The upholding of the majority and key points of the ACA by the Supreme Court was a monumental step in changing healthcare in the USA. It is reform. It is not the creative destruction that is necessary in order for medicine to fulfill its true potential for good to patients. However, it brings millions of participants to the table and allows for mHealth to reach those who might benefit the most. In addition, it creates an even bigger Perfect Storm of healthcare: increased demand for resources and increasing costs. When looking at this decision, certainly one might want to look at some of the economic ramifications seen of so-called Romneycare enacted in Massachusetts to get a peek at what is in store for the rest of the country. This makes the argument for more efficient and economical care all the stronger and visible. The mHealth technology sector is poised to address these issues.
1. The healthcare infrastructure will benefit from digital and mobile health technologies. Bringing tens of millions of new insured participants into the healthcare system will strain resources (see above). The easiest way for Medicaid providers to communicate with new enrollees will be via mobile technology programs. It would be much easier to provide public service announcements which include how to download an app to enroll or obtain information on benefits than to hire thousands of customer service representatives creating countless hours of telephone waiting time and the purchase of streamed music for the wait. ACOs and others adopting bundled and outcomes-based payments will require much more sophisticated data tracking and analytics. This type of data will become the basis of economic survival of hospitals, providers, and payers. Detailed data will follow patients, supplies, and provider performance. This data will determine reimbursement, facility and provider ratings, and transitional clinical care plans when patients are discharged.
2. The increased demand for mHealth will necessitate a more industry-friendly regulatory process. As the benefits of mHealth become magnified with the rapid expansion of covered lives, the government, which endorses mHealth from a conceptual standpoint given the NIH and other mobile initiatives it endorses, might realize the pressing need for creation of unique regulatory processes for mHealth. There is no question that the mHealth industry needs some oversight for the safety of the public. However there must be a realization that mHealth represents an unprecedented new sector of healthcare which deserves its own unique regulatory process, not adaptation of the same processes with retrofitting of definitions and reviews. The rapid demand of mHealth will require a change of how FDA and other oversight of mHealth is performed.
3. Health information exchanges will be critical for Medicaid success. The potentially large expansion of Medicaid services (though the court ruled that states cannot be coerced into Medicaid coverage for low-income people) will necessitate better healthcare IT services on a statewide level. Many states are severely lagging behind in HIE development. With rapid expansion of Medicaid services for states not opting out, the HIE will be important.
4. Patient engagement will become a necessity. Having had a son in college in Boston after the advent of healthcare reform in that state, I can attest to the resultant strains on the system. mHealth tools will help people become more involved in self-management. If patients are furnished with technology which helps them with minor symptoms, the scheduling of appointments, coordinating resources, and finding physicians, hospitals and other providers will be facilitated with apps. Caregivers will also benefit. The availability of these apps needs to be transmitted via public service announcements, insurers, and providers. The real challenge is to get people to truly take a more active role in their health. I believe the upholding of this legislation will begin to do that by bringing people into a healthcare environment which they previously were estranged from. Having a primary care provider, an insurance company to contact (hopefully easily via a patient portal), and healthcare facilities that welcome them instead of turn them away where they can receive preventative medical counseling and services.
5. It will expedite transition from fee for service to bundled and outcomes based reimbursement, facilitating mHealth adoption. With millions more people entering the healthcare system, the transition (already a given in healthcare policy circles) to bundled outcomes-based payments is both a foregone conclusion and a necessity. As noted in the link in the first paragraph, this reform, when fully enacted (even admitted by the Obama administration) will increase healthcare costs. Fee for service is both bad for health economics and bad for healthcare itself. It promotes useless and many times more risky tests and procedures, with no resultant improvement in outcome. This is borne out by cost and outcome comparative research among Western countries. The change in reimbursement models will facilitate mHealth adoption because of its relatively economical profile and potential for improving outcomes. The Department of Health in Britain will be asking primary care physicians to prescribe medical apps. Perhaps this might become a significant part of healthcare in the USA.
So while the SCOTUS decision will not directly affect mHealth, its ramifications will, in my opinion, not only facilitate but create the absolute need for proliferation and adoption of the technologies. It will also foster a participatory medicine mentality by necessity, and mHealth will be there when it happens.