Thanks for the quick response, Eli. My follow-up is similar to Jasons: I’m wondering not so much why insurance companies don’t pay for these devices right now, but more why there isn’t a push to use them to financially reward or incentivize healthy behavior or outcomes.
For example, if it costs an insurance company $10K more to care for someone with diabetes than someone without, what if the insurer offered the patient a deal: if via non-medication means you reverse your diabetes (as measured by insulin and hemoglobin A1C or HbA1c test), we’ll pay you $5,000 (or, if they pay privately for their insurance, we’ll give you a year-end cost refund of $$).
Or, different approach: if you do specific behaviors that we know will lead to your diabetes improving, we’ll pay you a certain amount per month each month you meet the targets consistently (e.g., wear a fitness tracker and exercise 5x per week for 30 min at vigorous intensity and wear a continuous glucose monitor and stick to a 10-hour feeding window by practicing intermittent fasting for at least 20 days/month).
Of course, the details would need to be worked out and there are lots of questions (e.g., how does this work for people who are already metabolically healthy vs. those who aren’t). But there are companies playing this space at a small scale, using biofeedback and clear lifestyle incentives to improve health outcomes (albeit without insurance pay-back), such as VirtaHealth, Levels, and HealthyWage, and commercial supportive counseling programs like Noom.
Given how immense the cost of metabolic disease is for individuals and society I’m surprised that there isn’t a larger effort to use these trackers to fundamentally change how the incentives work. Wouldn’t it be better if insurance companies actually helped people get healthy, rather than pay for ongoing medication for multiple chronic diseases?
I’m really curious if anyone has done any digging on the regulatory barriers that would make it hard to make this happen. (Or maybe this is an untapped business opportunity for someone, if there aren’t any major regulatory hurdles!)
Thanks for that link, Eli. This is exactly the type of context I was looking for. It woulds like there is a regulatory hurdle here with significant potential liability if the program were to get challenged as not meeting those requirements both on the actual program design and on the documentation.
Thanks for the quick response, Eli. My follow-up is similar to Jasons: I’m wondering not so much why insurance companies don’t pay for these devices right now, but more why there isn’t a push to use them to financially reward or incentivize healthy behavior or outcomes.
For example, if it costs an insurance company $10K more to care for someone with diabetes than someone without, what if the insurer offered the patient a deal: if via non-medication means you reverse your diabetes (as measured by insulin and hemoglobin A1C or HbA1c test), we’ll pay you $5,000 (or, if they pay privately for their insurance, we’ll give you a year-end cost refund of $$).
Or, different approach: if you do specific behaviors that we know will lead to your diabetes improving, we’ll pay you a certain amount per month each month you meet the targets consistently (e.g., wear a fitness tracker and exercise 5x per week for 30 min at vigorous intensity and wear a continuous glucose monitor and stick to a 10-hour feeding window by practicing intermittent fasting for at least 20 days/month).
Of course, the details would need to be worked out and there are lots of questions (e.g., how does this work for people who are already metabolically healthy vs. those who aren’t). But there are companies playing this space at a small scale, using biofeedback and clear lifestyle incentives to improve health outcomes (albeit without insurance pay-back), such as VirtaHealth, Levels, and HealthyWage, and commercial supportive counseling programs like Noom.
Given how immense the cost of metabolic disease is for individuals and society I’m surprised that there isn’t a larger effort to use these trackers to fundamentally change how the incentives work. Wouldn’t it be better if insurance companies actually helped people get healthy, rather than pay for ongoing medication for multiple chronic diseases?
I’m really curious if anyone has done any digging on the regulatory barriers that would make it hard to make this happen. (Or maybe this is an untapped business opportunity for someone, if there aren’t any major regulatory hurdles!)
It looks like certain wellness programs that are allowed, but there are limits on what you can do if you make it outcome-contingent. https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/publications/caghipaaandaca.pdf
Thanks for that link, Eli. This is exactly the type of context I was looking for. It woulds like there is a regulatory hurdle here with significant potential liability if the program were to get challenged as not meeting those requirements both on the actual program design and on the documentation.