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If it's beneficial, it should be reimbursed
According to McKinsey, in 2019, only 11 percent of U.S. consumers used telehealth. In July 2021, it increased to 46 percent. Although the pace of adoption of mobile health apps has slowed after the peak of COVID-19, it is still high.
And, most importantly, it is transitioning from a "spontaneous, need-of-the-moment" phase to one of sustained and mature development. Patients download and use digital health apps because they want to proactively take care of their health and well-being.
"Patients are starting to see that digital health tools help them navigate their health and well-being. This patient-centric approach has been neglected in the classic, non-digital healthcare system. As a result, health providers have recognized patients' changing needs and started supplementing their offerings with digital options. Now it's time to break the last barrier on the payers' side," highlights Dr. Komolafe.
With the increasing uptake of digital health tools among patients, payers will have no choice but to include them in their strategies. Otherwise, they will be left behind. However, the earlier the payers start to adopt mobile health apps and digital therapeutics, the better for themselves and the health system.
Policymakers should regulate breakthrough technologies if they contribute to lower costs, better patient outcomes, or higher quality of care. Healthcare is still an "open-loop system"—it doesn't have the ability to regulate itself in order to achieve specific goals.
"Delaying the adoption of digital health innovations into health systems means losing the engagement that is now rising among patients," says Dr. Komolafe. She gives an example of patients who monitor their blood pressure regularly, track their sleep quality, or use digital therapies.
They should be rewarded with lower cost of care. It's simply a matter of fair reimbursement for providers implementing digital solutions and the patients themselves, states Dr. Komolafe.
There is no integrated health without access to data
The American Psychological Association defines integrated healthcare as a collaborative approach to patient care that focuses on overall well-being. Thus, integrated healthcare requires health providers to create multichannel offerings and a new approach to address the patients' biological, psychological, and social needs.
An example is a digital platform that helps patients with diabetes manage their health and support their mental health. Such an approach favors holistic care instead of only focusing on selecting a chemical molecule for the ICD-10 code. Patients with diabetes are often at risk of depression and other comorbidities, which can worsen treatment results, reduce quality of life, and even lead to life-threatening complications.
Digital platforms support care coordination and activate the patient's engagement. They offer 24/7 health monitoring and feedback that patients need to stay motivated. They also collect and process data in real life, which is a prerequisite for Value-Based Care and Value-Based Payment—an incentive model that continues to influence preventative and proactive initiatives to improve treatment outcomes and reduce the cost of care,
according to Dr. Komolafe.
From the macroeconomic perspective, digital health tools can also potentially improve population health. For years, health systems have been trying to figure out how to achieve the so-called "Triple Aim": improve the quality of care (including the patient experience and satisfaction), improve the health of populations, and reduce the cost per capita of healthcare.
"One of the strategic ways to achieve the Triple Aim is to identify a population segment, and implement the right treatment modality with the right technology," she asserts.
Are Medicare and Medicaid fit for adopting care integration?
According to Dr. Komolafe, the U.S. health system needs digital health technologies and integrated health strategies to advance: "Digital health has come to stay here—it won't go anywhere. The care provided with digital platforms, apps, and other tools should therefore be reimbursed. Nevertheless, I'm aware such a deep shift takes time."
Telemedicine is the best example demonstrating that the uptake of technologies goes far beyond technology. The term was coined in the 1970s and we already knew 30 years ago that telehealth works and can solve problems like access to care in remote areas and for patients with chronic diseases. But there was no urgency to scale it up—healthcare systems functioned without it. We were stuck in pilot projects and thinking about technology in terms of "maybe tomorrow" instead of "let's try today."
It took a crisis like the COVID-19 pandemic to understand the value of telecare. All the previously unbreakable barriers were suddenly gone within a few weeks.
"Patients, providers and payers were excited about the rapid adoption and reimbursement of telemedicine during the pandemic. The technology for telemedicine was available in rural areas but only adopted country-wide due to the pandemic. Payer reimbursement of direct and indirect services delivered via digital devices such as wearable devices will increase as health plans incorporate billing codes, contracts and reimbursement around services associated with digital therapeutics," acknowledges Dr. Komolafe.
We need to be better prepared for future emergencies, and we can't afford to take chances with people's lives. We need to make sure our healthcare system is strong enough to handle whatever comes our way. If technology can contribute to the efficiency of the health system—taking into account the Triple Aim of population health—it must be reached for.
Fortunately, things are changing now. The Access to Prescription Digital Therapeutics Act will potentially provide coverage of prescription digital therapeutics in Medicare and Medicaid. In addition, the Centers for Medicare & Medicaid Services (CMS) are gradually releasing new billing codes for prescription digital therapeutics, opening the way to federal coverage.
Payers will face a wave of changes triggered by the demographic and technological shakeup
Dr. Komolafe believes that payers will include digital platforms in their offerings. They just want to make sure that what they pay for brings benefits to the patients and is safe for them. But sometimes, they simply don't want to lead the way, instead choosing to wait to see what others will do.
She also points out that the generational shift is a transformational power in healthcare to watch out for: "Millennials and Generation Z don't want to travel to see the doctor or even get calls from their care provider. Instead, they want access to healthcare on their smartphones."
Payers must realize that the young population entering working age are very different healthcare consumers.
"Healthcare transformation should not be driven by the urgency that emerges during crises. Instead, I would prefer we start exploring how digital health tools can contribute to better and more accessible care that saves costs and improves patients' experiences in our health ecosystems. There is no point in further delay so let's start doing instead of waiting," concludes Dr. Komolafe.
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