For a few reasons insurers will also play a pivotal role in the development and adoption of patient-focused mHealth technology adoption for wellness as well as for the management of chronic diseases.
1. Payers hold the purse strings. Insurers will be the ones paying for the use of mHealth for chronic disease management for the vast majority of patients. They have a vested interest in keeping the costs of medical care down, especially in the segment of patients most responsible for overall health care costs. Twenty percent of patients account for 80% of health care dollars spent. If payers, including Medicare reimburse for the use of mHealth, providers will adopt very rapidly these tools which will bring efficiency, better patient adherence, and management of patients via trend observation analysis and actionable alerts instead of medical disaster relief. The payer is the one who realizes the economic advantages of mHealth most. The development of health and medical app formularies is something I foresee. As medical apps (as opposed to consumer apps) will be prescribed, it follows that they will reside in formularies as drugs presently do. This will tie apps to reimbursement, connect analytics to determine the best app for the individual patient and condition, and control the use of only quality apps as determined by the best available objective criteria (Happtique, FDA, or others as they might occur). Many large companies are now self-insured (as per Kaiser Family Foundation 2012 Study of Employer Benefits). Because of this, they too will develop an interest and adoption of mHealth tools for employees and their families.
2. Payers can change physician behavior. As a practicing cardiologist, I observed firsthand how reimbursement policies by insurers change physician prescribing and care behavior. I am old enough to have lived through the conversion to all generic medications. This was hard for me as a cardiac electrophysiologist whose patients’ antiarrhythmic medication drug levels I used to monitor. Changing to generic drugs was a losing battle because of a combination of red tape one had to go through, the cost differential passed on to patients, and the eventual disappearance of the brand named drugs themselves. This is also seen in diagnostic tests and therapeutic procedures. Physicians today are more aware of cost as an issue in managing patients. Many ‘routine’ tests have been deemed to be ineffective and are now deemed inappropriate by medical professional societies and conveyed in a policy called Choosing Wisely. Physician behavior can change with education. If the worth of medical apps is demonstrated and encouraged by payers, I believe adoption will accelerate.
3. Payers realize the importance of patient engagement. They know the important role which patients can play in their own health. Payers were among the first to adopt patient portals (see below) and to use incentives to encourage employees to engage in healthier behaviors. mHealth tools are founded on patient participation with data originating from the patient (whether physically or automatically entered). Pooled unidentified data can be analyzed and utilized for developing best practices with regards to chronic disease management. Patient engagement decreases costs by having data come directly to the payer (see below) as well as potentially improving patient outcome.
4. Payers are the largest users of patient portals. Presently,most patient portals are provided by payers.Patients entering and correcting their own data serve the patient as well as the payer. Patient-derived health data from mHealth tools may be tracked directly by the payer. The data may be utilized to assess patient adherence, treatment effectiveness, and adherence to practice guidelines by the provider. One of the challenges lies in the lack of connectivity among medical apps, insurer portals and EHRs.
5. Payers can perform clinical studies. One of the biggest opportunities which insurers can afford (and many mHealth development companies cannot) is clinical research with relative ease of determining outcomes as well as cost analysis. Implementation of mHealth in ACOs or vertical organizations in which the payer is also the provider (Kaiser Permanente, Geisinger) is ideal for such evaluation of mHealth technologies, and indeed some has already been done with positive outcome results.
The importance payers’ potential for changing paradigms in health care by instituting mHealth cannot be understated. I believe they represent the fastest path towards adoption of the best that this sector has to offer. The political influence of the insurance industry which can affect necessary legislative and regulatory changes to accommodate mHealth needs to be considered in this argument as well.