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M-health, Mobile Apps from the Payer Perspective

 |  By smace@healthleadersmedia.com  
   January 29, 2013

Are healthcare payers ready to reimburse for m-health and mobile phone apps? This week, the conclusion of my healthcare-focused conversation at the International Consumer Electronics Show with Reed Tuckson, MD, UnitedHealthcare group executive vice president and chief of medical affairs.

HLM: What role do you think technology is going to play in mental health?

Tuckson: I think we are especially excited around the telepsychiatry services that are going on in mental health. We recognize the real issues of availability of supply, of trained mental health workers, and we clearly understand also the logistics of geography.

Telepsychiatry is really becoming an established, recognized field, and it is also encouraging that patients actually are not intimidated by not having a person in the room geographically and spatially with them, and seem to respond well to the technology.

HLM: So you've been reimbursing for it widely for a long time.

Tuckson: Yeah, just as we have been reimbursing for synchronous video communication on the clinical side. We reimburse the same for synchronous video on the clinical side as we do for whether you were spatially in the room.

HLM:  Do you have an ultimate vision of where all this is going?

Tuckson: We are obviously bullish. On the other hand, we are appropriately cautious. We do not get seduced by technology for technology's sake, and we recognize that while there are lots and lots of mobile apps being rolled out every day, the number of people that are using them is still fairly small.

... I like my FitBit; it works well, and it gives me that immediate feedback that I really want, and it gives me information in an interesting way that's not intimidating. But the ultimate vision, the ultimate excitement will be when we can take that technology and move it in a more integrated way with other things so that the combination of factors gives you a much better chance to move the needle to actual change in behavior.

If things are not moving the needle to change behavior, then it's just all been fun, and it's been interesting, but it doesn't mean anything. The only thing that matters is success. Our vision is interconnected, coordinated stitching together from the individual/personal into the clinical care delivery system in a meaningful way at scale. All of that then leads to people making personally appropriate choices and changing their behavior.

Are we excited about it? Bullish? Yes. Are we also recognizing that we don't have money in our society to waste, that the consumer is paying a lot of money for healthcare, and will be paying more for healthcare?

We're going to have to obviously make sure that any of the things they're doing that are discretionary add value. If things do not add value to healthcare, then they're not going to survive. They shouldn't survive.

HLM:  Do you feel your colleagues in the industry are tuned into this as you are, or does the industry as a whole have more work to do?

Tuckson: I think the industry as a whole has more work to do, but the key thing is, again, we're going to have to find a way that people come together. One of the things that's going to be very interesting in the future as we try to figure out where we go is, what happens when we start to go from the pure consumer space more into a medical space?

If the app that we're using to advance wellness now has to start moving into the space that may be associated with diagnostics, or disease monitoring—titrating of actual behavior—to start to look clinical, now we're starting to get to a whole 'nother area, which is going to be then subject to regulation, to regulatory oversight. All these are the issues that are there, and what we want to see is, How do all the participants in this space begin to see how these things connect?

HLM:  Scanadu delayed its launch so they can get FDA approval, so it can be used in a medical setting.

Tuckson: At some point, you get precise about what you're trying to do, and you want it to be demonstrable to have a real impact on human health. When you do that ... you make claims, and a consumer has to purchase something based on claims of reliability, that it will do what it says, [and] a physician's office has to say that in fact this thing that a patient is doing, if I'm going to incorporate it into my clinical paradigm, I need to understand its reliability, its trustworthiness and its appropriateness.

So you want there to be appropriate regulatory oversight. All these things have to be sorted out. What I would say is, let's not let those challenges slow down the train of innovation. We've got a lot of room to get to, and a dynamic dialogue. The alternative hypothesis is almost unimaginable, which is, we do nothing, we don't innovate, we don't develop new ideas, we continue to have this extraordinary increase.

HLM:  Or we wait for the clinical trial system to work, which takes forever.

Tuckson: If we don't do something, all we know is next year, the obesity rate will be higher, the percentage of people who get no exercise outside of going to work will go beyond 26% to—what? 30? That the [percentage] of diabetics go from 9.5 to—what? 13?

