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John Hancock Has a Not-So-Secret Weapon for Tracking COVID-19

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What You Need to Know

  • The data sources that power wellness programs can also pick up signs of infectious disease outbreaks.
  • Changes in heart rates and step counts tend to show up before COVID-19 symptoms.
  • Some of the same devices that record the heart rate data could also record blood oxygen levels.

John Hancock has a high-tech health incentive program that helps it encourage life insurance policyholders to take good care of themselves.

Today, the health information the program collects could, in theory, give John Hancock a kind of data window it could use to watch the COVID-19 pandemic sweep across the world.

John Hancock and Vitality USA, the companies behind the health incentive program, also have tools they might be able to use to try to protect consumers against the pandemic. Some employers with Vitality USA programs, for example, are sending the highest-risk people in the program blood oxygen level meters, to help them tell the difference between when it’s time to drink chicken soup and when it’s time to head to the hospital.

John Hancock is not yet actively using its version of the program, the John Hancock Vitality Program, to track the pandemic, and it’s not currently using the program to direct extra resources to high-risk insureds. But Brooks Tingle, CEO of John Hancock’s John Hancock Insurance unit, said in a recent interview that he’s happy his company has the Vitality program in place now.

“We’re finding it to be the right kind of solution for this time in history,” Tingle said. “COVID is kind of an interesting proof point.”

Tal Gilbert, CEO of  Vitality USA, said his company and its clients can now use the data they’re collecting to get a unique perspective on COVID-19 risk factors, as well as to know whether the participating consumers are exercising regularly, buying fresh fruits and vegetables at the supermarket and getting their checkups.

One finding Vitality program managers have noticed: 65-year-olds who exercise four times per week have about the same level of COVID-19 mortality risk as 45-year-olds who exercise just once per week.

Program Basics

John Hancock probably operates world’s most widely publicized Vitality health incentive program.

Vitality USA is a Chicago-based arm of Discovery Ltd., a large life and health insurer based in Sandton, South Africa. Years ago, when Discovery operated in the United States under the name Destiny Health, it helped pioneer the ancestors of today’s health reimbursement arrangement programs. Later, it sold the personal health accounts business and focused on bringing the Vitality health incentive program to the United States.

Vitality USA powers health incentive programs at many U.S. companies in addition to John Hancock, including CVS Health’s Aetna unit, the Walgreens drug store chain, and large employers.

John Hancock is a 158-year-old, Boston-based life insurer and financial services company that’s  now part of Manulife Financial Corp. of Toronto.

John Hancock once worked, alongside other life and health insurers, to fight tuberculosis, influenza and other communicable diseases.

The company began trying to fight obesity, diabetes, stroke and heart disease by offering its version of the Vitality program in 2015.

Today it offers two Vitality program tracks.

The basic track, John Hancock Vitality Go track, lets any consumer with John Hancock life insurance get access to personalized wellness tips and discounts on healthy foods and wellness-related equipment.

The other level, the Vitality Plus track, is aimed at John Hancock policyholders who take a more intensive approach to wellness. It provides a Fitbit or Amazon Halo wearable device for no out-of-pocket cost; lets a participant who meets strict wellness program standards reduce the out-of-pocket cost of an Apple Watch to as little as $25 plus tax; and lets participants who meet wellness program participation goals, and health goals, cut the cost of their John Hancock life insurance premiums by as much as 15%.

A guide aimed at agents gives an example of how one policy owner achieved “Gold status” and a high level of incentive program rewards.

The participant filled out an online health review; submitted normal blood pressure, cholesterol, blood glucose and body mass index statistics from an annual physical; continued to refrain from using tobacco and completed a physical activity review.

To get an Apple Watch, a policyholder in the program pays $25 plus tax up front, then pays the rest of the bill in monthly installments over two years. If the participant exercises enough, the Vitality program can reduce the monthly payments to $0, according to John Hancock.

The company made the Apple Watch Series 6 and the Apple Watch SE wearables available through the program in October 2020. The Series 6 model can measure a user’s blood oxygen level and conduct an electrocardiogram.

Program participants do use wearable devices to document exercise levels, by sending heart rate information to Vitality program managers.

The Impact on John Hancock, and Agents

Originally, John Hancock offered the Vitality program only to new policyholders but opened it up to all policyholders in 2018.

The policyholders who do participate tend to be more active people, and the Vitality program itself tends to make participants more active, Tingle said.

