Money is Mobile Health’s Biggest Obstacle

For $29.99 you can buy a smartphone app that translates a baby's cries. For $3.99 you can buy an app that claims to stimulate hair growth by issuing inaudible frequencies that increase blood circulation in the scalp. And for 99 cents you can flick a finger and send a cow bouncing around your phone's screen.

So what would patients pay for a mobile app to monitor their health? One recent study suggests the answer lies somewhere between the cost of an implausible baby decoder and that of a questionable hair restoration technique. Look at the numbers a little more closely, however, and the price drops to less than a game of cow-tipping.

Roughly half of patients surveyed said they would buy mobile technology for their health. Of those, 20% said they would use it to monitor fitness or wellbeing, 18% want their doctors to monitor their health conditions, and 11% would like to monitor an existing condition, according to a recent survey report by PricewaterhouseCoopers' Health Research Institute.

Although 40% of respondents said they were willing to pay for a monthly mobile phone service or device that could send information to their doctor, they don't want to pay more than $10 a month for it. And actually they don't even want to pay that: Most patients expect their insurance would cover the cost, according to the report. 

But with little or no evidence that mobile health improves quality and reduce costs, insurers aren't opening their wallets.

Other industries have figured out ways to get paid for electronic transactions and services—music downloads or stupid smartphone applications, for example. But healthcare lags in figuring out who pays—and how much.

The current reimbursement model is one of the barriers to more rapid adoption of mobile health: in-person consultation is still the main basis of reimbursement in healthcare, says PricewaterhouseCoopers. "Public payers and private health insurers, who are primarily responsible for paying for healthcare, have generally not pushed for adoption of mobile health."

This is beginning to change, as a small but growing number of health plans pay for remote monitoring devices to help reduce hospital readmission costs. According to the survey, physicians were most often reimbursed for phone consultations for chronic disease management. But wellness and maintenance—for which smart phone apps are well-suited—is still the least reimbursed.

Payers want to see evidence, says Roy Swackhamer, chief information officer of SCAN Health Plan. "Everyone is doing pilots, but it needs to be scaled so a physician with 500 congestive heart failure patients can take advantage of the data. We need predictive algorithms that can be used with data aggregation tools in order to analyze trends and perform predictive analysis."

Until that data-driven evidence comes in, physicians in the survey listed a number of benefits to mobile healthcare for payers, patients, physicians, hospitals, and other healthcare organizations. Among them:

• Of those physicians who are using mobile devices in their practice, 56% said the devices expedite decision making and nearly 40% said the use of mobile devices decreases time spent on administration. 

• Physicians agreed that the greatest benefit of mobile health would be to help them make decisions faster by accessing more accurate data in real time.  One-third of physicians surveyed said they currently make decisions based on incomplete information for seven out of ten patients they see.  Only half currently access electronic medical records while visiting and treating their patients. 

• Forty percent of physicians said mobile health could reduce office visits by 11 ? 30%, potentially easing the physician shortage, reducing hospital readmission costs, and increasing access for patients who delay care because they don't want to wait for an appointment.

• Forty-five percent of physicians said that Internet visits would expand access to patients, giving them more time to interact with patients.

"The technology of telehealth is well ahead of the socialization of the telehealth idea and we are at a tipping point for utilization to begin taking off," David Jacobson, WellPoint's staff vice president of business development, state sponsored business, says in the report.

All we need now is an app that shows when the cow is done tipping—and has finally fallen over.

PricewaterhouseCoopers' Healthcare Unwired report and survey highlights are available here.