Technology, Aetna, iTriage, and the Future of Medicine

Somehow I got invited to an Aetna coming out party for their Care Pass Platform. The corporate event complete with chocolate covered strawberries, wine, and beef and chicken on a stick was an opportunity to meet some of my longest twitter colleagues: @MatthewBrowning @unitystoakes @stevenkreinmd @paulomachado @sjdmd @boltyboy @hjluks @PJMachado @shwen

Mark Bertolini, the CEO of Aetna, first appeared on my radar when he spoke at HIMSS on the challenges that health care insurance companies face: “The end of insurance companies, the way we’ve run the business, is here.” Finally, an insurance executive who gets it. I am reminded of another CEO who told me, “I am more scared about our business model than ever before.”

Bertolini is an effective advocate for a new way of running Aetna. He traced his involvement in health care from being an assembly line worker for Ford, to a paramedic in Detroit, to running an HMO, to dealing with his 16 year old son’s rare cancer, to his eight year struggle with nerve damage in his left arm due to a skiing accident. He has experienced first hand what all of us know: doctors don’t talk to each other, care is disorganized and fragmented, and the economic downturn makes paying the increasing out of pocket expenses difficult. He quipped that even though he has pretty good insurance, he still had to pay about $7000.00 for his many visits to the orthopedist for his left arm injury.

Aetna’s Care Pass Platform is an agnostic tool that all consumers can use to aggregate and organize their fitness, medical, insurance, and nutrition data so that health care is about the individual patient, not the average patient in a defined population. Aetna is also partnering with Medicity to provide apps for providers and iTriage to provide apps for consumers. Aetna can offer these services for free because they save $5.00 every time they eliminate a consumer phone call, and $7.00 every time they avoid reprocessing a claim.

Peter Hudson, MD, co-founder and CEO, of iTriage presented six new features to this consumer health care app that has already been downloaded 5 million times. The new features include being able to search for a provider by ratings, gender, languages spoken, years of experience, and distance from the consumer’s home or office. iTriage can now also send news and alerts to consumers. Their new content now includes prognoses for several diseases, average cost data, ability to put reminders to refill medications into your calendar, and to find a physician who has available appointments for your specific symptoms.

Alan Webber of Altimeter shared his research on consumers that validated Bertolini’s observation that current health care delivery is not accessible, inconvenient, and disorganized.

A panel of Charlene Li, Matthew Holt, and Todd Park then discussed how technology can help us solve the above-described problems. Holt emphasized the increased number of platforms (smartphones, iPads, TV), the need to make the use of technology easier for consumers, and the future potential of big data. Without mentioning Epic by name, he shared his concern that hospitals and doctor offices are investing in systems that are closed and not able to communicate with each other. He also made the important point that the much-lamented 90,000-doctor shortage in 2012 may be an illusion if the delivery of health care is reengineered using technology and non-physician providers. Li emphasized that we are at the beginning of this journey and that trust will need to be developed so that consumers feel safe in sharing their data. Park drove home his now familiar message that CMS will liberate information, there will be a transition from fee-for-service to global payments, social media and mobile technology will transform medicine, and consumers are becoming more and more empowered and involved.

The few physicians sitting in the audience were like me supportive of the message, but skeptical. The iTriage example of finding a pain physician in Oakland who has 61 open slots for an appointment brought on whispered snide comments that nobody should go to a clinician who has that much availability. The comments about trust brought up the issue that many surveys show that health insurance companies are the among the least trusted of partners in the health care world; perhaps the panel and audience members were embarrassed to bring up this fact when Aetna was paying for such nice drinks and appetizers. Another elephant in the room was the enormous gap between the visions I keep hearing in these echo chamber meetings and the reality of getting physicians and hospitals to understand and embrace the technology that is so enticing and potentially useful. When I share a similar message to medical school and physician audiences, I am often met with either apathy or outright resentment.

I am reminded of something Lewis Mumford wrote years ago:

“For most Americans, progress means accepting what is new because it is new, and discarding what is old because it is old. This may be good for a rapid turnover in business, but it is bad for continuity and stability in life. Progress, in an organic sense, should be cumulative, and though a certain amount of rubbish-clearing is always necessary, we lose part of the gain offered by a new invention if we automatically discard all the still valuable inventions that preceded it.”

It is the job of physicians like me who see the convergence of cloud computing, genomics, the quantified self movement, social media, electronic medical records, and patient engagement and who also understand how physicians think and work today to integrate these two worlds. I fear we are not doing a very good job of this important task.