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.