mHealth Emerges as the New Essential Strategy for Specialty Pharmacies

Health care providers can utilize mobile health technology to provide patients with targeted adherence reminders and disease management guidance.

Communication across the health care continuum has been notoriously inconsistent and uncoordinated in its attempts to meet patients’ need for information. This communication gap becomes even wider in the case of a complex disease. For example, the average patient with cancer sees more than 13 different health care providers in a 12-month period, and 46% of these patients see more than 21 unique health care providers.¹ In such a complicated scenario, patient outcomes are compromised, which can lead to unnecessary and excessive costs.

The use of mobile software, smartphone technology, and targeted messaging has emerged as a way for specialty pharmacy and the entire team of health care providers to give individuals convenient access to pharmacy and medical information, along with tools for improving compliance and overall health. As a patient engagement strategy, these tools give providers a rare opportunity to drive better choices through targeted communication. When executed properly and with the right messaging platform, providers can join the growing number of employers and health plans that have adopted mobile-access and mobile-platform technology strategies to meet health care needs and streamline the management of chronic diseases and pharmacy utilization (Figure).

Benefits of mobile health (mHealth) programs include:

• Improved care
• Lower overall and information technology (IT) costs
• Targeted messaging that reaches individuals where they are most receptive
• Reduction in repeat messaging
• Greater ability to comply with the Health Insurance Portability and Accountablility Act and meaningful-use policies

What’s more, these programs, when combined with effective messaging services, increase customer satisfaction. Patients appreciate easy-to-access, consistent messaging, as well as configurable communication settings, to optimize their ability to communicate and feel empowered by their health care experience.

Ultimately, specialty pharmacies and health care organizations should look for a partner that offers the most robust platform functions, along with the right combination of pharmacy intelligence, reputation, and health care IT knowledge.

Challenges and Trends

One of the biggest challenges in health care has been finding ways to effectively prompt patients to make the right health care choices (ie, take their meds, undergo rehabilitation, and make follow-up visits). Improved medication adherence can greatly reduce total health care use and costs by decreasing hospitalization and emergency department (ED) use.² Recent data clearly outline the trend toward mobile communication³:

• 247 million Americans have downloaded a health app
• 95 million Americans use their mobile phones as health tools
• mHealth is a $1.3-billion industry
• Of US hospitals, 42% are using digital health technology to treat patients

Estimates show that the global mHealth market will reach $23 billion by 2017 ($6.5 billion for the United States and Canada).⁴ In addition, experts predict that remote patient monitoring using mobile will save the United States $36 billion in health care costs by 2018.³

How mHealth Messaging Works

A robust mHealth solution with an effective messaging service has the ability to analyze an individual or population’s demographic and health care data while prompting action that will contribute to wellness or care. Topics to consider include:

• Wellness reminders—Prompts and measurements for exercise, attitude, diet, and other activities have been shown to have a substantial impact on outcomes.
• Adherence—This includes simple medication/dose and prescription refill reminders, notices to return to the care setting for follow-up, and prompts for physical therapy or rehabilitation activities.
• Monitoring—Keeping track of patient information with regard to blood pressure, weight, blood sugar, mood, and pain levels helps providers get in front of health issues, which represents real opportunities to improve outcomes and cost savings. By the time the patient shows up at the ED, the opportunity is gone.
• Disease and condition management— Patients want help and guidance, but often do not get enough face time with their doctors. Messages specifically geared to medical conditions—such as diabetes, pregnancy, chronic heart failure, asthma, and others—are well accepted because they enable better care management between visits.
• Education—Messaging also delivers useful materials for educational purposes, “how-to” videos for rehabilitation exercises, 2-way communication for surveys or data collection projects, and telemedicine.

Current messaging services fall on a spectrum: on one end, services tend to focus on the mechanical aspects (delivery service), while the other end of the spectrum focuses on the more clinical (content-focused) side. Whatever form it takes, messaging is the ability to speak to the patient or stakeholder “where they live” and in the format they prefer in order to engage, educate, and generate better health.

With apps designed to support patient care and to enable pharmacists, clinicians, and hospital staff to encourage medication adherence for chronic health conditions (eg, diabetes and asthma), hospitals can cut costs and work with individuals who are at risk for adverse drug events that lead to hospital readmissions.

With access to their medical and pharmacy claim data, patients are able to make better-informed choices that can increase prescription drug adherence, reduce costs associated with emergency care, and improve their overall quality and satisfaction with health care. Apps can also serve as decision-support tools for health care providers, allowing them to quickly suggest additional prescription drug purchasing channels, such as mail order and retail discount options available through network pharmacies.

Some mHealth solutions are more effective than others. It’s important to find one that offers flexible mobile technology apps that enable patients to easily interact with health care providers and pharmacy benefit managers (PBMs). The mobile app suite should offer a configurable approach to placing mobile decision-support tools in the hands of patients, including:

• Medication history and drug look up
• Drug savings calculations and plan benefit options
• Personalized messages
• Biometric trackers
• Physician office visit preparation applications

A Closer Look at Targeted Messaging

The most effective use of these programs is for patients to have the information and guidance they need at certain “trigger points.” This strategy utilizes data analytics to detect a consumer’s current status before automatically initiating relevant communications to prompt plan members to take health and wellness actions. More than 50% of health plans intend to invest in trigger-based communications.⁵

Health care messaging is about identifying a population and quickly delivering appropriate content or information in actionable form. It should serve as a multimodal communication tool for stakeholders across the health care continuum, with particular attention paid to rapid or real-time trigger messaging via text message/short message service (SMS) or push notifications.

