More than 75 percent of healthcare costs are due to chronic conditions. Although chronic diseases are more common among older adults, they affect people of all ages and are now recognized as a leading national health concern. While we know that chronic disease is most effectively managed through frequent, near-continuous monitoring, there are pervasive problems with the quality of chronic disease care.
In the commercial health insurance marketplace, the Affordable Care Act (ACA) is forcing healthcare to undergo a rapid transformation. For example, with nearly the entire nation eligible for healthcare, health plans are faced with several significant challenges as they pertain to how they will treat the newly enrolled in the risk adjustment assessment process. One challenge is that many newly insured individuals will have little or no documented clinical history. Moreover, the lack of member-reported data will cause loss of revenue and increased utilization and cost. How will health plans capture and accurately code the actual health complexity of their member population? How will they identify and close treatment gaps sooner than later to improve confidence levels for suspected Risk Adjustment conditions?
The key to success is for patients in high-risk disease groups to be engaged in their disease management. Patients who were more knowledgeable, skilled and confident about managing their day-to-day health had costs that were 8 percent lower in the base year and 21 percent lower in the next year. However, many patients spend only a few minutes a year with their clinicians. According to the National Council on Aging, a third of all chronically ill people say that they leave a doctor's office or hospital feeling confused about what they should do to manage their disease, and 57 percent report that their providers have not asked whether they have anyone to help implement a care plan at home. This is where mobile technology can be utilized to help drive interventions, develop member wellness and capture member-reported data sooner or in between doctor visits. This in turn can help improve confidence levels for suspected risk adjustment opportunities and care gaps.
It is forecasted that there will be 1.158 billion mobile health technology users by 2020. A 2011 study reported there are now more people on earth that have access to a mobile phone than who have access to a toothbrush. Half of the 6.8 billion people on the planet use a toothbrush, but nearly 4 billion of them use a mobile phone!
Moreover, as many as 91 percent have their mobile phones within arm's reach at all hours of the day and there are five times as many cellphones in the world as there are PCs. There are 271 million mobile subscribers in the U.S. alone and 90 percent of text messages are read within 3 minutes of being delivered.
These statistics make it clear that mobile technology offers unprecedented opportunities to improve health and lower medical costs -- there is no doubt that we should use mobile phone apps to capture health data from members.
Medications, screening reminders, improving risk factors and more
Mobile member health apps are on the market today. Yet many of these apps are limited to displaying the basics of insurance benefits (i.e. show co-pays, pharmacy and provider options), but they do not capture real-time member-reported health data, send chronic care alerts to the member, or inform risk adjustment analytics to make them smarter and faster. If you're going to push out a mobile health app to your members, why not design to be one that those members turn to for help with staying healthy. Make your members smarter and engaged by informing them of interventions they can do right now. As such, with the questions you ask them, and the responses they give, your organization can accumulate more data. Once you securely pull the data back into your analytics it is possible to generate better outcomes.
We know member or patient-reported data is critical to better inform analytics. Another powerful tool to consider, however, is an online or mobile health assessment app to collect provider insight at the time of encounter with a direct data feed following a member's visit. Online and mobile health assessments are more than just another provider exercise, these applications are focused on improving care for patients, increasing efficiency for physicians, empowering more coordinated care, and lowering cost for payers and providers.
Indeed, as the new population of patients entering the insurance market often will not have well documented clinical histories, most will use mobile technology and will become increasingly likely to share health information with trusted partners. Health plans should embrace this opportunity to capture member-reported data to improve the accuracy of risk scores.