicare provider collaboration agreements.
UnitedHealth is taking a similar approach with its provider-focused Optum health IT business (a major driver of profits this year), and an ambitious goal of doubling its ACO contracts by 2017, envisioning $50 billion in annual reimbursements going to accountable care.
Other, smaller insurers are also investing in and experimenting with provider, employer, consumer and payer-facing technologies, among Cambia Health Solutions, the holding company of four Regence Blues plans in Idaho, Oregon, Utah and Washington, and a suite of mobile, web services and clinical companies, including the care management platform Care Team Connect, the revenue cycle and administration company TriZetto, and a concierge primary care firm, Qliance, with two locations in greater Seattle.
Cambia's portfolio includes a number of consumer-facing products and services, running the gamut from cost-comparison and HSA apps to Lively, an activity sensor for seniors that alerts family members and caregivers to behavior or movements suggesting a health problem, and Sprig Health, an online service that lets people book medical appointments, imaging and lab tests and other services online, offering them a discount for direct pay.
All of which is pursuit of a vision that Robert Coppedge, Cambia's senior VP for strategic investment, has for the future: "consumers and providers actually have contributing roles" in healthcare.
Meanwhile, Pennsylvania's largest insurer and one of the largest Blue licensees, Highmark, is treading into waters that other payers left long ago: owning and operating hospitals.
"You couldn't let a provider with 23 percent market share go bankrupt," said Highmark's chief strategy officer, Jay Godla.
After more than a year of regulatory scrutiny, Highmark finalized its acquisition of Pittsburgh's financially-strained West Penn Allegheny Health System this past April, renaming it Allegheny Health Network and positioning itself as a competitor to the University of Pittsburgh Medical Center, a health system with close to 50 percent market share and a fast-growing health plan.
Highmark's new ownership of the seven hospital Allegheny Health Network comes a decade after Cigna got out of the hospital business, selling New Mexico's Lovelace Health System in 2003 after acquiring full control in 1991 -- a few years before Humana spun off the 77 hospitals it bought and in many cases built during the previous two decades.
Now, few if any insurers own health systems or hospitals, even though some are betting on other areas of care.
"Humana has tried to integrate pre and post-acute," such as the urgent care network Concentra, Godia said. "But they don't want to touch hospitals."
So why would Highmark?
"Things may be different now," Godia said. The fact that two-thirds of U.S. provider markets are considered highly concentrated means insurers have far less leverage than in the past.
In Pittsburgh and western Pennsylvania, Highmark thought it needed more competition. "Adjusted for the cost of living," Godia said, "Pittsburgh is the most expensive place to get healthcare."
Highmark also wanted to bring more clinical innovations to healthcare, granting $11 million to Carnegie Mellon University for a research lab focused on medical diagnostics, behavior change, chronic disease management, data mining, improved endoscopy and infection prevention.
One example of that innovation developing Allegheny Health Network is a potential improvement in the treatment of esophageal cancer, which currently has a 90 percent five year mortality rate.
Allegheny Health Network's GI surgeon Blair Jobe, MD, has been using a regenerative technique, essentially peeling off the cancerous lining of the esophagus and replacing it with a new cell lining -- an alternative to esophagectomies, which come with an average 50 percent complication rate, a 21 percent mortality rate and surgery and hospital stay costs approaching $150,000.