As the patient’s cost share grows through both higher co-pays and higher deductibles, so does the opportunity to assist them in decision making. Increasingly, individuals seek information to help them maximize their health care dollars. Studies show that 21% of consumers want to receive health information via SMS text message⁶ and 77% of patients find technology “inviting,” rather than “intimidating,” when it comes to helping them manage their health.⁷ The challenge for specialty pharmacies and other providers is to find the most effective messaging platform.

Finding the Right Messaging Platform

Ideally, a multimodal messaging service should offer customizable content and delivery options to support targeted messaging to PBMs, accountable care organizations, or members of a health plan based on their preferred communication channel: SMS, e-mail, Web portal, mobile platform, customer service representative (CSR) outreach, and print/mail.

The service should offer menu-driven options for creating manual, automated, or serialized messaging campaigns to members, providers, caregivers, and pharmacists, covering such topics as:

• Pharmacy savings: generics, pharmacy network use
• Pharmacy compliance: refills, recalls, dosage, medication therapy management
• Medicine cabinet: drug search and use assistance, formulary criteria, co-pay discount offers
• Wellness care and immunizations: health maintenance suggestions, promotion of retail and alternative site delivery
• Compliance/adherence: increase star ratings, Healthcare Effectiveness Data and Information Set scores, meaningful use stages
• Medicare Advantage: reduce monthly drug summary print mailings

The platform’s analytics engine should leverage health care data to target populations, personalize messages, and facilitate targeted member selection based on a variety of data elements, such as demographics, drug use, and compliance history.

Two important features to look for in a messaging platform include:

• Dashboard/message builder—The dashboard should facilitate message construction and allow users to select distribution settings. It should include message scheduling (avoiding SMS text deliveries at night), message management (ie, how many messages individuals get and prioritization), and a message approval matrix to ensure appropriate, multitiered approvals for messages before they are sent.
• Outgoing messenger/delivery service—Message delivery should take place via a variety of channels (SMS text, push, e-mail, portal messaging, CSR, print/mail), as specified by the member or recipient.

Specialty pharmacies play an important role in the larger health care team of providers, partner pharmacies, payers, and biopharmaceutical companies. Communication, coordination, and collaboration among all stakeholders is imperative to support effective and efficient patient care.

A growing number of health care stakeholders recognize the power of the well-timed personalized message to encourage patients to make more responsible choices in care and reduce unnecessary costs.

Clearly, receptivity for targeted messaging is high and growing as more individuals embrace mobile technology. The remaining challenge for specialty pharmacies and their health care partners is to find and implement the most effective messaging platform on the market. The goal is to empower patients by quickly delivering the right message at the right time to prompt action, better choices, and improved health. SPT

References

• Smith R. Bridging gaps in patient care: the value of proactive engagement in the specialty care model. Biologics Inc website. www.biologicsinc.com/clinical-therapeutic-intelligence/bridging-gaps-patient-care-value-proactive-engagement-specialty-care-model/. Accessed October 7, 2014.
• Oscar R. Smarter pharmacy benefits: how mobile technology communications improve pharmacy utilization and cut costs. RxEOB website. www.rxeob.com/secure/pdf/MCO_Smarter_Pharmacy041513.pdf. Managed Care Outlook. 2013;26(8). Accessed July 22, 2014.
• Fay T. This infographic shows the power of wireless medical innovation. Senior Lifestyle website. www.seniorlifestyle.com/infographic-shows-power-wireless-medical-innovation/. Published February 2014. Accessed September 29, 2014.
• GSMA and PwC. Touching Lives Through Mobile Health. PriceWaterhouseCoopers website. www.pwc.in/assets/pdfs/telecom/gsma-pwc_mhealth_report.pdf. Published February 2012. Accessed September 19, 2014.
• Miliard M. Payers do trigger-based communications. Healthcare IT News website. www.healthcareitnews.com/news/payers-moving-toward-trigger-based-communications. Published April 16, 2012. Accessed September 19, 2014.
• Dolan B. Text messages: the workhorse of mobile health. MobiHealthNews website. http://mobihealthnews.com/19440/text-messages-the-workhorse-of-mobile-health/. Published December 11, 2012. Accessed September 19, 2014.
• Monegain B. Consumers want technology to help keep them healthy, survey shows. Healthcare IT News website. www.healthcareitnews.com/news/consumers-want-technology-help-keep-them-healthy-survey-shows. Published June 5, 2009. Accessed September 19, 2014.

About the Author

Robert Oscar, RPh, president and chief executive officer of RxEOB, has more than 25 years of experience in health care. Throughout much of his career, Mr. Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk, including pioneering work in the Medicare HMO market. Before founding RxEOB over a decade ago, he worked in the medical information systems industry designing, developing, and implementing several different claims analysis tools. A registered pharmacist licensed in Virginia, Mr. Oscar is a graduate of Ohio Northern University and is certified in pharmacy-based immunization.