Because of those factors, the program participants take about twice as many steps per day as the non-participants, and are more likely get preventive screenings, he said.

The average age of a John Hancock Vitality Program participant is only about 42 to 44, and one encouraging sign is that, as of early December, no program participant had died from COVID-19, Tingle said. (Most people who die from COVID-19 tend to be over 65 years old.)

Tingle said he thinks a life insurer like John Hancock is the natural sponsor of a program like the Vitality program, because it forms relationships with policyholders that often last for many decades.

“We’re not trying to turn our customers into marathon runners,” Tingle said. But, in the long run, he said, persuading insureds to eat better, move more and get their health screenings is bound to pay off.

John Hancock presents the Vitality Plus program to agents as something that can appeal to affluent prospects, who tend to place a high value fitness and may enjoy some of the travel-oriented discounts and perks the program offers, such as hotel discounts.

The Internet of Bodies

John Hancock and Vitality have not been using Apple Watch blood oxygen data or Apple Watch cardiogram data to run the health incentive program.

But, because the companies are using heart rate data from digital devices to verify exercise levels, they are part of the ”Internet of Bodies” — efforts to connect people’s bodies to the internet through biometric sensors and other devices.

Andrea Matwyshyn, a professor at Penn State University’s law school, used the term “Internet of Bodies” in a widely cited paper published by the William & Mary Law Review in 2019. She focused mainly on the legal issues involved with connecting human bodies to the Internet

Xiao Liu of McGill University and colleagues then wrote in another widely cited paper, for the World Economic Forum, that the Internet of Bodies could lead to insurers discriminating against people in unfair ways.

Vitality says the kinds of internet-powered health incentive programs it runs help people and society as a whole, not just insurers.

In South Africa, Vitality has about 400,000 active participants in its exercise incentive program, and those participants have increased their number of physical activity days by 39%, Vitality says.

But the sensitive nature of the Internet of Bodies may put constraints on what insurers can do with digital devices and health incentive programs.

Vitality has focused mainly on talking about what its program can do for the well-being of the health incentive program participants themselves.

COVID-19 Uses

Oracle Corp., the business software company, reported in June 2020 that some insurers were already collecting streams of COVID-19 data from wearable devices. Those insurers are hoping to use the data to manage future COVID-19 risk, Oracle said.

If insureds agree to send wearables data to insurers, the firms could warn the insureds when they seem to be suffering from early COVID-19 symptoms, Oracle said.

Conor Heneghan and other researchers at Fitbit — the maker of one brand of the devices available to John Hancock’s Vitality Plus program participants — reported in August 2020 that they could use Fitbit data to detect about half of COVID-19 cases one day before participants reported the onset of symptoms.

“This is important because people can transmit the virus before they realize they have symptoms or when they have no symptoms at all,” Heneghan wrote in a summary of the research published by Fitbit. “If we can let people know they should get tested a day before symptoms begin, they can isolate and seek care sooner, helping to reduce the spread of COVID-19.”

Another team, led by Tejaswini Mishra of Stanford University, reported in Nature Biomedical Engineering in November 2020, that it had analyzed wearable device heart rate, step count and sleep data for about 5,300 people, including 32 people who had COVID-19.

The team said 22 of the 32 people who developed COVID-19 had changes in their heart rate, step count or time asleep before COVID-19 symptoms showed up, according to Mishra’s team.

Wearables Observatory

Vitality USA’s Gilbert has not been using health incentive program participants’ heart rates to create COVID-19 forecasts, but he can use a community or employer’s underlying Vitality population health statistics to predict how hard the pandemic will affect that group of people, he said.

One simple protective step an insurer or employer can take is to send $30 pulse oximeters, or blood oxygen measuring tools to plan members who appear to be at high risk of developing severe COVID-19, Gilbert said.

If people know their blood oxygen levels, that reduces the odds that they’ll go to the hospital emergency room simply because they have an annoying cough, and increases the odds that they’ll seek appropriate care if they’re have serious problems with breathing, Gilbert said.

Something else Gilbert has noticed is that Vitality participant activity levels and shopping patterns change in roughly the same way when COVID-19 begins to surge in a community, no matter the location.

Program participants in communities with surging COVID-19 tend to eat out less, cook more at home, stop exercising at outside fitness facilities and spend more on home exercise equipment, Gilbert said.

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