Wireless health needs to engage payers: Now.

By: Brian Dolan | May 13, 2010        

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West Wireless Health Institute CEO Don Casey“The wireless health industry needs to focus more on lower cost solutions,” West Wireless Health Institute CEO Don Casey told MobiHealthNews during an interview at the Wireless Life-Sciences Alliance this week. “Instead, the industry is too focused on leveraging specific technologies to deliver a wireless data set that only increases utilization of the system and therefore costs. If we are able to offer lower costs solutions, our market won’t be 100 percent reliant on CMS coming out with reimbursement codes,” Casey said.

Casey said that low costs solution were likely to come from developing markets. Large, self-insured employers in the US, however, are also likely to push the industry in that direction too. Also, intergrated delivery care providers like Kaiser Permanente and Intermountain Healthcare would also be very interested in these types of solutions.

“The biggest problem in healthcare today isn’t access to care or quality of care,” Casey said. “It is cost. Until we focus on cost-based problems, we will continue to run into roadblocks.”

“As far as I can tell, with health reform we did not add any new hospitals or doctors or other care providers. We did, however, add 15 million to 25 million new people into the healthcare system,” Casey said. “On top of that aging baby boomers will demand more care from the system.”

Casey believes that now is the time to offer low cost solutions that appeal to payers. Payers, after all, will soon be (or already are) fielding calls from large employers who are looking to reduce healthcare costs. The window of opportunity for engaging payers may be short.

“I think we have the opportunity to get in front of payers for the next 12 to 18 months,” Casey said. “We have the opportunity to shape wireless health solutions for them. If we haven’t adequately addressed the needs of the payer in that time frame, they will fund their own solutions. We will then go from an offensive position to a defensive position. We’ll go from a proactive stance to a reactive one.”

  • http://frankavignone.blogspot.com/ Frank Avignone

    While I think I understand what Mr. Casey has eloquently positioned in his interview I would take some exception to the idea that leveraging specific technologies to deliver a data set that increases utilization of the health system and therefore costs? Also I was not quite sure what offering lower cost solutions in order to not be reliant on reimbursement codes from CMS meant? Not sure if I understand these points completely. The issue is not the availability of low cost wireless solutions the issue is adoption. Most every health plan in the country has some semblance of a mobile strategy leveraging everything from Location Based Services to back ends claims data to drive mobile handset based secure personal health records. There is a plethora of “Low Cost” mobile solutions in the health plan space but not much incentive to use them as a member of the plan.

    The costs in health care will not be resolved by technology but by shifting from a supply driven market where we reward volume instead of quality to one that is consumer driven and focused on prevention and compliance not treating illness. What I believe many people fail to see is that health plans are extremely focused on reducing costs and have implemented a huge network of health and care management programs that are under utilized why would they want to invest in any more technology to layer on top of existing frameworks?

    So while I respect Mr. Casey’s points I would have to disagree with his interpretation of the problems and the current health reform. Breaking the cycle of health care payments complexity and errors may be one way in which to stem the cost of moving to a consumer oriented health care system, which is one of the popular solutions discussed during this health care debate. This concept of consumerism in health care and payments for services may be provocative to many readers of this blog but the facts as they stand currently demonstrate that we have to start somewhere and the health care revenue cycle management process is easier than some agendas would have you believe. The current legislative efforts have provided little in the way of support for what the American people have expressed they want in the way of a public option. Perhaps as an industry, we can begin to resolve some of the issues that plague the reform effort and will eventually lead to what the polls say the American people desire. It is a fact that when compared to other business sectors, health care revenue cycle management is difficult at best, fraught with paper and consists of very little standardization. This is clearly an area that is replete with opportunity to drive new business, create jobs, and leverage existing infrastructure investments all while creating better efficiencies and timelier payments for providers.

    So throwing more technology at the payers is not the answer. Leveraging the impressive network of technology already in place and under utilized is part of the answer. Another key component is to shift to a consumer based market, which is happening like it or not, and lastly to deploy mobile solutions where and when they make sense. Mobile technology can provide invaluable tools in the health plan space for engagement of consumers in private and public health plans and I believe that their time has come. The challenge for Mr. Casey is to drive adoption through common sense deployment of useful and usable mobile solutions in this space. On that we can agree. Thank you.

    Frank Avignone

  • Mike

    I too, respectfully disagree w/Mr. Casey, on several points.
    1. What kind of low-cost solutions is he talking about? I take it, not medical devices or condition-based solutions, but rather the IT-type of connectivity which ostensibly would offer savings to medical systems. These solutions are obviously not dependent on CMS and help reduce payers’ internal costs.
    2. He’s basically saying to forget about medical wireless device and apps space in the US, since CMS won’t happen in the foreseeable future: this what he means by ‘developing markets’. I happen to agree with him on this one, BTW.
    3. Why is there an apparently short window of opportunity to pitch to large payers? They may decide to lower their costs, all of a sudden? OK, if that happens in response to the new healthcare landscape, will they do their own R&D? No: they are not R&D or even technology companies, and they will start shopping around for solutions. Again, they will be looking for system-wide solutions, and most likely from the big and established players, like wireless providers (if they actually believe in wireless), network specialists and database managers, not a bunch of wireless startups with limited solutions and resources.

    Which leads me to the final and most important point: coming from the CEO of WWHI, we might finally have gotten a glimpse of the Institute’s strategy: partner with large wireless technology developers (Qualcomm) and offer systemic (rather than device-, or even health technology- based) cost-saving solutions to large payers and self-insureds. If this is indeed the Institute’s strategy, the small tech guys would be better off partnering with the large wireless providers and system integrators in the hope of integrating their morsels of technology into the large integrators’ packaged solutions. Going directly to large payers (or to the Institute, for that matter) will be a waste of time. This really should not surprise anybody, as we dealing with a consolidating healthcare solutions market which favors size over innovation, in the hopes of decreasing costs through economies of scale.

    Would be interesting to hear a rebuttal/comment/confirmation from Mr. Casey.