Digital Health Innovations for Medicaid Super-Utilizers: Consumer Feedback
Digital health technologies — ranging from smartphone apps to simple text-based reminders — are rapidly emerging to help individuals manage their own health. However, few of these tools address the needs of Medicaid’s highest-need, highest-cost beneficiaries. Individuals in this population often have unique health and social needs and face a variety of challenges in accessing and navigating the healthcare system.
To better understand how digital technologies can potentially help high-need, high-cost Medicaid populations in better managing their health, the Center for healthcare Strategies (CHCS), with support from Kaiser Permanente Community Benefit, conducted a series of consumer focus groups in the spring of 2013. Focus group participants described the challenges they experience in managing their care; the role that technology plays in their lives; and opportunities for technology to help better manage their health.
This brief summarizes focus group themes and explores new opportunities for developers, entrepreneurs, and healthcare delivery systems to pursue digital health innovations to benefit Medicaid’s most complex need populations.
Overview of article
- This article explores how existing and emerging technologies can address the needs of high-need, high-cost Medicaid beneficiaries. The brief synthesizes key focus group themes and highlights opportunities for entrepreneurs, developers, healthcare delivery systems and policymakers to pursue improved care for complex Medicaid populations through digital health innovations
- Two of the greatest challenges facing providers when working with this population are initially locating and establishing relationships, and then maintaining these relationships. The increase in prevalence of mobile phone ownership and internet access presents new opportunities for healthcare professionals to maintain regular contact with these individuals and to receive real-time information about their clinical conditions and needs
- The study conducted 4 focus groups with consumers from 4 organizations: 1) Federation Employment and Guidance Services (FEGS) – young group with most members under age 35; 2) Community Behavioral Health (CBH) – all had a diagnosis of serious and persistent mental illness and had been previously homeless; 3) Westchester Cares Action Program (WCAP) – largely suburban group, most had to travel moderate to long distances to receive care and did not have easy access to public transportation; and 4) Institute for Community Living (ICL) – roughly half of participants were younger than 35 and several reported being homeless in the past
- In the focus group, participants described the challenges they experience in managing their care on a day-to-day basis, the role that technology currently plays in their lives, and opportunities for technology to help better manage their health
- Patients were most comfortable with voicemail, computers, and text messaging. They were least comfortable with video conferencing, iPad, and apps
- Several focus group themes emerged and can help inform healthcare professionals considering integrating digital health tools into their work, and for entrepreneurs and developers looking to design new products for this population. Such themes include: 1) There was widespread interest among focus group participants in using digital health tools with most recognizing that healthcare is becoming increasingly digitized. They were also eager to access technologies to help them manage various aspects of their health; 2) Many of the challenges the group members experienced related more to navigating the healthcare delivery systems than to managing their conditions; 3) A significant portion of the participants had low literacy levels; 4) There were broad differences in technology exposure and adoption along age lines. The greatest difference among technology exposure and utilization was with participants over the age of 40 being much less familiar and comfortable with technology; 5) Several of the participants had impaired motor functions as a result of medication side effects or health conditions; and 6) The group had mixed feelings about products or tools that shared data about their activities with providers. Some felt that these tools would help to loop care coordinators and providers into their care, while other thought they would be intrusive
- Challenges discussed in patients trying to manage their care fall into 5 areas: 1) Coverage – participants mentioned having difficulties getting real-time information about their Medicaid eligibility and enrollment status. Thus, there is an opportunities to integrate tools to address this information gap; 2) System fragmentation – participants often received care from multiple different health systems, making it difficult for all providers to coordinate their efforts. Thus, there is an opportunity to simplify the consent process and interoperable scheduling systems; 3) Medication management – nearly all participants agreed that tracking their prescriptions was a huge task. Thus, these is a clear need for products that help individuals track their medications, both at home and in pharmacies; 4) Appointment management – there was a lot of discussion about the challenges of remembering many different appointments and also of arranging for reliable transportation to get to appointments. Participants expressed frustration at often having to wait for long periods of time to see a doctor once they arrive at the clinic. Thus, there are many opportunities for entrepreneurs, healthcare delivery systems and policymakers to address these issues; and 5) Records tracking – many participants were overwhelmed by the amount of paperwork they generated and were not always certain what should be kept, what should be thrown away and what should be brought to future medical appointments. Thus, tools that allow individuals to electronically access and share their records would help address this
- Participants felt that many of the digital health products that are currently on the market could be useful to them, if they were slightly adapted to meet their needs. Adaptations may include adding text messaging features; accommodating for low literacy levels and decreased motor function capabilities; expanding the range of conditions addressed; and leveraging remote tracking features to address the transient nature of this group
- Group members were interested in: 1) Tools that monitor, track, and provide data visualizations of health progress over time; 2) Tools that allow individuals to take clinical measurements at home and transmit those data to clinicians remotely; 3) Products that are not condition-specific, but focus on overall health and wellness; 4) Mobile apps or web-based programs that turn managing health conditions into a game with points and rewards that may provide motivation for treatment engagement and adherence; and 5) Social networking tools that help individuals connect with others who are dealing with similar issues and provide them with a sense of community
- When creating digital health tools for individuals with complex needs, entrepreneurs and developers should consider the following: 1) Interface design should be intuitive, uncluttered and incorporate icons/images and voice-over features; 2) Tools should be made in multiple languages; 3) Touch features should be adapted to low-motor skill functions; 4) Tools that have direct messaging features should include test messaging capabilities for individuals without smartphones; 5) Tools should easily allow users to set and modify their data sharing settings, including the ability to send previously collected data to new contacts; and 6) Tools should go beyond addressing physical and mental well-being, taking into consideration what is needed to navigate the system and the social circumstances that impact an individual’s ability to manage his or her health
- Implications for policymakers, payers and program administrators who are using digital health tools to engage individuals with complex care needs include: 1) Medicaid health plans, healthcare delivery systems, and local and state governments can explore partnerships or pilot programs with phone carriers to receive discounted rates on smartphone units and services; 2) Payers can consider investing in consumer technologies such as mobile and text-based apps, web-based portals, and remote monitoring tools to improve the effectiveness of complex care management effort; 3) Delivery systems can consider investing in computers and tablets that consumers can both practice on, and use for health management purposes during an office visit. Care management programs can potentially link consumers to existing computer, internet, smartphone and tablet training opportunities, or create opportunities for individuals to gain experience and guidance with these tools; and 4) Delivery systems and health plans may want to explore opportunities to partner with digital start-up companies to address specific problems they are experiencing as many of these companies preliminarily test out their product with low- to no-cost pilots