Startups, Payers

Cardiogram signs first reimbursement deal with Oscar Health

If Cardiogram’s technology highlights a potential issue of atrial fibrillation or diabetes, patients will be given free access to what the company calls a “gold standard” diagnostic test to confirm the results. 

Digital health startup Cardiogram, which uses wearable optical sensors on wearables to detect health conditions like diabetes and atrial fibrillation, has signed its first reimbursement deal with upstart insurer Oscar Health.

The new partnership is built on the back of clinical validation results for the company’s DeepHeart deep learning algorithm. In a 2018 study done in collaboration with UC San Francisco, the company was able to detect diabetes in patients with 85 percent accuracy.

In order to take advantage of the benefit, an Oscar Health member would need to have their own Apple Watch, Garmin or Android wearable which can be linked to the Cardiogram app for passive health monitoring.

If Cardiogram’s technology highlights a potential issue of atrial fibrillation or diabetes, patients will be given free access to what the company calls a “gold standard” diagnostic test to confirm the results.

This takes the form of a diabetes blood draw test done at a local diagnostics center or an at-home patch-based EKG monitor. If this test is positive, Cardiogram then will link the patient to their PCP for a follow up appointment or find a doctor in network for follow up care.

Cardiogram co-founder Brandon Ballinger said the confirmation test is a key part of the Cardiogram Care model and was introduced in part to address concerns about false positives.

“The algorithm isn’t enough on it’s own, we don’t just want to alert people and send them to the emergency department,” Ballinger said.

The deal also represents first reimbursement deal between Oscar Health with a digital health provider and works much like a traditional relationship between a health plan and a provider.

If Cardiogram is successful in diagnosing a condition through its program then it files a medical claim with Oscar Health for reimbursement.

The service is offered at no cost to Oscar Health members and claims from Cardiogram will not be subject to a member’s deductible.

Moving forward Ballinger said the company expects to add a few more payer partnerships by the end of the year as well as additional device integrations.

Insurers have increasingly looked at using consumer wearables as part of their strategy in risk stratifying their membership pool and shifting patients toward preventive health.

One key recent example has been the partnership between Apple and Aetna on their Attain Apple Watch app, which allows users to set personalized goals, track activity levels and recommends healthy behaviors and actions.

Picture: Cardiogram