It's easy to launch a consumer product in the App Store and get a quantified-self early adopter with low BMI, disposable income and internal motivation for a healthy lifestyle. Indeed, ease of distribution is one of the main reasons so many are developing for the quantified-self group.

To really have a widespread impact, we need to reach their opposite: Low-income Medicaid patients. Getting to them means gaining a foothold in markets where there is payer-provider alignment AND Medicaid risk contracts evolving.

Seeking feedback from the “collective brain” of thought-leading physicians can help refine and iterate the mHealth “super app” that will accelerate and automate the reversal of early lifestyle disease. 

Here are five tips culled from what we’ve learned thus far:

1. Identifying and onboarding patients. Ninety percent of my patients have Android phones, which is higher than the national average of 70 percent. Since we started our development on iOS, this has become a barrier. Once we do find iPhone users in my practice, there are barriers to downloads, like having an up-to-date credit card that actually has money loaded. They do have iTunes accounts, and they do buy stuff with their phones and through Facebook, and you'd be surprised how many of these people are one click to purchase, according to Facebook. But I have had to sit with my patients to help them find the app in the store and get it on their phone, so it's not easy. Getting the platform on the low-income, at-risk population's phone requires considerable work. This is the business that nobody wants to do. We are doing it, payers are working with us, and the upside has so much potential.
2. Persuading payers to become involved. My gut feeling was that payers would sign on for pilots ahead of health systems and we were right. Payers have a more acute pain point of the costs than hospitals, who are not in Medicaid risk contracts right now. Medicaid departments, for instance, are bearing the brunt of these high inpatient and utilization costs while the health systems are focusing right now on readmissions, ICD-10, secondary prevention and later-stage chronic disease management initiatives. These Medicaid payers — ripe for advanced ACO alignment, risk contracts and true shared savings — are dragging hospitals in, sometimes kicking and screaming. But they are not waiting on mHealth; even simple things like increasing outpatient use and soft satisfaction survey results are very valuable. We went into this thinking behavior change as our end game, but softer objectives like engagement and improved ratings are still valuable.
3. Identifying the right physicians. We are looking for the early adopter physicians who have a persistent focus on patient-centered care. Perhaps the doctor who has been recommending consumer apps and has had experience adopting these into their practice. What we don't need, however, are early adopter patients as users. We need physicians who have a consistent flow of low-income Medicaid patients at risk for pre-diabetic or prehypertension in their offices. We need physicians caring for "the anti-quantified-self," so to speak.
4. Collecting feedback from patients and physicians. If we are ever going to scale this solution, we need lots of docs and patients helping us refine our product. What if a doc has a patient who can't walk 10,000 steps? What if they want to start them at 3,000 steps, then ratchet up from there? What if a physician wants to have his face in the patients' photo upload stream cheering him on to skip that evening dessert? These are all easy features to add if we get this kind of feedback from docs. And it’s also why we’re looking to get feedback from not just the users but also those general internists and family practice doctors who gravely need assistance in accelerating patient behavior change. We need physicians who are up to their elbows in failed behavior change.
5. Picking a price point. A lifetime of physician knowledge went into this. Also, our market research confirms that the $4.99 price converts best with consumers. Who knew consumers were more likely to download our product at this price point than for free? Perhaps it being physician-developed and functioning on evidence-based guidelines had something to do with it. Why should a detailed mobile behavior change prescription from a physician be free?

Medicaid ACOs are severely lagging behind Medicare, and this is part of why the industry has been slow to help this population with mHealth. Medicare ACOs have benefited from mHealth chronic disease management tools and readmits reduction specifically for the older age group — so there is no reason to think the Medicaid ACOs will not see the same rewards with targeted solutions.

Otherwise, providers would have no incentive to spend time eliminating visits from their schedule. Why would they remote-monitor from afar if they made less money as a direct result?

Brandi Harless is CEO and Natalie Hodge, MD, is chief medical officer of Personal Medicine Plus.

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