Patient Engagement Efforts Drive Mobile Health

Patients were identified as the blockbuster drug of the century last year in a Health Affairs article and the healthcare industry, from payers and providers to innovators and the government, is taking that declaration to heart particularly by tapping the resource through mobile health.

“The opportunity is exciting because we’re always carrying our mobile devices and they’re always on and connected,” says Joseph Kvedar, MD, director of Partners HealthCare’s Center for Connected Health in Boston. 

Smartphones can pick up numerous variables in a person’s environment and can serve as sensors, aggregators and displays. People don’t have to think about healthcare delivery as being something that exists just when a patient is calling or visiting a doctor’s office.

Studies have shown that people check their phones an average of 150 times a day. Kvedar says healthcare providers can take advantage of the addictive nature of smartphones. “It’s a whole new tool to engage people. Mobile is transformational in many different ways.”

Critics have cited health literacy and low access to mobile devices of the underserved as challenges facing the future of mHealth. “Underserved populations are adopting mobile as their primary resource for accessing the internet. They are leapfrogging computers,” says Kvedar. He says the center sampled a health center in a low-income area and found that 60 percent of the patients are using smartphones.

“That was a turning point for us. If we can hit 60 percent of chronically ill patients with an app, that changes our thinking.” Patients prefer text messaging over phone calls and other forms of communication he says, even asking them to develop an app.

Proven results

mHealth market set to rocket

Research firms predict the wireless health market will grow by more than 20 percent over the next five years. Juniper forecasts that by 2018 there will be 96 million users of app-enabled mHealth and mobile-fitness hardware devices, up from 15 million this year. In the healthcare sector, app-enabled mHealth will be used to enable services ranging from remote patient monitoring to mobile ultrasound services. Market Research and Competitive Intelligence Reports says the global mHealth market could reach $20.7 billion by 2018. The mobile healthcare market is broadly categorized into connected medical device and healthcare applications; the former dominates the revenue market with approximately 80 percent in 2013. Diabetes management devices will drive the highest growth market due to the increasing global burden of diabetic population. Research and Markets attributes the growth to remote patient monitoring applications and diagnostics, aging populations and growing hospital deficits.

The Center for Connected Health has proven the relationship between patient engagement and convenient mobile access. Patients using wireless mobile devices to collect and transmit their data to the center's secure database more frequently measured their blood pressure and uploaded their data than patients using telephone modem-based devices. The results of a randomized, controlled clinical trial—BP Connect—were published by Kvedar and his colleagues in the May issue of Journal of Diabetes Science and Technology.

The center offers remote monitoring programs for chronic disease self-management in diabetes, hypertension and heart failure. Two types of data transfer technology are used in the Diabetes Connect and Blood Pressure (BP) Connect programs: telephone modem-based devices and wireless-based devices. Individual patient data  are collected and transmitted from the patient's home to a secured database at Partners HealthCare.

The transmitted data are processed and displayed in a user-friendly format on a secure Web portal where patients can view and monitor trends in their readings. Providers also have access to their patients' data to monitor patients’ progress and to provide timely feedback based on the objective data captured.

“As mobile technologies are becoming more affordable and acceptable, this is an opportune time to widely adopt mobile technology to engage patients in the self-management of chronic diseases,” Kvedar wrote. “Adopting the right technology should be a priority. Our goal is to sustain this initial interest and help patients continually and consistently engage in the program."

Payers play too

Payers are not about to be left out of efforts to improve patient engagement through mobile health. Aetna, which covers 22 million members through more than 1 million healthcare providers in the U.S., launched CarePass in June.

The concept is rooted in improving convenience, says Martha Wofford, head of Aetna’s CarePass platform. Citing online banking and shopping, she says Aetna “wanted to deliver the same convenience consumers have in other aspects of life.” By mapping out the pain points, she says the company decided to purchase itriage to develop its consumer platform. Since the launch, the app has been downloaded more than 2 million times. By offering wait times, hours, the ability to book appointments and more, Aetna is working to “make the access side as easy as possible.”

CarePass is focused on wellness, Wofford says. Rather than building its own mobile apps, Aetna makes it easy for its members to access the best mobile apps already available and integrate the data so people can see their whole health. “A lot of times we’re not patients,” she says. “When we’re managing wellness, it’s more of a consumer activity.”

The changing healthcare economic landscape is driving a lot of these changes, Wofford says. With the increase in healthcare costs outpacing wages and inflation threefold, more and more people are in high deductible health insurance plans and making more decisions for themselves. “It’s incumbent on us to make it easier for people to find information to understand their options. Mobile is incredibly powerful. People can find information right when they’re trying to and also capture data that they can then use.” The trick, she says, is helping consumers navigate all of the information and options. Helping consumers get care or stay well “can really drive change.”

CarePass helps with navigation by, for example, letting a consumer know where the closest emergency department is but that urgent care would be appropriate and the out-of-pocket cost is much lower. “Providers want that information out there,” Wofford says, so through itriage, Aetna utilizes a broad set of partners on the delivery side.

Wofford says the payer is pleased with uptake of CarePass so far and plans to expand the information the app covers. The company will continue to make the app connected and “as relevant as possible.”

Expanding reach

Retail giant Walgreens is actively pursuing mobile health as part of the continuum of consumer engagement with impressive results, according to Abhi Dhar, chief technology officer of eCommerce.

