Using mobile technology to improve care management and drug adherence for at-risk patients.
Kim
Labow
It is challenging for physicians and health plans to maintain regular contact with Medicaid patients, who typically require more healthcare services and are prescribed more medications but are often not compliant with medication regimens due to a number of socio-economic factors. As a result, Medicaid patients are at increased risk for medication errors, prolonged treatments and hospitalizations, all of which result in higher medical costs for all stakeholders in the U.S. healthcare system.
Oftentimes, the only engagement physicians will have with their Medicaid patients is when the patient is in the office or hospital ER for a visit — when the patient may already be suffering from health complications. Innovative Medicaid health plans are developing new strategies and implementing cutting-edge mobile technologies to get important and timely patient information to those physicians when it matters most — in those critical few minutes when they are actually with the patient in the exam room. Mobile technology can put patient information into the physician's hands which he or she might not have otherwise seen, including claims-based medication history and non-adherence notifications, prior treatments, data from other physicians and clinicians, and so on.
Why mobile?
Provider surveys published by Manhattan Research and SDI estimate 81 percent of physicians use smartphones, with more than 50 percent of those using the devices to access medical information multiple times daily. Chillmark Research reports that 22 percent of U.S. physicians are currently using iPads, and the health marketing firm Aptilon reported in February that four out of five doctors surveyed plan to purchase iPads by the end of the year. It makes sense, then, for health plans and other stakeholders to look into how mobile care alerts and e-prescribing can leverage the physician-patient relationship to facilitate patient engagement and behavior change, improve coordination of care and optimize medication management.
While in the exam room with the patient, physicians can use handheld devices — iPhone, iPad, iPod Touch, Android and more — to electronically prescribe medications and review the medication history sent from health plans. These mobile messaging platforms provide information about medication non-adherence, formulary benefits, notifications about lower-cost alternatives and need for prior authorization, enabling the physician to have informed dialog with the patient about the best treatment plan and drug options. Medicaid plans can also send and receive relevant, real-time, patient-specific messages. The physician reviews the care alert and discusses it with the patient during the visit, then can instantly send a response indicating the action taken to close the gap in care.
Mobile technology yields benefits for providers and payers alike
As the number of physicians using mobile devices to access medical information continues to increase, Medicaid plans have an opportunity to deliver value-added and contextual patient information directly into providers' hands. This facilitates collaborative communications, patient and physician engagement, enhanced care coordination and management, improved care and more cost-effective care delivery. Delivering mobile information enables Medicaid plans to:
• Empower providers: Providers have the tools and information to make more informed decisions, improve safety, streamline practice efficiency and maximize reimbursement.
• Engage members: The trusted physician-patient relationship can be leveraged to drive member engagement and optimize “teachable moments” at the point of care.
• Facilitate improved and more cost-effective care: Improved formulary compliance and use of lower-cost drugs; reduced therapeutic duplication; reduced preventable adverse drug events and their associated hospital, emergency room and physician office costs; lowered administrative expenses associated with manually authorizing medications and communicating with physician staffs.
With access to e-prescribing solutions and mobile care alerts from Medicaid plans, providers benefit from enhanced clinical decision support and save time by reducing administrative work related to prescriptions and managed care protocols. Mobile solutions can be integrated with practice management systems, thus enabling the real-time delivery of actionable gaps in care, a comprehensive medication history across practice settings, group-specific formulary information, prior authorization, mail service options and patient out-of-pocket financial responsibility. Using mobile solutions, providers can improve:
• Patient care: Better outcomes to timely, relevant clinical data since it will eliminate gaps in care by identifying unaddressed tests, procedures or therapies. Additionally, e-prescribing tools can help improve patient care by improving medication adherence by tracking refills and efficiently delivering reminders during and after visits; and minimize duplicate therapy by knowing which medications were prescribed by
other providers.
• Patient satisfaction: Lowered patient out-of-pocket expenses by presenting options for therapeutically equivalent, lower-cost drugs covered by patient benefit plans; and improved patient convenience by streamlining processes at the pharmacy and eliminating hassles of formulary confusion, including frustration caused by step therapy and prior authorization rules.
• Practice operations: Streamlined prior authorization, eliminating manual administration and reducing operational costs; increased productivity from reduced mail, faxes and phone calls from health plans for gaps in care; and fewer pharmacy phone calls and faxes for drug incompatibility, formulary issues and renewals.
• Reimbursement: Capabilities that enable reporting necessary to qualify for federal incentives and offer a pathway toward demonstrating meaningful use.
Mobile technology in action
Many health plans are now offering mobile-enabled care alerts and e-prescribing to providers at no cost, supporting physicians in the clinical decision-making process by supplying important patient information than can help to close care gaps, improve quality of care and safety, and increase the effectiveness of care management programs.
To curb healthcare costs and improve care management for an at-risk population, the country's largest Medicaid managed care plan is preparing to implement a program to deliver real-time, patient-specific clinical and medication information to the physician via mobile devices. The project goals are to improve overall quality of care by supporting care management and medication adherence, reduce medical errors and costs, and minimize emergency room and hospital visits for low-income, chronically ill Medicaid patients. Outcomes of this mobile alerting will be measured in a controlled study that will examine care gap closure rate, HEDIS scores and medication adherence.
In addition to offering myriad medical and cost benefits, mobile technologies can lead to reduced administrative hassles for both patient and physician, leading to increased patient and physician satisfaction, which is a boon to the health plan as well.
Kim Labow is CMO of NaviNet.
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