By Robert Oscar, R.Ph. President and CEO, RxEOB
In the wake of the Affordable Care Act and the Supreme Court ruling to uphold its challenging mandates, employers are looking for the best tools to help them provide for employee healthcare needs. If or when the health insurance market begins to move towards more individual purchasing of coverage (e.g., the uninsured and/or small employer groups that move employees to insurance exchange purchasing), more people will comparison shop in order to lower their premium costs and to purchase benefit packages that offer better value.
Into this new environment, the global market value for mHealth, the use of mobile software and devices for healthcare purposes, is set to explode over the next half-decade. In particular, smartphone technology has emerged as a revolutionary way for physicians and patients to communicate, access medical records and claims data, and improve compliance. Therefore, a thoughtful and engaging mobile-access and mobile-platform technology strategy will make it easier for employers and health plans to meet their employees where they want to meet – which is increasingly at the employees’ convenience. In addition, this new strategy will greatly simplify the management of chronic diseases and reduce the cost burden of unhealthy lifestyles and aging populations.
Smartphone technology and mobile website capabilities give employees easy access to a wealth of essential medical and pharmacy benefit–related information, including:
- 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
Consequently, employees are empowered to make better, more well-informed choices that will increase prescription drug adherence, reduce costs associated with emergency care, and improve the overall quality of healthcare. In addition, health-related apps support programmatic interventions and provide employees with tools for self-managing existing health-related conditions. They can also serve as decision-support tools for healthcare providers and pharmacy benefit managers (PBMs), allowing them to quickly connect plan members to appropriate care sites, encourage healthy behaviors, deliver compliance alerts and suggest additional prescription drug purchasing channels, such as mail-order and retail discount options.
By leveraging this instant access to information, employers have an opportunity to influence individual employee behaviors in order to lower rates and improve overall workforce health and productivity. Additionally, health apps can help streamline the flow of information between health plans, physicians and patients — facilitating one-on-one exchanges that close gaps in care, shorten medical response times, and improve the overall healthcare system. For employers, this means a positive impact on the bottom line.
Designing an effective mobile strategy begins by partnering with a service provider that can offer Web-based platforms that automate labor-intensive processes, such as gathering, integrating and accessing drug claim histories and formulary data. These platforms should also have the capabilities of delivering:
- Personal notifications to members regarding drugs that require prior authorization
- Personalized messaging to increase the effectiveness of consumer engagement communications
- Web-based reporting applications that measure changes in pharmacy utilization and prescription drug adherence for chronically ill patient populations
Automated personal mobile app services – combined with reporting apps that measure the appropriate use and effectiveness of healthcare – will not only increase satisfaction rates among purchasers/employers and patients/employees or dependents, but also save time and money across the healthcare delivery system. A unified approach to mobile access through an integrated suite of apps gives employers and employees the best approach to informed and personalized decision-making.
Robert Oscar, R.Ph., has more than 25 years of experience in healthcare. Throughout much of his career, Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk including pioneering work in the Medicare HMO market. Before founding RxEOB more than a decade ago, Oscar worked in the medical information systems industry, designing, developing and implementing several different claims analysis tools. Licensed in Virginia and certified in pharmacy-based immunization, Oscar is a graduate of Ohio Northern University. Contact info: info@rxeob.com.
