Leveraging mHealth to reduce hospital readmissions

A growing number of top hospitals have begun to incorporate mHealth — the use of mobile technology devices and smartphones for healthcare purposes — to connect patients and clinicians, improve care coordination and reduce avoidable, costly hospital readmissions.

Hospital readmissions stem from multiple comorbidities and the use of six to 12 (or more) prescription medicines, according to the Henry Ford Health System, as well as the need for healthcare providers and community partners to close gaps in transitions of care.

According to Kaiser Health News, in 2013, 2,225 hospitals paid penalties for high hospital readmission rates, costing them up to 2 percent of their Medicare reimbursements — a collective total of $227 million. According to Health Affairs, historically, about one in five Medicare patients discharged from a hospital are readmitted within 30 days. While healthcare reform has helped reduce hospital readmissions — which dropped from 19 percent in 2011 to 17.5 percent in 2013 — more can be done.

According to a 2012 HIMSS Mobile Technology Survey of clinicians, 52 percent believe the use of mobile technology will substantially impact the delivery of healthcare in the future, with another 16 percent noting that the use of mobile technology will dramatically change the way that healthcare is delivered in the future.

Respondents also ranked pharmacy management (medication reminders), care continuum (remote patient monitoring and post-acute readmissions) and preventive support care (wellness management) as benefits that mobile technology can deliver.

Critical advantages to adopting mHealth strategies
One key reason for preventable readmissions is that patients do not always hear or remember what is communicated to them during the discharge process, fueling a non-compliance issue that costs the U.S. healthcare system $300 billion each year, according to the PhRMA Organization.

mHealth directly addresses gaps in communication across the healthcare delivery system, impacting outcomes in chronic disease management, improving care coordination and gathering data for population health management.

Forging a strong connection with patients and aiding the post-discharge process is critical for improving outcomes. Healthcare apps offer patients easy access to essential medical and pharmacy benefit–related information, including the following:

  • In-network provider directories and directions to offices
  • Pharmacy and medical benefit summaries and claims history
  • Drug formularies and drug prior authorization status
  • Deductible summaries and cost-sharing requirements
  • Drug prices of nearby pharmacies and expected out-of-pocket costs with generic and therapeutic alternatives
  • Self-diagnosis tools with symptom and disease lookup features
  • Daily wellness tracking tools for achieving health-related goals
  • Health-related symptom checkers
  • Reminders and alerts for prescription drug compliance
  • Options for in-home monitoring and in-home care

Currently, health-related apps are used primarily for information retrieval, with some mobile devices providing more one-on-one interaction. For example, RxManager, which is offered by Physician's Plus, provides personal drug utilization information for each patient, including specific money saving suggestions for better pharmacy benefit use. The app also offers patients a number of features, including the following:

  • Records immunizations and health screenings, and those recommended based on the individual's profile
  • Tracks health and wellness, including weight, HgA1c, headache log, blood pressure, cholesterol and more (the date and time selector supports multiple tracker measurements per day)
  • Creates a list of questions to ask the physician

The most effective Web-based platforms perform these tasks:

  • Gather, integrate and access drug claim histories and formulary data
  • Deliver personal notifications to patients regarding drugs that require prior authorization
  • Contain personalized messaging to increase the effectiveness of consumer engagement communications
  • Include reporting applications that measure changes in pharmacy utilization and prescription drug adherence for chronically ill patient populations

Ultimately, the widespread use of mHealth will save time and money across the healthcare delivery system, simplify pharmacy understanding and utilization, and enhance the effectiveness of medication therapy management.

As more hospitals and hospital systems begin to develop networked apps for their providers, physicians will be able to extend their clinical tools — and reach — to more people. Along these lines, apps designed for physicians are expected to become better connected to patients' clinical records so that information can be easily shared between healthcare providers.

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

Leveraging the mobile technology revolution
Nielsen's Digital Consumer Report estimates that 65 percent of all Americans owned a smartphone in 2013, according to Engadget, and experts predict that healthcare and medical app downloads will reach 142 million by 2016, making mHealth one of the most promising ways to curb avoidable hospital readmissions, according to Managed Care Outlook.

A growing number of top health systems have adopted mobile technology for reducing hospital readmissions and achieving a return on investment. Danville, Pa.-based Geisinger Health Plan developed its Geisinger Monitoring Program, which uses remote monitoring technologies to increase interactions between caregivers and patients upon discharge. The program recorded a 44 percent reduction in hospital readmissions, according to Healthcare IT News.

Boston-based Partners HealthCare saw a 50 percent reduction in hospital readmissions of its heat failure patients through the use of home telemonitoring, according to Kvedar, according to The Commonwealth Fund. In Grand Rapids, Mich., Spectrum Health Heart Failure Clinic launched a collaborative remote monitoring technology program for heart failure patients in December 2010. Within the program's first year, the clinic realized a cost savings of 34 percent, or approximately $1.7 million, and a 73 percent reduction in hospital readmissions, according to Dorland Health.

Given that a significant portion of a healthcare provider's cost is for human resources, mobile technology — including smartphone apps and Web platforms — offers significant promise for creating a more efficient system at the point of care, and an ecosystem of Web applications and services that work in collaboration to connect and support patients, caregivers and providers.

Robert Oscar has more than 25 years of experience in healthcare. 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, Mr. Oscar worked in the medical information systems industry-designing, developing and implementing several different claims analysis tools. Mr. Oscar, a Registered Pharmacist licensed in Virginia, is a graduate of Ohio Northern University and is certified in pharmacy-based immunization. Contact info: info@rxeob.com or 804.643.1540 x221.

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