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Pager-Horizon BCBSNJ Agreement Looks to Shake Up the User Experience

Mary Caffrey
While many payers, and the Blues in particular, have invested in digital health startups, a new agreement will pair Horizon with a company whose philosophy rejects the operating mentality of most insurers.
Pager, the app once called the Uber of healthcare, has formed a partnership different from the alliances that have cropped up lately in digital health: the partner is not Apple or Google or a pharma company, but a payer.

Last week, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) and Pager announced an agreement that will allow Horizon members to use Pager’s single-entry point to schedule appointments, find specialists, or meet other needs–without flipping through directories or sitting on hold.

In doing so, Horizon BCBSNJ becomes the first of the Blues to reach a care delivery agreement with Pager, and the first publicly announced payer as well, although Pager officials said other partnerships are coming. In a statement, Horizon BCBSNJ described the agreement as a “milestone” for both sides, saying “it marks a critical investment in its digital strategy and a commitment to a consumer-centric member experience.”

“They are very much our partner and anchor customer,” said Sander Duncan, vice president for business development at Pager, in an interview with The American Journal of Managed Care®.

Horizon is hardly first payer to pursue a digital strategy, and in fact the Blues have been among the most active investors in digital health startups that manage or prevent diabetes or provide automated cognitive behavioral therapy. Kaiser Permanente, Anthem, UnitedHealthcare, and others have also invested heavily in building mobile platforms.

What makes this partnership different is Pager’s origins as a venture designed to be the opposite of what health systems have been for decades–giant enterprises that made patients adapt to their rules. Instead, Pager made its name with an orientation toward the consumer, even bringing back the house call in some cases.

Pager’s early days of telemedicine and matching patients with specialists operated entirely outside the insurance system, but as it evolved, scaling from tens of thousands of patients to millions meant that had to change, said Duncan.

However, “Our mantra remains simple access to care,” he said. The things consumers dislike about insurers–the hassle of having to figure out if a doctor or a specialist is “in network” to avoid paying more out of pocket, and having to do all the legwork themselves–are the very things Pager aims to solve with a few clicks on a smartphone, he said.

For Horizon BCBSNJ, the need for something like Pager arose with the creation of the OMNIA tiered health plan, which offers substantial savings in both premiums and out-of-pocket expenses for patients who use doctors and hospitals in the preferred tier. In an e-mail, Horizon said the product will be tested in-house before an initial rollout to a small group of commercial enrollees.

Since the first generation of Pager made its mark in New York City and San Francisco, one question is obvious: Did a Horizon executive staying across the Hudson River give the service a try?

Duncan confesses that’s exactly what happened, and for privacy reasons he can’t say who it was. It took a long time and plenty of due diligence for that positive experience to translate into a deal, he said, but “it doesn’t hurt to have a decision maker love your product.”

Pager’s technology connects the patient to a broad array of resources–payer claims databases, electronic health records, and ultimately a nurse who has the job of triaging what the patient’s complaint is and making a decision. Sometimes it will be a telehealth visit, sometimes it will be a social worker. Pager can be programmed to send transportation to the patient if the partner desires.

While the tool makes use of artificial intelligence (AI), it’s not a replacement for the trained professional. “AI works in tandem with the human nurse to make a care decision–it allows the nurse to give the patient a more personalized experience, to ask tailored questions,” Duncan said.

Working with a payer has possibilities beyond connecting patients with resources that exist today. Care coordination, obesity counseling, and diabetes prevention functions that are done by phone or as separate apps can included in the platform. Most likely, Duncan said, Pager would form partnerships with existing providers who already meet reimbursement standards in those areas, and fold them into the existing program.

In the joint statement, Pager praised Horizon BCBSNJ for taking this step.

“Horizon is on the forefront of payers investing in superior member experience and it is leading the transformation of healthcare in New Jersey through the OMNIA Alliance. Pager will be focused on helping drive this vision, ultimately increasing member satisfaction while lowering the costs of care.” said Gaspard de Dreuzy, Pager co-founder and president.

Terms of the deal were not disclosed.

 

 
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