Payers, Telemedicine

Highmark Health provides initial stamp of approval for virtual cardiac rehab program

Highmark Health is reimbursing Moving Analytics’ virtual cardiac rehab tool through an innovation program and is expected to roll it out more broadly should the tool lower readmissions and lower costs.

The Movn platform provides virtual cardiac rehab for patients.

Highmark Health is testing the benefits of a digital health product that seeks to provide cardiac patients with a virtual rehabilitation program.

On Wednesday, the Pittsburgh insurer is expected to announce that eligible patients will now be able to use the Movn product and companion app from Moving Analytics to manage their heart health. What’s more, Highmark Health Plan is even reimbursing the digital health product.

“The program is already underway and we are excited by how it
represents a leap forward in the history of virtual cardiovascular
care,” said Moving Analytics CEO Harsh Vathsangam, in an email. “Highmark agreed to reimburse us based on the quality of our
clinical evidence and a prospective analysis showing several million
dollars of cost savings if we were to increase penetration in cardiac
rehab.”

Vathsangam noted that through this program with Highmark, Moving Analytics is pursuing the “first-ever commercially reimbursed virtual
cardiac rehab program through a payer.”

The period of the partnership is 12 months or until Moving Analytics shows statistically significant cost savings (which Vathsangam expects at around 200 patients) whichever comes first. If and when this happens,  Movn will be a covered benefit across Highmark.

Highmark is rolling out Movn through its VITAL Innovation platform. This platform should be of interest to digital health startups because in effect what Highmark has done is to transform its internal innovation program into a commercial offering where startups can validate their products in real-world clinical environments and prove their economic value. The platform falls under the Highmark Health umbrella, which allows it easy access to claims data from the Highmark Health Plan, as well as clinical data from the company’s Allegheny Health Network health system. Highmark covers around 4.5 million members in Pennsylvania, Delaware, and West Virginia.

“In support of Highmark Health’s mission to create a remarkable health experience, freeing people to be their best, VITAL continues to focus on major diseases and early-stage FDA-approved health innovations that show promise for improved diagnosis, treatment and return to better health,” Dr. Anil Singh, Allegheny Health Network (AHN) and VITAL medical advisor, is expected to say in the Highmark Health announcement Wednesday. “By testing Movn, we’re studying a new cardiac rehabilitation delivery system that could significantly benefit our patients and the millions of Americans living with heart diseases.”

Specifically, Movn targets patients with coronary disease, valve disease, or heart failure, or patients who have undergone a cardiac surgical procedure. The product combines evidence-based guidelines, behavioral science, remote monitoring and health coaching to engage patients and encourage them to change behaviors and adopt a healthy lifestyle that in turn is likely to improve outcomes. Patients can access a care management team, and a digital app equipped with user-friendly tools and trackers through Movn.

Ken Rayl, a consultant with VITAL Innovation platform, said in an email forwarded by a Highmark representative, that the objectives of the test include whether the Movn platform will be more cost-effective than the traditional in-person rehab which requires patients to travel to places that offer such medically-supervised rehabilitation.

In providing a remote, digital disease management program, Los Angeles based Moving Analytics is similar to other digital health companies like Omada Health that have embarked on a path of providing clinically-validated tools to lower the cost of chronic diseases while removing barriers of access. The Movn platform has been validated in more than 70,000 patients, according to the company’s website.

“The sorry fact is that only 15 percent of patients today participate in [cardiac] rehab because to do so they would have to visit a hospital 36 times,” Moving Analytics CEO Harsh Vathsangam said in a previous interview after winning the MedCity’s INVEST Digital Health’s Pitch Perfect Contest in the Twin Cities in 2018.

Integrated health systems and hospitals that treat heart failure patients have an added incentive to try new fangled products aimed at helping to improve outcomes for cardiac patients. The Centers for Medicare and Medicaid Services are focused on a Hospital Readmissions Reduction Program that docks reimbursement to hospitals that have high rates of heart failure patients being readmitted within 30 days of discharge. Chronic diseases such as heart disease and heart failure are also expensive to treat and of interest to payers who are hoping to reduce their exposure to such conditions by encouraging members to have healthy behaviors.

Forward-thinking payers and providers are therefore looking for innovative ways to get patients to adhere to rehab programs while removing the obstacles that make compliance hard. Aside from Moving Analytics, there are other companies that are attempting to establish that virtual cardiac rehab works. In August, an article published in the New England Journal of Medicine showed that a remote cardiac rehab program developed by Samsung and Kaiser Permanente showed improved outcomes for cardiac patients in terms of higher program completion rates and lower heart failure hospital readmissions.

For Highmark to deploy and reimburse Movn across its patient population, Moving Analytics has to show economic results.

“In fact, one of the conditions of the VITALS program is that the technology or service already has proven clinical outcomes and the focus is on showing economic outcomes to get broader reimbursement coverage,” Vathsangam explained. “The idea is that there are tons of solutions with clinical evidence but how does one get a solution adopted into broader clinical practice. For this to happen, payer coverage is necessary and for payer coverage, harder evidence around cost-savings is needed.”

And Vathsangam appears to be confident that Movn will deliver those results.

“Our company’s goal is to eventually syndicate this coverage across other Blues [Blue Cross Blue Shield, of which Highmark Health is an affiliate],” he said.

Photo: Moving Analytics