I have talked about some of the major stakeholders in mHealth adoption, what technology companies need to consider when developing and marketing to them, why mhealth will be important to the various stakeholders, and why the stakeholders are, in turn, important for adoption. Physicians (http://davidleescher.com/2011/10/10/five-reasons-why-physicians-will-love-mhealth/), non-physician providers (http://davidleescher.com/2011/10/11/why-non-physician-providers-will-love-mhealth/), ACOs (http://davidleescher.com/2011/09/17/why-mhealth-will-be-critical-for-the-success-of-acos/), hospitals (http://davidleescher.com/2011/11/10/five-reasons-hospitals-need-mhealth/), and caregivers (http://davidleescher.com/2011/10/24/caregiver-the-key-to-mhealth/).
For a few reasons insurers will be a big part of mHealth technology adoption 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.
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. It was a lesson, however, in payer-physician dynamics. It has been relived recently with insurers dictating which type of stress tests a physician may order for patients, even though some types of cheaper stress tests are not appropriate for all patients. But the string of phone calls and energy expended to argue a case as an advocate for a patient is very difficult and most physicians are giving up. As much as what has been perceived by physicians as negative behavior changes, I believe that the encouragement of mHealth tools will be welcomed.
3. Payers realize the importance of patient engagement. They know the important role which patients can play in their own health. mHealth tools are founded on patient participation with data emanating from the patient. Pooled unidentified data can be utilized for helping prevent chronic disease and assessing treatments. 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. Pooled unidentified data may also be evaluated by the payer or even others, in order to perform population-based research. One of the challenges lies in the lack of connectivity among insurer portals and EHRs.
5. Payers can perform clinical studies. One of the biggest opportunities which insurers can afford 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 owns the hospital such as Kaiser Permanente, Geisinger, or Highmark is ideal for such evaluation of mHealth technologies.
Payers occupy the middle of the health care space. Their importance in their potential for changing paradigms in health care by instituting mHealth cannot be understated. I believe it could be the fastest path towards adoption of this needed technology. The political influence of the industry which can affect necessary legislative and regulatory changes to accommodate mHealth needs to be considered in this argument as well.
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