New iPhone poised for mobile health

The iPhone 5S, released in September, includes a second processor dedicated to tracking motion and location, which will allow developers to build stand-alone apps that don't need wristbands or other accessories to measure steps taken or distance traveled. The Nike+Move app was one such tool that was showcased during the official launch of the latest phone from Apple. The information even feeds into Apple's Games Center so that app users can compete with friends, set goals and track performance. The new M7 processor can gather data from each of the phone's sensors—accelerometer, gyroscope, compass and GPS—even when the device is on standby, in order to track a user's movement throughout the day.

Walgreens wants a relationship with patients and customers across all the available channels, Dhar says, speaking during the mHealth + Telehealth World Congress 2013 in Boston last summer. The pharmacy chain has the market penetration to drive increases in patient engagement: 2012 revenues totaled $71.6 billion and most Americans live within a three-mile radius of a Walgreens store. With more than 8,300 stores, the chain has a significant “ability to influence change,” Dhar says.

Walgreens “has been very focused on innovating and providing ways for consumers to engage with our brands. Mobile affords us brand new opportunities for what we’ve been good at for a very long time.”

The chain’s mobile strategy focuses on whatever, wherever and whenever the consumer prefers, Dhar says. “We speak about mobile but the continuum of care stems from our retail locations.” Customers log 12 million visits per week to Walgreens' properties whether retail or online and approximately half of that comes from a mobile device.

“Mobile is irreplaceable—the customers have spoken. We accept the fact that mobile is now a true omni-channel platform for innovation. More than 40 percent of our customers use our app while in a Walgreens store. More than 70 percent of the Pill Reminder app users strongly agree that the app helps them stay on track with their medications.”

More than 35 percent of households are wireless only, according to 2012 data, Dhar says. And, consumers use their smartphones even longer during the day than they use their computers—checking their phones first thing in the morning and last thing at night. However, you can’t just take tools designed for the computer and “jam them into a mobile phone. We concentrate engagement in our brand app leveraging the uniqueness of the channel.” Studies have shown that many people use their phones in the bathroom. That proximity to the medicine cabinet could trigger reminders for prescription refills.

Using shopping list capabilities, coupons and refill reminders “allow us to build a holistic relationship with our brand,” Dhar says. “All of that is integrated in that relationship with customers to drive engagement and can create urgency. That allows us to optimize our resources so customers can have a better experience in the store.”

The percent of online refills from mobile devices was 10 percent in 2010 and jumped up to more than 50 percent today, Dhar says. That’s more than one refill from a mobile device every second and indicates actual adherence, he says. And, patients are enjoying the tools. He cites one customer who said the refill app is “so fun I wish I had more prescriptions to fill.”

Empowering patients

Kaiser Permanente (KP) also has embraced mobile health and its opportunity to improve patient engagement. The organization is the largest healthcare provider in North America and HealthConnect—its comprehensive EHR system—provides information to 16,000 physicians and nine million members.

Final guidance finally released

The FDA just released its long-awaited final guidance on mHealth apps. "Uncertainty is hard," says Martha Swofford, director of clinical operations at Aetna. "We want to know the rules so we can operate within them." The guidance took so long, she says, because mHealth is so complex. "The regulatory framework isn't there and the industry is moving so fast, [the government] has to figure out how to keep. They're probably struggling with that." Stay tuned for the November/December issue of Clinical Innovation + Technology where we'll take a closer look at the new federal guidance on mobile health apps.

KP decided to integrate all ancillary systems into HealthConnect because “we believed that having all systems connected for the benefit of patients is critical to care,” says Philip Fasano, KP executive vice president and CIO of Kaiser Permanente (KP), speaking at the mHealth + Telehealth World Congress 2013. All information is available in real time for all patients no matter the care setting.

Fasano sees a fully engaged, empowered patient in the near future. But, those patients want and need to be engaged “on their terms, not ours. Technology tools play a big role in allowing us to connect with patients in a much more proactive, seamless, service-oriented way. Once we’re down to that level, the patient/consumer defines what’s personal to them.”

KP’s mobile apps have been available for just over a year and already have been downloaded by more than 250,000 people. “They tend to use it more and more often because it’s always with them,” Fasano says. And, studies have shown that more engaged patients are healthier. “KP members say they would never join another organization that doesn’t offer Kaiser. There’s a level of service they’ve come to expect.”

Looking ahead

Over the next couple of years, the mHealth market will consolidate and we’ll “see some clarity around which of the apps are really worthwhile,” says Kvedar. Today, about 60 percent of chronically ill patients are using apps but he predicts that figure will be closer to 75 percent. “We’ll be using more and more software apps on devices to connect with them which really enables new opportunities for accountability as well as coordination of care.”

As part of the shifting healthcare landscape, Kvedar sees physicians serving more as a sherpa than the traditional stern kindergarten teacher. The healthcare industry can give patients “so much more to do for themselves. Nobody cares more about your health than you do,” he adds.

The mHealth market is “an incredibly dynamic space,” says Swofford. She predicts mobile health playing a role in advances in personalized medicine. Apps “can capture your information and make tracking of that so easy that it lends itself to refinement of a personalized care plan.” That also means “a lot of data are going to be exploding onto the scene that we then have to figure out how to provide insight around. Data can be really overwhelming and we need to make them actionable.”