Lab Soft News

@Alt_CDC on Twitter: Resistance to Trump's Anti-Science Propaganda

As part of the resistance movement aimed at the anti-scientific agenda of Trump and his administration, unidentified personnel at the CDC have launched a Twitter account -- @Alt_CDC (see: ‘Alt’ CDC Twitter account joins the resistance). Below are some details from an article about this account and others like it:

“Join the Resistance.”That’s one of the first messages on a newly created Twitter account that says it’s trying to protect the scientific integrity of the Atlanta-based Centers for Disease Control and Prevention. The AltCDC account – like its counterparts set up for other federal agencies that deal with scientific matters – is a reaction to moves by the Trump administration to prevent federal scientists from sharing data with the press and the public. Pres. Donald Trump’s administration moved quickly...to shore up its control over communications with the public and the press, as officials at the Environmental Protection Agency and the U.S. Department of Agriculture e-mailed staff to inform them that they may no longer discuss agency research or departmental restrictions with anyone outside of the agency—including news media. Both agencies also told their scientists and other staff that press releases and external communications about taxpayer-funded work would stop until further notice. It remains unclear if these will be temporary or long-term policies. Nothing on the AltCDC page identifies who is behind the account....AltCDC retweeted a message by a Canadian doctor and drug researcher who recalled that President Donald Trump has expressed the belief – widely discredited – that childhood vaccines can cause autism and other disabilities (see: The Shadow Network of Anti-Vax Doctors). Trump has met with anti-vaccine activists since winning the election.

Trump is aggressively trying to control most of the mainstream media which have now been described as the "opposition party" by his chief strategist, Steve Bannon (see: Trump Strategist Stephen Bannon Says Media Should ‘Keep Its Mouth Shut’). Fox is the approved Trump cable TV outlet (see: Trump says yes to Fox, no to virtually all other TV interviews). He has also assigned two of his young political operatives to run the Voice of America (see: Donald Trump sends two aides to Voice of America studios, raising fears he’s going to politicize the outlet).

The irony relating to the Alt_CDC account is that Twitter also is the favored social media channel that Trump uses post-election as @realDonaldTrump and @POTUS. At the time that this note was written, there were a number of other alternative governmental agency accounts including the following: @alt_NIH, @AltForestService, @alt_fda, @altusda, @AltNatParkSer, @AltHHs, and @Alt_NIH. I am sure that this situation is changing on a daily basis and that some attempts may be made to suppress these resistance Twitter accounts. You may need to search for the ones you are interested in following.

WHO Guidance on HIV Self-Testing; Availability of Test Kits

The World Health Organization (WHO) has issued new guidance on HIV self-testing (see: WHO issues new guidance on HIV self-testing ahead of World AIDS Day). Below is an excerpt from the article:

In advance of World AIDS Day, WHO has released new guidelines on HIV self-testing to improve access to and uptake of HIV diagnosis....The report reveals that more than 18 million people with HIV are currently taking ART, and a similar number is still unable to access treatment, the majority of which are unaware of their HIV positive status. Today, 40% of all people with HIV (over 14 million) remain unaware of their status. Many of these are people at higher risk of HIV infection who often find it difficult to access existing testing services....HIV self-testing means people can use oral fluid or blood-finger-pricks to discover their status in a private and convenient setting. Results are ready within 20 minutes or less. Those with positive results are advised to seek confirmatory tests at health clinics. 

Here is more information about the HIV self-testing options (see: Check Your Status: HIV Home Testing with the Rapid HIV Test):

...[T]there are options for taking an HIV test in the privacy of your own home.The OraQuick In-Home HIV Test [$39.99] and Home Access HIV-1 Test System have been approved by the Food and Drug Administration (FDA). Both are sold at drugstores, but you need to be at least 17 years old to purchase them. Other home tests are available in the United States, but they have not been FDA-approved and may be inaccurate or unsafe.

