The landscape of healthcare is changing quickly, no more so than in the vendor-purchaser arena. GPOs are going away. ACOs are coming (whether they are liked or not, in some form or another). Hospitals are beginning to consolidate once again and insurers are buying hospitals, establishing vertical organizations. Profit margins are dwindling and operating costs are rising for both hospitals and vendors (have I given anyone good news yet?). So where is the silver lining? It may very well lie in mHealth technologies. There are ways in which it can directly impact vendors in a positive way.
- Medication tracking: mHealth technologies may track medications from the time they are electronically prescribed until a pill is taken by the patient. There are multiple medication adherence solutions out there, reminder systems to both patients and caregivers, none perfect. But they will improve. What are the implications for this? Potential data may be used by (and already has) pharmaceutical companies in evaluating adherence for clinical trials. Marketing data on medications will be much more accurate than the IMS which exists today. Pharmacies, having data electronically prescribed will have more accurate information for the FICO medication score (yes, this exists): http://well.blogs.nytimes.com/2011/06/20/keeping-score-on-how-you-take-your-medicine/ .
- ACO Pathway: ACOs will be reimbursed based on patient outcome, and will receive lump payments (in some models) for a patient’s diagnosis, with the patient followed from an inpatient to the end of treatment whether it be as an inpatient or outpatient. In other words, if a patient goes to a rehabilitation facility, that facility in the ACO will receive part of that payment which will include drugs devices, and other materials used during the entire period encompassing that diagnosis. ACOs may become purchasers, not just the individual hospital. They may utilize higher volumes of materials and therefore command cheaper prices. However, mobile health technology will make the process better for vendors in the following ways: Drugs, devices, and materials can be tracked much more accurately. Less waste and loss. The supply chain can run smoother with the vendor having an electronic inventory simultaneously of all the players in the ACO. Mobile health will take the bar coding supply data entry and either replace or improve it, with improved communications. Mobile health technology may allow for instantaneous competitive bidding for a product in need at a given moment.
- Marketing: A provider prescribes a specific drug or device from a drop down menu furnished via a list of established institutional formularies or contracts. If the vendor needs to be present at the hospital (for example a cardiac device implant), this would help scheduling workflow. It can also trigger an automated inventory control (even for medications). Physicians are carrying iPads more frequently. Mobile apps that have educational (CME) programs, highlighting specific disease states or treatment guidelines. Prompts towards these apps may be triggered by a physician’s specialty or clinical rotation. There are opportunities for patient education. A patient in the hospital may be prompted, via their PHR or patient portal of their health record, to go to an app providing education about their condition, procedure, or medication. They may be on a cardiac floor and the hospital may use industry-furnished disease state awareness information on mobile apps that they give a patient a menu of, suggested by a case manager, with the list derived automatically from a provider’s list of diagnoses, from a device implant or utilization, or from certain medications prescribed.
- EHR connectivity: Some of this has been alluded to in the previous points. The common thread is that the EHR is going to be the hub of a patient’s care. It will be the most important tool for an ACO, insomuch as it will track the diagnosis, the patient, and treatments. There is a growing secondary market of unidentifiable data in the healthcare industry. The IMS is the traditional example, as are sales tracking of devices. But this data is not extremely accurate, and mHealth technology can help. From the source of purchase and utilization directly, information may become more accurate and timely. The vendor, by way of certain mHealth technologies might know when there is a defect or malfunction of a product, and not have to wait for a clinical event. This can immediately show up on an EHR (or personal communication) as a clinical alert to the physician.
Granted, all of the things mentioned might not be immediately possible. But they all make sense to me, a former practitioner who loved things making sense. Technology can facilitate things making sense in a workflow manner. That is the beauty and promise of mHealth.