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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
future.
This article is for general information and does not include
full legal analysis of the matters presented. It should not be
construed or relied upon as legal advice or legal opinion on any
specific facts or circumstances. The description of the results of
any specific case or transaction contained herein does not mean or
suggest that similar results can or could be obtained in any other
matter. Each legal matter should be considered to be unique and
subject to varying results. The invitation to contact the authors
or attorneys in our firm is not a solicitation to provide
professional services and should not be construed as a statement as
to any availability to perform legal services in any jurisdiction
in which such attorney is not permitted to practice.
Duane Morris LLP, a full-service law firm with more than 700
attorneys in 24 offices in the United States and internationally,
offers innovative solutions to the legal and business challenges
presented by today's evolving global markets. Duane Morris LLP,
a full-service law firm with more than 700 attorneys in 24 offices
in the United States and internationally, offers innovative
solutions to the legal and business challenges presented by
today's evolving global markets. The
Duane Morris Institute provides training workshops for HR
professionals, in-house counsel, benefits administrators and senior
managers.
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