by Luke Shulman

Is this the wearable revolution? Apple Watches to Aetna

Many in the Heath IT (HIT) community are abuzz on a report from CNBC that Aetna and Apple are in discussions to roll out Apple Watches to all 23 Million Aetna customers.

Much of the initial reaction has focused on two things. First, from a purely tech market perspective, this could re-energize the wearable market that failed to explode when Apple introduced the watch in 2015. Second, we are seeing a continuing refrain that there is little to no scientific consensus that wearables, step counting and the like improve health outcomes or wellness.

My reaction to this was very different and I want to offer an alternative take to this news.

Visible Physical Engagement

One of the major identified challenges with Accountable Care Organizations (ACOs) is member churn where patients are attributed in and out of the population before any intervention can be effective or any meaningful progress achieved. Contrast that with the smartphone which is the most potent tool for engaging a consumer ever invented. While the Apple Watch may or may not make someone healthier and may or may not have a killer feature that everyone needs to have, every patient given an Apple Watch has to have a phone. Presumably, the Aetna or ACO app is on that phone. This tool creates an engagement channel to drive enrollment, engagement, and attribution for years, not months.

With great power comes great responsibility, simply having a presence on each member’s phone isn’t going to matter if the member can’t do anything to engage with you. Smartphone and wearable apps are only useful if they are helpful. The right organization to capitalize on this makes it simple to schedule an appointment or answer a question. Taken together this adds up to engagement, engagement leads to attribution, attribution means revenue will continue to flow uninterrupted. Are there opportunities to also influence health and outcomes? Sure, but most high-cost patients eventually regress to the mean, some low-cost patients eventually have accidents and illness. The win for an insurer and an ACO is to have a patient engaged and enrolled long enough to capitalize on the population trends.

Interoperability Catalyst

Again, this isn’t really about the watch specifically but it allows Aetna and Apple to further push for the smartphone ecosystem (no Apple watch works without an iPhone) to be a critical source of patient health data. This patient data source could be in opposition to the EHR or in concert with the EHR again depending on the organization involved.

As has been reported, Apple’s software framework for healthcare dubbed HealthKit has long been built with EHR interoperability baked in. This can’t be reported on enough but every iPhone has a built in HL7 Clinical Document Architecture (CDA) Reader. You can see it Apple’s own documentation. FHIR and other standards also won’t be far behind if they gain adoption.

Aetna knows their claims information is insufficient for advanced use cases in population health. They want more comprehensive clinically derived data set. They maybe can look ahead and see ACOs that don’t process claims at all. On the flipside, they can’t integrate with thousands of EHRs across hundreds of vendors. They can ask their members to allow their smart phones to send information. The same way every other app on the phone sends information to your service providers from Facebook, Google, Uber etc.


Do Apple watches promote health? Maybe, maybe not. Author Note: I wear an Apple Watch and I do think it helps. It is clear to me that broad deployment of these devices moves Aetna and any other insurer/ACO into the driver seat to engage the patient and begin to influence their health through an always on, super addictive, mobile device

Update 8-16 Right has I hit publish, rumors circulated that new Apple Watches would have their own standalone cell connections. While the watch would be able to make calls or stream music on its own, I still think its unlikely that the watch still won’t rely on the phone for critical set-up, ongoing configuration, and notifications similar to how the Series 2 Apple Watch works currently. Reports surfaced on CNBC, Bloomberg and 9to5mac