Below are listed some of the precautions and warnings about the OraQuick HIV test copied from the company web site:

• A positive result with this test does not mean that you are definitely infected with HIV, but rather that additional testing should be done in a medical setting.
• A negative result with this test does not mean that you are definitely not infected with HIV, particularly when exposure may have been within the previous 3 months.
• If your test is negative and you engage in activities that put you at risk for HIV on a regular basis, you should test regularly.

Below are directions about sample collection for the OraQuick test (see: How does the OraQuick test work?):

Swab the inside of your mouth. Place the swab in a tube with a developing solution. Results are available in 20 to 40 minutes. If one line appears, the test is negative. Two lines mean you may be positive. You’ll need a follow-up test from a lab to be sure.

Over-the-Counter FIT Test for Colonic Cancer Looks Effective

A large very number of colonoscopies are performed yearly in the U.S. for cancer screening. For older male non-smokers, colonic cancer ranks with prostate cancer as a major cancer threat (see: Men and Cancer Risk). Here are some specific numbers about the frequency of gastroentestinal endoscopy (see: $4.4 Billion Gastrointestinal Endoscopic Market in the U.S. and Europe Projected for 2020):

Gastrointestinal endoscopy is one of the most widely performed medical procedures in the world. It is projected that there will be over 75 million gastrointestinal endoscopic procedures performed in the U.S. and Europe combined by 2020. The majority of these procedures are colon cancer screenings, the removal of gastrointestinal tract abnormalities, as well as the placement and replacement of enteral feeding. Recent positive publicity for virtual colonoscopy will act as a market driver, likely at the expense of conventional colonoscopy revenues. 

I have suspected that virtual colonoscopies would replace many of the current GI endoscopic procedures at some point but there continue to be definite limitations to the growth of this procedure (see: Virtual Colonoscopy):

[V]irtual colonoscopy may not be as effective as colonoscopy at finding certain polyps. Also, doctors cannot remove polyps or treat certain other problems during virtual colonoscopy, as they can during colonoscopy. Your health insurance coverage for virtual colonoscopy and colonoscopy also may be different. Virtual colonoscopy may not be as effective as colonoscopy at finding certain polyps. Also, doctors cannot remove polyps or treat certain other problems during virtual colonoscopy, as they can during colonoscopy.

The Dark Daily posted a recent article on the consumer-driven market for self-testing kits in which they made mention of the immunochemical FIT screening test for colonic cancer. Below is an excerpt from it (see: Consumers Increasingly Purchase Medical Laboratory Self-Test Kits)

Research published in the Annals of Internal Medicine (see: Fecal Immunochemical Test Program Performance Over 4 Rounds of Annual Screening: A Retrospective Cohort Study) suggests that one of the most common at-home tests—the fecal immunochemical test (FIT) for colon cancer screening—is an effective and suitable alternative to invasive colonoscopy.....Researchers from Kaiser Permanente Northern and Southern California involved 323,349 health plan members in the first of four rounds of FIT. FIT screening detected about 85% of colon cancer cases in the first round and 73 to 78% of cases in follow-up rounds, the study noted. The researchers found that FIT was “highly sensitive for detecting” colon cancer, and that people were more likely to participate, as compared to colonoscopy,,,,

The FIT test uses antibodies to detect blood in the stool and can be performed at home. The test does not require special preparation or medication restrictions and is superior to the use of the fecal occult blood test (FOBT).The guaiac-based FOBT tests have a risk of false positive results related to both red meat consumption and the use of certain medications around the time of sample collection. The FIT test is available on the web at a cost of $29.99 for a two-pack. The test is suitable for home testing and is another example of consumer-driven self-testing (see: Home Colorectal Cancer Test - 2 Pack). Some consumers have an aversion to the stool sample collection required for the at-home FIT but I think that's it's far easier, less expensive, and safer than a colonoscopy.  

