Health care payors (plans, insurers) are emerging quickly as one
of the dominant players in the mobile health (mHealth) marketplace.
Apps to exchange information with patients regarding appointment
reminders, to coordinated care among various providers for diabetes
and other conditions, and to provide patients with personal health
records (PHRs) are becoming all the rage. Payors command a unique
place in the healthcare industry; not only do they receive and
distribute the healthcare dollars but they maintain deep files of
information on the consumers whose care they pay for. With their
reserves of funds, payors are also uniquely positioned to invest in
the use of mobile health in the delivery of health care. They can
develop and distribute apps from basic-to-sophisticated, from those
that merely provide good diet tips to beneficiaries, to those that
collect and transmit critical health data to physicians and other
providers. They can also incentivize beneficiaries to adopt mHealth
solutions by, for instance, offering to reduce premiums in exchange
for compliant behavior. Further, the employers who pay for health
coverage may incentivize, or penalize, employees that do not
utilize mHealth tools offered by payors.
As the mHealth field develops, it will be interesting to see who
pays for it. In the private healthcare market (i.e., separate from
Medicare and Medicaid), the costs for many mHealth services may be
picked up by the payors, but the payors may also seek to shift
the costs to the providers by, for instance, requiring
participation in mHealth initiatives under the provider-payor
contract and payor policies. Suddenly the hospital or physician
will have to use an app to collect data from the patient on his or
her heart condition, whether or not the provider currently has the
right platform for the app, the correct privacy and security
measures in place, etc. The advent of health insurance exchanges
(HIEs), health information organizations (HIOs),
provider-maintained electronic health records (EHRs) and
accountable care organizations (ACOs) under the Affordable Care Act
may also change the marketplace, and how costs are distributed. If
you're a provider, review you payor-provider contract
and start tracking the costs of mHealth and other initiatives
imposed by payors, to prepare for a wireless health care
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