There's a missing connection in the health insurance exchange debate that could push mHealth to the forefront: pharmacists.
The pharmacist, after all, knows more about your drugs and prescriptions than anyone else. So a real-time mobile link with the local pharmacy could be the key to medication management and adherence — two drivers of healthcare costs and clinical outcomes that factor in today's fractured healthcare landscape.
That's the opinion of Robert Oscar, president and CEO of RxEOB, a Virginia-based developer of software solutions that help consumers work with health plans and pharmacy benefit managers.
"It's my job to help people with healthcare questions when they're not in a doctor's office," says Oscar, himself a pharmacist. "It's all about connectivity and information-sharing."
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With the Affordable Care Act pushing millions of Americans into health insurance and consumers gaining more control over how they manage their health, health plans and payers are taking on new challenges in the healthcare cost debate. They want to cut into the nation's healthcare bill, either by reducing unnecessary expenses or improving health management and outcomes, and a link with both consumers and pharmacies would certainly help.
They're also sharing the risk. Oscar points out that high-deductible health plans are "going to be more widely and wisely used" and payers realize they have to compel consumers to make better health decisions. That means improving communication between the health plan and the member.
"This will change how people view these plans," he says.
Indeed, that might just work both ways. While consumers will need digital tools to research various health plans and determine if a brand-name or generic drug is better, health plans will want to use the latest information from pharmacies to measure medication adherence and patient engagement, from which they can develop or modify programs that compel members to make better health decisions.
Oscar sees pharmacy data as "the canary in the coal mine." Health plans are just waking up to the fact that medication data recorded by pharmacists can be used not only to chart adherence, but as a sign of future healthcare costs. After all, if a consumer isn't taking his or her prescribed medication, or if he or she is loading up on other medications, that's a sure sign of more health issues down the road. And the sooner those trends are noticed, the better chance that they can be addressed before a serious health issue occurs.
[See also: Telecom giants paving path to healthcare.]
In an op-ed written last year, Oscar points out that "consumer demand for convenient, streamlined information and access" will drive health plans to invest in the latest mHealth technology. This is true in the self-insured market, where employers will want health plans that allow their employees to look up drug prices and benefit options and individuals want the latest information as they shop the health information exchange for the best plan.
"Technology plays a crucial role in managing the pharmacy benefit expenses consumers will face as they purchase various health insurance policies from the private exchanges," he wrote.
In addition, health plans and pharmacies are looking at mobile messaging as a means of helping members and consumers make the right choices. They can push medication reminders, get feedback on programs and offer health and wellness advice that can be targeted to specific consumers — the idea being that the more personal the message, the more likely it is to be understood and followed.
And no one knows how to prepare that message better, Oscar says, than a pharmacist.
"This is an exciting time for us," he says. "We have the expertise."
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