Site-Less Clinical Trials as a Possible Means to Democratize Them

Clinical trials have long been criticized on the basis of their lack of racial diversity or impracticality for potential subjects (see: 2016: The Year of Diversity in Clinical Trials). This has resulted in the call for the "democratization" of trials (see: TrialReach And The Democratization Of Clinical Trials). Here's an excerpt from an FDA article about the challenge of reaching a broad swath of subjects for clinical trials (see: 2016: The Year of Diversity in Clinical Trials):

Controlled clinical trials provide a critical base of evidence for evaluating whether a medical product is effective before the product is approved for marketing. One challenge that remains for FDA is ensuring that research participants are representative of the patients who will use the medical product. Moving from the result of a clinical trial to applying it in practice is complex. But it’s generally agreed that the composition of the population enrolled in a trial should help FDA reviewers, clinicians, or policy makers to have confidence that the trial results will apply to future practice. Furthermore, a wide range of people should have the opportunity to participate in trials, both for access to new therapies and to have the chance to contribute to better treatment of everyone, an important altruistic goal for many Americans.

I came across a recent article that discussed how the Center Point Clinical Services, a contract research organization [CRO], has launched a series of "site-less" trials (see: Site-Less Clinical Trial Depends On Pharmacists' Relationships With Patients). Below is an excerpt from it:

[R]ecruitment relies on the Center Point Clinical Trial Research Pharmacists (CTRP), who know a study’s inclusion and exclusion criteria and can share it with potential patients....Center Point also filters health records through a HIPPA-compliant collaboration with pharmacies and health systems. Site-less trials only recruit for one site instead of multiple; they operate remotely but coordinate with health care teams according to trial protocol....“Patients will often see multiple doctors,” says ...[a company spokesperson], “but will stick with one pharmacist, who usually knows his or her patients very well.” Information from wearable devices goes immediately into the cloud and then the study’s database. All information is confidential. ...[He] attributes these patient-pharmacist relationships, emphasizing protocol, compliance, and compassion, for increasing patient engagement. The CTRP “are the glue that hold everything together,” he says.....Center Point became an LLC in 2014 and has performed up to 10 site-less studies...[T]his model is good for “80 – 90%” of trials but works particularly well for trials in which office visits are not needed or can be done remotely. 

The basic idea behind site-less clinical trials is that subjects are remotely managed by a team of pharmacists working for the CRO and by sponsor clinical teams in lieu of the subjects being required to travel to a study site. Information from subjects' wearable devices goes immediately into the cloud and then the study’s database. Such health wearables are revolutionizing clinical trials by acquiring objective information such as subject physical activity (see: The Growing Availability of Wearable Devices: A Perspective on Current Applications in Clinical Trials). I would draw an analogy between telemedicine visits by a physician and the site-less clinical trials discussed here. Clearly, this new approach is not suitable to the more complex studies in which subjects need to be examined by a physician or imaging studies are frequently required. Nevertheless, I think that new idea is an interesting one and I look forward to reading more about it. 

Drug Distributor McKesson Pays Record Penalty For Suspicious Opioid Orders

Drug distributor McKesson will pay a record $150 million civil penalty and also suspend sales of controlled substances from distribution centers in four states over allegations that it has once again failed to detect and report suspicious orders of controlled substances (see: McKesson finalizes $150 million settlement for failure to report suspicious opioid orders). An excerpt from this article is below:

The nationwide settlement also imposes “new and enhanced compliance obligations” on McKesson's distribution system....The latest announcement follows a 2008 settlement in which McKesson agreed to a $13.25 million civil penalty and committed to come up with an “effective system” to detect and report suspicious orders for controlled substances distributed to its independent and small-chain pharmacy customers. The Justice Department says McKesson designed a compliance program but failed to fully implement or adhere to it, resulting in the latest penalties. Under the new agreement, McKesson must hire an independent monitor to assess its compliance. This is the first time the government has required such a monitor in a civil penalty settlement related to the Controlled Substances Act....Woonsocket, R.I.-based drug store chain CVS Health and distributor Cardinal Health have also settled similar violations with the federal government. Cardinal also settled with the state of West Virginia earlier this month to resolve allegations that the company failed to maintain adequate controls to prevent the diversion of opioids.

Everyone probably knows that we are in the middle of a crisis regarding the abuse of opioids. Here is a brief paragraph summarizing the problem from the CDC (see: Drug overdose deaths in the United States continue to increase in 2015):

Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses....We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.

