Insurer's App Aims to Lower Healthcare Costs, Securely

Aetna will allow patients and providers to communicate directly via a mobile application that protects data privacy and indicates when care options are high cost, out of network, or present challenging payment arrangements.

If you have any doubt that leading mobile health apps are about to become a whole lot more important to providers, let Aetna's iTriage set you straight.

Aetna's application developers are preparing to allow patients and providers to directly communicate with each other in a new version of the iTriage app due to hit the streets in the next two months.

The new version, first revealed in a post-HIMSS video by Pat Salber, MD, uses the Direct protocol to solve a major usability problem with doctor/patient communications today.

That problem has to do with the fact that email is inherently not a secure medium. Due to the constraints of HIPAA, physicians cannot use ordinary email to communicate any protected health information to patients, nor to receive PHI from patients.

Instead, patients must log into secure Web portals to send and receive PHI to doctors. This personal data can be anything from test results, to changes in their treatment, to medical advice.

In the fee-for-service world, this mattered little, because email consultations were not billable events. In an accountable care world, the physician is incentivized to keep the patient healthy, while at the same time keeping costs low, including minimizing office visits, as well as enhancing patient satisfaction.

There's nothing very satisfying about a secure Web portal from a user experience standpoint. But apps such as iTriage are hot. In the iTunes app store alone, it has more than 70,000 reviews, an unheard-of number, even for game apps, according to iTriage co-founder and chief medical officer Wayne Guerra, MD. In all, more than 8 million people have downloaded iTriage to enter their symptoms and be directed to appropriate medical help.

So, the next release of the app, which was acquired by Aetna in 2011, will connect those questioning patients directly to their doctors, (if the doctors' health plans enter into agreements with iTriage). No more tedious logging into secure Web portals. Now, answers will be available with a couple of smartphone gestures.

It's not just a boon for patients. The app also helps providers meet a Meaningful Use Stage 2 requirement that a small but significant amount of data shared between patients and providers be secure. "Even five percent is a huge task, if no one's going to your portal," Guerra says.

Guerra tells me that iTriage has a letter of intent with Pennsylvania-based Geisinger Health System to manage a population of 100,000 Medicaid lives through this new app. Another Medicaid population in Delaware will see iTriage through the Delaware Physicians Network. More deals are in the works, he says.

Once iTriage identifies the patient, based on group number and member ID, recommended care starts to tackle the cost side of the equation as well. The app will continually reinforce when care options are higher cost, out of network, or face challenging payment arrangements, says Peter Hudson, MD, co-founder and CEO of iTriage.

"What we've found is when we offer lower-cost care, right on that screen, the utilization of higher-cost care, emergency department care, goes down 40 percent, because you have this great, contextual approach to your provider service," Hudson says.

iTriage's founders have been attracting a lot of attention in high places. First Lady Michelle Obama asked them to join her during February's State of the Union speech.

"The most disruptive thing in the history of medicine is for the consumer to be engaged in the knowledge of medicine, the knowledge of treatment, understanding the ecosystem, having a better dialogue with their doctor," Hudson says. "I think it has the ability to be a blockbuster drug."

As if that weren't enough, iTriage will soon be able to check multiple symptoms. When a patient enters a symptom, such as lower abdominal pain, and then their gender and age, the most common medical conditions for lower abdominal pain for that patient profile show up right on the patient's mobile device.

The change will be all the more dramatic because iTriage leverages the power of cloud computing to render a response quickly. Most of the computation is not happening on the smartphone or tablet. It's happening in the cloud, on a cluster of powerful servers.

Users can add other symptoms for a more refined—dare I call it this?—diagnosis. There's also an element of big data to this, because the new version relies upon the National Ambulatory Medical Care Survey, a surveillance survey from the Centers for Disease Control, to determine the probability of a symptom being related to a disease for a certain age group, using Baysian statistical methods.

This is an exercise in technological force multiplication and disruption. The cloud is a transformative technology. Big data is another one. Mobile technology is a third. And adding secure, private communications to healthcare—something that's been cumbersome at best, and more often impractical—makes for a fourth.

If you doubt that this sort of innovation is turning heads, this may help you see the light: I am writing from the first-ever industry-wide healthcare tech investor conference, HealthBeat 2013 in San Francisco. The halls are teeming not with patients, and not even with doctors or tech geeks, but with investors.

Some of their portfolios are already bulging with energy and "clean tech" investments, now they seem to finally understand the urgency of tackling the healthcare tech problem once and for all.

This week, they're busy learning about ACOs, bundled payments, and meaningful use. The conference has the feel of another inflection point for healthcare technology—the moment that Silicon Valley's deep pockets and brain trusts really get it.

It could have the makings of another bubble. There's already dire talk here of a coming implosion of physician practices, of hospitals closing due to the unsustainable waste, and of the slow reactions of many healthcare systems.

It may not be pretty at times, but we need this transformation to speed up.