mHealth’s Use by Payers
Payers can promote wellness programs and health tips through
mobile apps that potentially reduce the number of claims in the
future. If payers are successful in keeping their consumers healthy,
it may help them reduce costs and payment claims. In addition, the
payers—with the help of data from the patients—can target specific
populations and communities that are at a risk of specific illnesses
and alert them to lifestyle changes that can aid in prevention.
The diagnosis of congestive heart failure is a widely prevalent
chronic condition that can have frequent acute exacerbations often
resulting in (repeated) hospitalization. From the payer sector this
highly prevalent and expensive course of treatment became one of
the dreaded “never events” for which reimbursement would be denied if a hospital readmission occurred within 30 days of a previous
admission for the same diagnosis. Many of these patients undergo
a course of home health services post discharge from the hospital.
A sentinel condition for this diagnosis is rapid weight gain in a brief
time period, indicating fluid retention, which puts patients on the
path to hospital admission and payment denials.
Home health caregivers can use mHealth devices like a clinical scale with recording and transmitting connections to measure a patient’s weight daily and transmit the data back to the
agency. This provides an early warning of weight gain and leads
to quicker intervention—everybody benefits. This same set up
could be used by the patient at home with similar results.
mHealth Challenges and Implications
mHealth is in its infancy and will continue to grow and evolve as it
is driven by biomedical and technological research enterprises in
search of “newer and better” products or new revenue streams. In
the current technology revolution, it can pretty much be said, “If it
can be imagined, it can be done.” However, there are several major
challenges within mHealth technology, including issues with confidentiality and security, regulation, and technology integration.
Confidentiality and Security
As HIPAA requires, the personalized data of the patients must be
safeguarded. Any breach in patient confidentiality due to hacking
of non-secured applications can lead to HIPAA violations. Thus, security of patient information is a never-ending challenge. In addition, digital technology is moving at an unprecedented rate, causing regulations and standards to fall behind. As millions of people
are using some form of mHealth, a software bug can invite hackers.
Another issue is theft of mobile devices, which is prevalent and can
lead to a data breach. Finally, viruses or malware can infect apps
and the entire network to which they are connected.
Navigating healthcare regulations remains a hurdle for content
developers and providers. These laws may pertain to reimburse-
ment or prescribing. There are a number of regulations that need
to be met in order for mobile devices to become true tools for
hospitals and practices to use. For example, an app that is direct-
ly involved in dispensing or controlling prescription drugs and
controlled substances may have to meet FDA regulations and re-
quirements before being accepted and authorized for use.
mHealth requires seamless integration of devices and applications. Thus, overdependence on these devices can cause a system to stop when there are software or connectivity issues.
mHealth technology is changing the traditional data collection practices. Traditionally, vital signs are collected in doctors’
offices or bedside, and data are recorded in patient medical
records. Mobile devices allow patients to collect these vital records and daily physical activities at home or on the go. HIIM
professionals need to be familiar with and have skills to manage
this kind of non-traditional approach to data collection.
The information recorded and collected from each activity in
mHealth is segmented unless it can be integrated with electronic
health records (EHRs). EHR integration can enhance the provider
workflow, promote better care delivery, and improve data collection.
The major role of HIIM professionals in this mHealth era is designing, managing, and enhancing EHR integration with mobile devices.
Change is Constant, Stay Current
As with all things related to the delivery of health services,
change is a constant and very fast. Staying current is a continual
challenge, as is the awareness of obsolescence and the need to
discard what was recently new but is no longer relevant. ¢
1. World Health Organization. “mHealth: New horizons for
health through mobile activities.” 2011. www.who.int/goe/
2. BCC Research. “Global mHealth Technologies Market Projected to Reach nearly $21.5 Billion in 2018; Europe Segment
Growing At 61.6% CAGR.” Press release. March 25, 2014. www.
3. Taylor, Karen. “Connected health: How digital technology
is transforming health and social care.” Deloitte Centre
for Health Solutions. 2015. www2.deloitte.com/content/
4. mHIMSS App Usability Work Group. “Selecting a Mobile
App: Evaluating the Usability of Medical Applications.” July
5. van de Sande, Michiel. “A Doctor’s Perspective: How Mobile Messaging is Providing Faster and More Cost Effective
Care in Hospitals.” Journal of mHealth. October 26, 2017.
Shannon H. Houser ( email@example.com) is an associate professor, Howard W.
Houser ( firstname.lastname@example.org) is a professor emeritus, and Neeraj Puro (neera-
email@example.com) is a doctoral student at the University of Alabama at Birmingham, Department of Health Services Administration.