I don't think that there has been sufficient attention to the role of drug distributors like McKesson and Cardinal Health (see: Cardinal Health fined $44 million for opioid reporting violations) as well as retail pharmacies like those of CVS (see: CVS to Pay $3.5 Million to Resolve Allegations that Pharmacists Filled Fake Prescriptions) in our opioid crisis. Just business as usual. Here are more details about the key role of drug distributors in the opioid epidemic from a former DEA agent (see: DEA targets drug wholesalers to stem opioid epidemic):

"In 2014 almost 19,000 people died from opioid overdose -- and we're not talking about heroin," said Joe Rannazzisi, who was with the DEA for 29 years. He said wholesale distributors play a huge part in the epidemic....If a pharmacy was ordering 5,000 tablets per month, over a series of months, that's not a big deal. But one month he orders 30,000 tablets. And then the following month, he orders 60,000 tablets, and now he's up to 100,000 tablets. Well, the wholesalers were seeing this and no one was...[reporting] suspicious orders [to the DEA] ." 

Self-Collected HPV Testing for Cervical Cancer Screening

HPV infection is the cause of cancer of the cervix (see: HPV and Cancer). Here's a short quote from the National Cancer Institute about the etiology of this neoplasm: Virtually all cases of cervical cancer are caused by HPV, and just two HPV types, 16 and 18, are responsible for about 70 percent of all cases. Cytopathologists have long known about this association and kept it in mind when screening cervical specimens. Here's another quote from the NCI addressing the relationship between Pap tests and HPV testing:

HPV testing is used to look for the presence of high-risk HPV types in cervical cells. These tests can detect HPV infections that cause cell abnormalities, sometimes even before cell abnormalities are evident....Most [HPV] tests detect the DNA of high-risk HPV, although one test detects the RNA of high-risk HPV. Some tests detect any high-risk HPV and do not identify the specific type or types that are present. 

Because of this correlation between HPV and cervical cancer, some researchers have been addressing the value of self-collected HPV specimens for cancer screening (see: Self-collected HPV testing viable option for cervical cancer screening). Below is an excerpt from an article on this topic:

Although cytology-based screening has helped reduce the percentage of cervical cancers, it often must be repeated to help identify underlying abnormalities that eventually could prove to be cancerous. HPV testing has demonstrated greater specificity and sensitivity than cytology-based screening for identification of precancerous lesions, according to study background. HPV testing also has the advantage of self-administration, as women can collect necessary samples themselves in a noninvasive manner and likely at reduced cost. Carolina Porras...and colleagues performed a secondary analysis of a large Costa Rican HPV vaccine trial to determine whether self-collected HPV samples could detect cervical intraepithelial neoplasia grade 2 or higher...and do so with the same accuracy as HPV tests administered by a clinician....The similar performance of the self-collected and the clinician-collected HPV test for detection of prevalent and incident disease indicate that this could represent an invaluable tool for improving screening coverage,” the researchers wrote. “Our data indicate that PCR HPV testing on a self-collected sample is feasible and well-accepted and provides sensitivity and specificity comparable with clinician-collected specimens. In addition, it detects disease earlier than cytology and should be considered in cervical cancer screening programs to reduce cost and improve coverage.”

As noted above, PCR HPV testing on self-collected samples seems to be an effective way to screen for dysplasia and cancer of the cervix and may detect these conditions earlier than cytologic examination. This made me wonder about the availability of such testing on the web. I then discovered the At Home HPV Test Kit with a vaginal HPV test costing $79. The company also offers a variety of STD tests for both men and women including tests for chlamydia and gonorrhea. I can't vouch for this company -- I only make reference to it as an example of HPV and STD testing on the web using self-collected specimens. I think that self-testing generally requires out-of-pocket payment whereas physician-initiated testing would be covered by health insurance. A physician visit also provides the opportunity for immediate treatment. Self-testing does offer privacy and this will be a viewed as an advantage by some. 