At the end of the day, the null hypothesis doesn't work. So let's get us moving. Let's keep at it, and then let consumerism take over. Let the consumer tell us what they want and how they want it, what works for them. If we're in this era of patient-centered care, let's take it for what it means.

Let's all figure out how what we do connects into meeting the comprehensive, holistic needs of the patient, and continue to ramp up the interventions for those needs as the patient changes. As they get healthier or less healthy, as their disease challenges change, as their social environment changes, let's keep giving them what they need so they can make the choices and the behaviors that we want.

HLM:  Arianna Huffington said 44 million healthcare apps will be downloaded this year. You've got to leverage that.

Tuckson: Some will survive. Some won't. Some should. Some shouldn't. Let the marketplace go forward, but let us all try to at least engage the person. ... I wrote a book called The Doctor in the Mirror. The thesis of the book is in the title. Look in the mirror, and you will see the best doctor you'll ever meet. That's you!

Who knows you better than you? Who makes more decisions every day about your health than you? Who loves you more than you? The reaction to that book has absolutely astounded me, because the people that I talk to now who have read it are almost overwhelmingly reminding me of the importance of empowering people to make choices and decisions.

Now you and I, we sort of take that for granted. [But] the majority of people still do not have the message that you can and should take charge of your health, in every area. So we've got to keep having that conversation. Then, once you have people engaged and excited, then you're saying, I've got this tool, or they will find a tool and say, This meets my needs, I've decided to take charge of my health. Now how do I do it? Oh, here is an aid. It fits into my normal lifestyle.

Tuckson: You asked about a vision for the future, and what really gets me excited. Move the health out of the health ghetto and into your life. I was at a conference in New Orleans where I first got this. I was in my hotel room. I had conference call after conference call. I finally said, I've got to get out.

I go to my smart phone, I put in an app, AroundMe. It tells me which are the coffee shops, or anything, around me. A map comes up that shows me how to get there. I go outside and I walk. I take steps, I go somewhere. I get inside of the coffee shop, and I pull up an app that tells me the nutritional content of what's in the store. I figure out the one that's best for me. I'm getting ready to order. I love the song that's playing. I hold up my phone. There's an app that tells me the name of the song. Then it asks me do I want to buy it? I buy the song, I buy my food, I go back to my hotel.

When I finish my last conference call, I go to the gym to work out. I put on the song I just downloaded. My heart rate goes up 20% more than it was before, because I'm moving to the rhythm. Which part of that was health, and which part of that was living? That's when it hit me. Now I got excited, because instead of my deciding now, I'm going to go do health, no, no, no. I'm just going to go do living. The health happens.

HLM:  I was looking at a feature on UnitedHealth's website called My Cost Estimator. Would you ever consider making that social—so if I'm checking my cost estimator, my friend who is with UnitedHealth and she's checking hers, and we want to compare notes, we could decide to share up what we're estimating and costing out, and have kind of a social aspect to it. Under our control, of course—it's our data, and you're part of that ecosystem. Does that look like something that would be a part of this?

Tuckson: I applaud you for an intriguing idea. I think as we would evaluate that, the issue is that we believe in transparency. We think the information ought to be available for people to make appropriate choices and decisions. We think that people should have information first about the quality of the care that's provided, and one of the key elements of care provider quality is patient experience with care, and the satisfaction they have with care—which is very much a social issue, and as people start to say, 'well, how were you treated when you went to such and such a health group or physician?'

So the fact that you would have that kind of social conversation about it would be interesting. If people were to share and begin to understand the differences in costs based on health benefit design, that would be very useful.

Now, of course, knowing that there will be differences in that, vis-à-vis the employer's benefit plan offering and the risk profile of an employer, that might make it a little bit different—so there may not be that ability to do direct one-to-one comparison—but at the end of the day, having more people have more of an informed conversation on the quality and cost effectiveness of care delivery is certainly something that we desire, so thank you. We'll continue to think about that.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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