Despite a constant buzz around the idea of using mobile technologies for patient engagement, the depth and breadth of these solutions has remained consistently thin and frankly dated. Today, healthcare organizations who are adopting and deploying engagement solutions are focusing these efforts on marketing/patient retention (e.g., simplifying transactional processes such as appointment scheduling, prescription refills, etc., online access to lab results & records) and accelerating payments (online bill-pay). Despite all the talk about using mHealth for care provisioning, our research for the upcoming report that will be released later this month, mHealth Adoption Trends for Provider-Patient Engagement, finds a market that is still in an early, embryonic stage of development.
So why the disconnect between the hype of mHealth for care provisioning and reality? Of the many potential reasons, there are two that are dominant: a lack of solutions with proven clinical efficacy and few financial incentives to drive adoption.
While there is little argument that increasing the interaction between a care team and their patients is a good thing, the best means for accomplishing this feat are still unclear. A year ago, Group Health published results from an internal study testing just what impact this increased communication may have on outcomes and patient satisfaction. What they found comes as no surprise to us as trusting advocates of patient engagement. In this study, Group Health provided patients suffering from depression a relatively simplistic form of engagement wherein patients were able to communicate with their care team through the EMR portal. The results, impressive: antidepressant medication adherence increased 33%, overall depression scores decreased, and satisfaction with treatment improved 61%.
While this study fostered communication via a computer/portal, it is not too big a stretch to see such communication readily migrate to a smartphone modality wherein a patient would not be tethered to a computer and could communicate from virtually any location. But that is part of the problem. This study, which was published only last year, uses a relatively old model of communication (portal), which has been used to varying degrees in the healthcare sector for years. And if there is a paucity of clinical evidence for the efficacy of portals, for mHealth Apps it will approximate a vacuum. Sure, basic logic tells you that increasing patient-provider communication should lead to better outcomes, but the healthcare community can be a bit odd at times in its demands for stacks and stacks of clear evidence before it is willing to take the plunge, either providers adopting such models of care and more importantly, payers will to reimburse for such models of care.
Therein lies the crux of the problem – reimbursement.
Now we don’t mean to be crass but physicians are like the rest of us. We are dedicated to our work, we work hard and at the end of the day we receive compensation for those efforts. For physicians, who seem to be perpetually overbooked, their time is particularly precious and adding another activity (patient communication outside of the exam room) without compensation, is a non-starter. There is also the issue of how does one bring mHealth data into an existing HIS let alone into the daily workflow of a physician is not without costs. Who will shoulder those costs when there are few if any reimbursement models in place to support such? This idea scares away investors and many innovators.
And that creates a Catch-22. Without clear reimbursement models there is little incentive to support the adoption of mHealth for care provisioning and therefore, little financial upside for innovators and subsequently creating an unstable market. To date, no mHealth engagement solution for care provisioning has been able to gain enough traction (relates back to financial) in the market to make a significant impact and thus are perceived as risky partners by healthcare organizations. There is ample proof for such concern as there remains a tremendous amount of churn in the mHealth market. For example, two startups in the space were recently ‘acquired’ by other startups: Pipette by Ginger.io and WellApps by Medivo (both in the same week no less!), yet far more start-ups simply fold-up their tents and move on. But without having healthcare organizations willing to take a chance, how are these young companies going to demonstrate clinical efficacy. Yes, Catch-22 indeed.
But all is not lost.
As we’ve written before, reimbursement models are migrating away from the traditional fee for service model and one that is structured around value-based outcomes. These new reimbursement models will in-turn lead to more capitated models of care where healthcare organizations will take on greater responsibility for managing patient risk. To effectively and efficiently do so, these organizations will need to create new models and processes of care delivery that extend beyond the confines of the exam room and actively engage the patient as a critical member of the care team (where they are capable of course). This has the potential to create a “Golden Age” for such new technologies as mHealth. But like all new market opportunities, a big question is timing – just when will the inflection point occur that will truly launch this market. In that forthcoming report we mentioned previously, we intend to provide some insight into that question as well.
John Moore is an IT Analyst at Chilmark Research, where this post was first published.
Technology is advancing at an extremely fast pace. With the advent of smart phones nothing seems impossible now. How fast mHealth will be fully there in place is yet to see though. Although I agree that it should be used as a service rather than a fee. And it should only be a matter of time before it becomes a way of life.
From a John to another John, thanks for posting on this.
The proliferation of mHealth apps is likely to garnish increasing amount of attention as the cost of a smartphone decreases. Here at the American Action Forum, we are working on policy discussions surrounding the FDA regulation of mHealth and the potential consequences. Be sure to check out the article…it’s short dont worry. http://bit.ly/ynprju
There is no doubt that reimbursements are one of the fundamental components that will make accelerate the adoption of mHealth apps and technologies. But sometimes it could be a chicken or egg situation. If the technology will produce outcomes more cost effectively than through existing solutions, one would have to presume that reimbursements for such new applications would have to follow due to market and business demand. One such mhealth app that seems to have some traction in the market is for managing diabetes. A number of products in the market today are showing some promise, like the one recently developed by Confidant Systems. For more information, see: http:///www.confidantinc.com.
You capture the key point. When financial incentives are aligned with patient outcomes/engagement, the obvious becomes reality. As many know, Group Health is an integrated system (payer/provider). Meaning no offense to Group Health as they deserve a ton of credit for innovation, a muddy puddle of water in the Sahara Desert is a welcome improvement. As I understand it, they started simple with secure messaging. For anywhere else, that is a laughably simple thing to add (and a couple decades overdue) but that was a welcome sight to their members. Group Health was smart in that they initially marketed it more to their members than the MDs as the compensation issue for the MDs had already been taken care of.
For those outside of integrated systems, it will be crawl-walk-run. Meaningful Use incentives will help in driving secure email adoption, but it will ultimately be driven by reimbursement reform. Commercial and gov’t payers are doing that. I’d pay close attention to the video in this article from last summer – http://techcrunch.com/2011/07/31/healthcare-disruption-healthcare-providers-repeating-newspaper-industry-mistakes-part-iii/. It’s subtle but it speaks to how easily reimbursement can be changed for Medicare which will drive the market as a whole.
The best chance at breaking the dam that has held back startups in healthcare is to strengthen the proposed Stage 2 Meaningful Use requirements around patient engagement. That, in turn, will help the “crawl” stage of engagement. It’s necessary before the “walk” and “run” stages where real breakthroughs will come.
At Group Health, we are now mobile – enabled, with about 40K on iPhone and Android and great usage stats using the “portable” portal.
John: excellent post, thanks for sharing.
The pace technology is so fast that using apps from last year is no longer valid. My 17 year old son speaks of technology gap between him and his sister, 2 years younger. Technology is moving forward that fast.
Hopefully we’ll continue to move toward reimbursement to a value-based model. Fee for benefit, rather than fee service.
Keith Taylor, Health Insurance Advocates