Entrepreneur Develops Combined Database of Medicaid Patients and Treatments

A recent article in the New York Times discussed the work of a young entrepreneur in the development of a  consolidated Medicaid database based in the cloud (see: Medicaid’s Data Gets an Internet-Era Makeover). It reminded me of how much work needs to be done in the development of such critical healthcare databases including those at the hospital level (see: More Hospitals Buy Clinical Data Warehousing Apps). Below is an excerpt from the article: 

Jini Kim, a Nuna founder,...working with the federal government, has built a cloud-computing database of the nation’s 74 million Medicaid patients and their treatment. Medicaid, which provides health care to low-income people, is administered state by state. Extracting, cleaning and curating the information from so many disparate and dated computer systems was an extraordinary achievement, health and technology specialists say. This new collection of data could inform the coming debate on Medicaid spending. Andrew M. Slavitt, acting director of the Centers for Medicare and Medicaid Services, described the cloud database as “near historic.” Largely because Medicaid information resides in so many state-level computing silos, Mr. Slavitt explained, “we’ve never had a systemwide view across the program....The data set will be stripped of identifying information before it is released to researchers. 

Here's some interesting information about why Medicaid data is so important (see: The Power of Medicaid Data):

In 2014, Medicaid covered ~80 m low-income Americans

Largest insurer in USA (by beneficiaries)

~2.8% of GDP

~50% of all births

~50% of total expenditures on long-term care

~16% of total healthcare spending

It's interesting to me that it took a young entrepreneur, Jini Kim, to hatch and execute the idea to aggregate all of the state-based Medicaid databases. Why had this idea not thought about previously by perhaps someone in the federal government? Kim was a former Google employee and perhaps this project required someone well versed in cloud and database technology. As the NYT article noted, " ...the new cloud-based technology, using internet-era software, is flexible and interactive. It opens the door to real-time monitoring of [Medicaid data such as] emerging disease clusters, billing patterns and program effects. For example, did the percentage of low birth-weight babies decline after a Medicaid program was put in place?"

Does it Make Sense for Hospital Executives to Sell Their Lab Outreach Operations?

Hospitals have been selling their lab outreach operations for a number of years, mainly to the two large national reference labs, Quest and LabCorp (see: LabCorp to Acquire Assets of Mount Sinai Health System Clinical Outreach Laboratories). A recent article in CAP Today raised the issue of whether hospital executives understand the true value of their lab outreach programs and may even be undervaluing these properties when selling them (see: Is the value of hospital lab outreach underrated). Below is an excerpt from the article:

Hospitals across the nation have been selling their laboratory outreach operations to national laboratories, which have been snapping them up from community hospitals and larger enterprises ....Management executives at many hospitals and health systems have said their impetus to sell is to focus on what they consider more profitable parts of their operations. And observers say such transactions are likely to continue. But what if it turns out that selling those laboratory businesses means their owners are actually selling them short?....According to data Chi accumulated through its industry surveys, in 2013 the average outreach program enjoyed $58.33 of revenue per requisition (compared with slightly more than $44 apiece for both Quest and LabCorp); annual revenue growth per requisition of 5.3 percent (versus a 4.3 percent decline and a one percent dip for Quest and LabCorp, respectively); and a profit margin of 28 percent per requisition (compared with less than 19 percent for Quest and less than 16 percent for LabCorp). And outreach has grown significantly over the years.....[M]any hospitals simply book their gross revenues without looking at outreach-related net revenues. That’s exacerbated when it comes to billing, as laboratory is often mixed with other services such as x-rays.....[B]y not breaking them up and understanding what their real profitability is as part of the institution as a whole,...[lab outreach operations] can be undervalued....Not only does this suggest hospitals may be misjudging the need to sell their outreach, but they lack the data necessary to negotiate a strong sales price.

