As healthcare reform shifts into high gear, a growing number of employers recognize the value of convenient, streamlined health information and access. Specifically, they are investing in mobile health (mHealth) -- the use of mobile technology devices and smartphone apps for healthcare purposes.
Predictions show that healthcare and medical app downloads will reach 142 million by 2016.[1] What's more, an increasing number of remote symptom checking and condition monitoring apps, designed to simplify the management of chronic diseases, present an effective method to reduce the costs of conditions that will develop into a significant burden.
Why mHealth Now?
Mobile technology enables health plans and pharmacy benefit managers (PBMs) to interact with members and providers anywhere they have their mobile phones - whether at the point-of-care, pharmacy or home - and at any time of the day. Think of mobile messaging as a way to help members make the right choices by:
- Pushing medication reminders
- Getting feedback on programs
- Offering health and wellness advice that can be targeted to specific employees
By using mHealth apps, employers can offer a high level of convenience to their plan members; while using the pharmacy data to measure adherence and patient engagement, develop or modify programs that encourage members to make better health decisions and analyze data for future healthcare cost trends.[2]
The idea is that the more personal the message, the more likely it will be understood and followed.[3] The key to doing this the right way depends upon finding the right mHealth solution.
Choosing the Right mHealth Options
Employers should look for an mHealth solution that offers robust and flexible mobile technology apps which enable plan members to easily interact with the health plans and PBMs responsible for managing the employee and their dependent's care.
The mobile app suite should offer a completely configurable approach to placing mobile decision-support tools in the hands of members: medication history and drug look-up, drug savings calculations and plan benefit options, personalized messages, biometric trackers and physician visit preparation.
Most health-related apps are primarily for information retrieval, with some mobile devices providing more one-on-one interaction. For example, a mobile platform could deliver personal drug utilization information for each plan member, including specific money-saving suggestions for better pharmacy benefit use. The mHealth solution should offer plan members easy access to essential medical and pharmacy benefit-related information, including:
- Reminders and alerts for prescription drug compliance
- In-network provider directories and directions to offices
- Pharmacy and medical benefit summaries and claims history
- Drug formularies and drug prior authorization status
- Deductible summaries and cost-sharing requirements
- Drug prices of nearby pharmacies and expected out-of-pocket costs with generic and therapeutic alternatives
- Self-diagnosis tools with symptom and disease lookup features
- Daily wellness tracking tools for achieving health-related goals
- Health-related symptom checkers
- Options for in-home monitoring and in-home care
With access to a patient's medical and pharmacy claim data, health plans can empower members to make more well-informed choices that can increase prescription drug adherence, reduce costs associated with emergency care, and improve the overall quality and satisfaction with healthcare.
Apps can also serve as decision-support tools for healthcare providers and PBMs, allowing them quickly to suggest additional prescription drug purchasing channels, such as mail order and retail discount options available through network pharmacies. Health insurers have also developed mobile apps that allow members to use smart phones for a variety of medical management activities, such as:
- Displaying electronic ID cards
- Accessing network physician and pharmacy directories and getting directions to the provider locations
- Viewing past medical and prescription claims
- Accessing eligibility, cost-sharing requirements for a given visit
- Seeking the balance on a health savings account
- Viewing medical and pharmacy coverage and out-of-pocket totals
- Journaling allergy and screening/immunization information
- Buying additional "after-tax" insurance products (e.g. long term care, pet insurance, etc.)
- Tracking wellness activities and biometric screening results for sharing with trainers and care managers
Automated personal mobile application services - combined with reporting applications that measure the appropriate use and effectiveness of healthcare - will inevitably increase satisfaction for all health and healthcare stakeholders by:
- Saving time and money across the delivery system
- Simplifying plan benefit design and utilization
- Enhancing the effectiveness of medication therapy management, as well as value-based drug benefit designs
- Integrating financial data from the plan for easy reference and point of care purchasing.
Other mHealth Advantages
Employers can better engage plan members using text, email, interactive voice response (IVR), and other communication channels, and automate the creation of messaging services to personalize all communication content. This will enable them to leverage daily member pharmacy claims to generate personalized member "nudges" to take their meds and to communicate about specific pharmacy cost-savings opportunities, potential drug interaction alerts, and drug-switching opportunities. The ability to reduce workflow costs by supporting pharmacy and therapeutic decisions through access to enterprise-wide databases has many key benefits:
- Reduction of administrative burden
- Improved response time to market-based requests for new formulary benefit designs and the potential financial impact to plan sponsors
- Cost reductions by fewer formulary errors during claim processing
- More efficient process for compliance and documentation to myriad federal and state reporting requirements
Bottom line: mobile apps enable the healthcare industry to decentralize the care management process, mobilize millions of patients for accessing relevant healthcare services information and personalize their experience with the healthcare delivery system through diagnostic and health maintenance that can be customized to each person's preference.
This transformation will help employers who continue to sponsor healthcare benefits for their employees to see improved employee satisfaction with their benefits, more productivity from healthier employees, and eventually a reduction in health benefit costs.
About the Author
Robert Oscar, R.Ph., has more than 25 years of experience in healthcare. Throughout much of his career, Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk including pioneering work in the Medicare HMO market.
Before founding RxEOB more than a decade ago, Oscar worked in the medical information systems industry, designing, developing and implementing several different claims analysis tools. Licensed in Virginia and certified in pharmacy-based immunization, Oscar is a graduate of Ohio Northern University. Contact info: info@rxeob.com.
Sources:
[1] Oscar, Robert; Smarter Pharmacy Benefits: How Mobile Technology Communications Improve Pharmacy Utilization and Cut Costs; Managed Care Outlook; April 15, 2013; https://www.rxeob.com/secure/pdf/MCO_Smarter_Pharmacy041513.pdf; accessed October 2, 2013.
[2] Wicklund, Eric; Can pharmacists fuel mHealth?; Feb. 5, 2014; mHealthnews; http://www.mhealthnews.com/news/can-pharmacists-drive-mhealth-adoption-HIX-mobile-insurance?single-page=true; accessed May 5, 2014.
[3] Wicklund, 2014.
