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Health Plan Strategies: Smartphone Apps Engage Patients, Improve Compliance | NEWS-Line for Pharmacists
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Health Plan Strategies: Smartphone Apps Engage Patients, Improve Compliance

The Affordable Care Act (ACA) has created an opportunity for health plans to streamline health-related communication, improve compliance and curb healthcare costs. At the same time, it has paved the way for more complicated benefit designs, prompting payers to seek enhanced tools that will also engage consumers.

The key to success is to optimize access to clinical data and better manage member services in an integrated, cost-effective and patient-facing way. Right now, mobile technology platforms and health-related smartphone apps are coming into their own, and proving to be the ideal engagement tool. In fact, nearly 17 million consumers were accessing health information on mobile devices in 2011, representing a 125% increase from 2010. Meanwhile, healthcare and medical app downloads are expected to reach 44 million this year, and 142 million by 2016.

As a source of comprehensive, patient data from multiple provider sources, health plans are well positioned to drive health and wellness initiatives and compliance. Smartphone apps elevate connectivity to new heights, providing an unprecedented level of safe, timely care communication, customer service, patient engagement and, ultimately, health plan differentiation. As the consumer channel of choice, mobile platforms and their related smartphone and mobile device apps are beginning to play an essential role in outreach efforts, with the mobile channel informing and influencing members or potential members like never before—and at their convenience.

Furthermore, mobile technology promises to offer an efficient means for streamlining applications for health coverage and subsidies, recertification and management of eligibility that will be generated by ACA's addition of 22.4 million Medicaid recipients to the healthcare system. This creates an opportunity for health plans to offer smartphone apps that can allow members to have plan and provider information at their fingertips.

Pocket Portals

A mobile platform solution can enable coordination of access to health plan member data via mobile phone, while the Web portal allows plan members to access personal pharmacy claims, formulary and benefit information that is integrated into a database connected to the health plan's website portal. Instant access to personal healthcare data not only better engages members and improves compliance, but also helps to cut costs. Further, it enables members to take charge of their healthcare—from finding drug savings information to preparing questions for an upcoming doctor's appointment. In addition, a plan can deliver innovative pharmacy information and health-related tools to its members on an ongoing basis.

Ideally, the mobile platform should offer various personalized modules designed to accelerate member health commitment and wellness goals. Also, the platform should include a personal medications module that offers access to historical pharmacy claim information, allowing members to provide accurate information to providers.

Streamlined Access

The primary purpose of adopting a robust mobile technology platform aims to positively impact how health plans and pharmacy benefit managers (PBMs) enable their members to communicate and look for information about their healthcare and pharmacy benefits. Toward this end, they must have the capabilities to simplify the flow of information between health plans, physicians and patients; facilitate one-on-one exchanges that close gaps in care; create quicker care response; and improve the overall healthcare environment. To provide all this, the mobile health web site capabilities must provide access to:

• 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;

• Reminders and alerts for prescription drug compliance; and

• Options for in-home monitoring and in-home care.

As ACA deadlines approach, the US healthcare system can expect to undergo a series of growing pains. Fortunately, the technology has kept pace with the social and economic changes, providing payers with the engagement tools they need to meet the healthcare needs of a growing number of covered lives and thrive in a challenging new marketplace.

About the Author

Robert Oscar, RPh, 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: [email protected]

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