None of the points made in this article were surprising to me. Hospital executives may not understand how significant their outreach programs actually are for their bottom lines. However, I also think that a larger issue is that some executives are not that interested in their diagnostic units, particularly the labs. They have a better appreciation and understanding of direct patient care operations and can therefore justify spin-offs of lab outreach on the basis of the programs being not profitable. Selling hospital labs to a reference lab may also be a strategy for addressing persistent lab management and quality problems. In a previous post about outsourced diagnostic services (see: Value-Based Healthcare Will Drive Outsourcing of Hospital Diagnostic Services), I made the following point:

Hospital executives will have a near-total focus [under value based care] on the delivery of clinical services as opposed to ancillary [i.e. diagnostic] services. Although critical in diagnosing and monitoring disease, diagnostic services remain tangential to this view of the role of the hospital. In the movement from fee-for-service to value-based care, there will no longer financial incentives to encourage the use of radiology and lab services which in the past have made major contributions to the hospital bottom line.

I personally believe that hospital executives who outsource or sell their outreach operations may be losing sight of the quality implications of such an initiative. I don't believe that outsourcing lab operations to a national lab reference lab will necessarily result in higher quality lab testing for hospital physicians. Of course, while all of this is occurring, we also are experiencing a trend toward hospitals going out of business or being acquired by larger ones. There is also a trend toward "bedless" hospitals which I discussed in a recent blog note (see: Some Additional Ideas About the Bedless Hospitals of the Future). As described, there is another strategy that comes into play for providing lab support for these acquired hospitals or all hospitals in a single system:

Under pressure from MACRA, some large health systems will consolidate/insource their lab operations and testing to their own central labs. With economies of scale, these centralized labs will be able to perform most esoteric testing with few remaining send-outs such as some genomic and molecular tests. Some of these large health system centralized labs will be located in bedless hospitals.

Telemedicine as a Tool for Physician Visits in Senior and Assisted Living Facilities

Delivering physician services to residents of senior and assisted living facilities has always been challenging, particularly in smaller facilities. The patients are older with multiple chronic conditions. Many have limited financial support. A recent article discussed the use of telemedicine as an "instant" link to patients in these settings (see: Telemedicine Gives Long-Term Care Facilities an Instant Link to Healthcare). Below is an excerpt from it:

Telemedicine platforms like Signature Healthcare's YourDoc2U are reducing costs and improving outcomes in senior and assisted living facilities across the US. A telemedicine platform launched by a Kentucky-based long-term healthcare system is poised for growth after officials say it helped one facility decrease costs by 30 percent. YourDoc2U, a startup created in 2015 by executives at Louisville-based Signature Healthcare, is now being used in 40 Signature LTHC and rehabilitation centers in four states....The company is following a tried-and-true business model for telemedicine platforms in senior, assisted living and long-term care facilities: Set aside a kiosk or room with a secure, private audio-visual connection, provide a mobile cart with devices that can capture a patient’s vital signs and transmit them securely, then connect on the other end to a clinician who can conduct a real-time virtual visit. A separate connection allows family members to listen in on the visits. The telemedicine cart can also be moved to a patient’s room if the patient is incapacitated. Dorian Goodman, who oversees 12 Signature LTHC facilities in Tennessee and Kentucky, said one 128-patient center saw a roughly 30 percent increase in profits using the telemedicine platform, primarily through reduced transport costs and better medication management. He said the platform is especially helpful for patients with conditions such as pulmonary disease and dementia, as well as those which might require specialist care and transport to and from a distant hospital.

Here is a list of possible benefits of telemedicine for senior care facilities (see: Should your facility try telemedicine?)

• Improved access to care
• Competitive advantage
• Better risk management  
• Regulatory compliance
• Increased revenue

As the first link above emphasizes, it's important to have a kiosk or room in the facility with a secure, private audio-visual connection and a mobile cart with devices that capture the patient’s vital signs and transmit them securely. In many telemedicine scenarios, patients will be of relatively low acuity or known to the physician or nurse practitioner so observation of vital signs may not be necessary. With older and chronically ill patients in long-term care facilities, it's critical for the remote physician to have access to the patients' vital signs.

It's interesting that the excerpt above cites about a 30% increase in profits for facilities with telemedicne platforms. In previous blog notes about telemedicine (see: Xerox Enters the Rapidly Maturing Telemedicine Business), I emphasized the financial advantage of a telemedicine program for health systems. Here's an excerpt from that note:

There have been a number of bullish signs that telemedicine is reaching a critical mass such that larger hospitals without a program may start to feel anxious. This anxiety may also become more acute in the face of federal cost reduction programs because telemedicine provides a way to increase patient services without investing in bricks and mortar. I have been blogging about telemedicine for years but it has remained a marginal form of healthcare delivery until recently.

Obviously, long-term care facilities already have made their investment in bricks-and-mortar. However, it can be expensive for physicians to travel facilities for, say. one patient with acute problems. Hence the emphasis on the increased revenue resulting from a telemedicine program discussed above. For long-term care chains, I suspect it would make sense to hire a physician to provide telecare visits to residents across multiple facilities.

United Healthcare Expands Its Wellness Program Using Activity Trackers

There's no question is my mind that most health insurance plans will soon offer some sort of a wellness program with a rebate to insurance holders for healthy behavior, most notably exercise. A recent article provided details about UnitedHealthcare's mHealth program (see: UnitedHealthcare Announces a Huge Expansion of its mHealth Program). Below is an excerpt from it:

An mHealth program launched by one of the nation’s largest insurers that pays employees for meeting activity goals is getting a huge upgrade. UnitedHealthcare announced...that it is expanding its Motion wellness program to 40 states and opening up the digital health platform to accept more activity trackers – including the Fitbit Charge 2 - through a “bring your own device” model.....Running on Qualcomm Life’s 2net hub, UnitedHealthcare Motion enables businesses to track employees’ step counts throughout the day as they work toward three separate goals, known as F.I.T. goals. F.I.T. stands for frequency (six five-minute sessions per day, at least one hour apart, of at least 500 steps), intensity (3,000 steps within 30 minutes) and tenacity (10,000 total steps in a day). Employees taking part in the program can earn up to $4 a day in deductible costs if they meet those goals, or as much as $1,460 in a year....The growth of UnitedHealthcare Motion showcases the value of providing companies and their employees with personalized, connected health and wellness resources....Wearable technology can help encourage employees to walk each day and earn financial rewards at the same time, using secure technology that we believe is intuitive and convenient....UHC tacked on a $40 registration credit, giving employees that extra little momentum and bringing the total savings up to $1,500. The second point ties into the popularity of....[T]he activity tracker market [is very popular] – more than 13 million wearable fitness and activity trackers are expected to be incorporated into employee wellness program by 2018....

Plans like mHealth provide an opportunity for consumers to push back on the rising cost of health insurance, particularly high deductible plans (see: High Deductible Health Insurance Plans; Discount on Initial Services?; High Deductible Health Insurance Plans Becoming the Norm in Large Companies; High Deductible-Health Plans Causing Hospital Billing Problems). Of course, the rebates now being offered with wellness plans mean that the cost for the insurance is less because the policy holder is getting healthier and using fewer services.

I have come to the conclusion regarding wellness programs that, first, the most effective way to convince consumers to lead healthier lives is to pay them in some way to do so. The rebates of mHealth accomplish this goal. My second conclusion is that, for most people, the best way to achieve fitness is through a walking program (see: Walking: Your steps to health). mHealth achieves both of these goals with rebates and with the use of the Fitbit wearable, which allows logging of the distance walked by the policy holder to qualify for the rebate.

The Fitbit Charge 2 costs at least $150 on the web so it's understandable that the mHealth program requires those who enroll in mHealth to BYOD -- bring your own device. As the cost of these wearables and the value of the program increases, I can see a future where the insurance company lends or gives the consumer the device but this may take a while to occur. This wellness program is analogous to automobile insurance discounts in exchange for monitoring driving habits (see: Auto insurance discounts and monitoring). The companies need some sort of foolproof record of events in order to offer the discount.

One feature available on the Fitbit Force 2 that caught my attention was guided breathing (see: Fitbit’s New Guided Breathing Experience). This is a good example of how some forms of alternative medicine such as yoga and meditation are now achieving mainstream status. Breathing exercises have been shown to lower blood pressure (see: How to Use Breathing Exercises to Lower Blood Pressure).