Christa Eans, PharmD, AAVHIP, MSPBA Candidate

Mobile technology offers new capabilities that can drive important aspects of specialty disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. The ubiquity, cost-effectiveness, and personalization of mobile devices are providing unforeseen opportunities to deliver health-related services promptly and efficiently.

The World Health Organization defines mobile health (mHealth) as a medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices.

mHealth involves the use and capitalization of a mobile phone’s core utility of voice and short messaging services, as well as more complex functionalities such as general packet radio service, third and fourth generation mobile telecommunications (3G and 4G systems), global positioning systems, and Bluetooth technology. Patient-facing apps that collect patient-generated health data can provide a low-cost mechanism for gathering real-world, high frequency, and/or longitudinal data on measurable outcomes to ultimately improve patient outcomes.

This emerging field of digital health care, which includes a combination of remote monitoring, behavior modification, and personalized intervention overseen by health care practitioners, which can improve patient outcomes in disease management. In addition to improving patients’ disease state management and quality of life, these innovations allow health care providers to gather real-time data about patient behavior and symptoms, and allows for intervention opportunities when patients have a flare-up in their disease.

The use of mobile and wireless technologies to support the achievement of health objectives has the potential to transform the face of health service delivery. mHealth holds promise for improvements along the value chain by maximizing time and productivity, improving quality, increasing access and equity, stimulating greater patient engagement, and potentially decreasing costs.

The number of clinical trials utilizing mHealth through mobile apps has more than doubled in the last 3 years.

 Momentum is building for practitioners to prescribe mHealth apps as part of treatment protocols given growing evidence through observational studies and randomized clinical trials to support the value of apps in improving outcomes and lowering health care costs.

In addition to the increase in the use of mHealth during clinical trials, there has also been an increase in the implementation of clinical programs leveraging mHealth apps, which provides greater real-world evidence to support the use of these apps in health management. Recent mHealth studies have highlighted the positive impact that mHealth interventions have on chronic disease management, highlighting opportunities for improved clinical outcomes and cost effectiveness.

This is a crucial time for mHealth, with growing attention to overcoming the challenges of interoperability, common data elements, and data definitions that allow disparate data streams to combine and create actionable insights for improving or maintaining an individual’s health and disease progression.

Traditionally, patient-reported data are reported manually by the patient or their caregiver. These data may include responses to questionnaires, symptom and behavior tracking, or other means of collecting patient-reported outcomes.

Patient-reported data have also been captured through paper-based and web-based surveys, phone calls, and so forth. However, such data can be collected through mHealth apps. These data can be used for, but are not limited to, validated outcome measures known as patient-reported outcome assessments. This could allow researchers to collect data more frequently and/or longitudinally.

There is an abundance of opportunities for the use of mHealth in the specialty pharmacy setting. The development of novel outcomes and data collected in real time on daily living activities have the potential to evaluate outcomes that are significant to patients.

mHealth apps can help fill data gaps by providing a wealth of real-time, high frequency, and longitudinal data. Additionally, mHealth for novel real-world evidence generation has the potential to transform the delivery of health care.

In 2017, CVS Health launched a specialty medication adherence campaign that includes a secure messaging and digital engagement platform for patients receiving specialty pharmaceuticals. The aim of the campaign was to offer a stronger level of engagement for patients who were already connected with caregivers and to encourage a patient-prescriber relationship to develop a stronger relationship and to improve patient outcomes.

When the campaign was initially piloted among patients with chronic myeloid leukemia, approximately 70% of patients achieved optimal medication adherence (defined as taking the prescribed medication as prescribed more than 85% of the time) whereas the control group achieved medication adherence 53% of the time.

Evidence suggests that patients want their clinicians to value and incorporate their mHealth data to inform care decisions. This can increase patient/consumer engagement substantially. Moreover, mHealth offers patients with a greater sense of connectedness to care providers, improved sense of well-being, and increased satisfaction with the overall care experience.

There are many advantages of mHealth utilization, including its versatility across all sectors of health care and its potential to improve the health monitoring of at-risk patients. mHealth allows for earlier interventions and a significant decrease in hospital admissions, along with visits to health care practitioners. Additionally, mHealth promises to revolutionize patient engagement, provider excellence, and the effectiveness of health care delivery to improve patient outcomes.

Ultimately, mHealth brings more than new technologies to the table. It is an innovation that facilitates a new way of interacting and transforms the delivery of health care. Accordingly, an integrated mobile strategy should be a key component of growth strategies for pharmacies, practitioners, health plans, pharma, and medical device companies to yield competitive advantage in an increasingly competitive system.

The specialty pharmacy market is flourishing, as a flood of new manufacturers, pharmacies, and health care providers seek to break into the specialty world. The boom in the specialty landscape has been driven by competitors that often have connections with partners in the system to strategically position themselves.

In a market driven by intense competition, specialty pharmacies understand that they must continuously innovate and diversify their strategies. The adoption of mHealth by specialty pharmacies can create tremendous value for the patient and the organization and generate a competitive edge by engaging patients and improving patient outcomes.

Data are considered to be the “sweet spot” among strategy integration initiatives in the specialty pharmacy space and is the most common enhanced service provided by specialty pharmacies. The industry is continuing to shift toward enterprise analytics and advanced data science, which are embedded across the value chain to influence clinical and business decision making at all levels.

When data and analytics work together, this information can be leveraged to create a strong competitive advantage and build an exceptional patient experience. The data ecosystem can offer a host of benefits for multiple stakeholders in the specialty pharmacy industry.

Through the course of patient care, a specialty pharmacy provider captures innumerous amounts of data. These data capture valuable information regarding all stakeholders: patients, manufacturers, payers, and prescribers.

Specialty pharmacies build out data collection services in response to manufacturer demand. In alignment with their high-touch services, specialty pharmacies customize data collection plans for a contracted manufacturer. The market is shifting from simply returning data to manufacturers, payers, etc, to transforming data into useful information and valuable insights for the above-named stakeholders.

In order to secure valuable contracts with manufacturers and payers, specialty pharmacies must go beyond accreditations and improved internal operations. They need consistent proof that they’re surpassing the other players in the competitive space.

The collection of data through an app is a unique opportunity for the manufacturer to gather clinical data for their subset of patients to gain clinical insights for their patient population. Moreover, the data gathered by the application can be used by prescribers and clinical pharmacists to evaluate adherence rates and to engage patients with insufficient disease state management to identify and mitigate specific patient challenges and improve outcomes.

Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. Investing in and staying ahead of the technological curve will not only enable a competitive edge, but it will help the organization gain deeper app adoption while supporting other lines of business.

The pace of change is rapid, and “future-proofing” an enterprise mobile app program is essential for building a competitive strategy. It is imperative that specialty pharmacies continuously assess the mHealth strategy and identify other areas in which the innovation can drive additional productivity and further differentiate to leverage business over competitors.

Building a genuine patient-centric culture is a critical component in gaining a competitive advantage in the marketplace. With the massive health care industry shift from volume-based care to value-based care, cookie-cutter models are no longer an option. The unique, personalized needs of the patient must be accommodated and built into a specialty pharmacy’s operations.

This is one of the key strategies that will help to solve the treatment adherence dilemma, which continues to drive a devastating toll. A patient-centric culture starts with speaking the patient’s language, engaging the patient to achieve mutual goals, customizing their care plans to best fit into patient’s lives, thereby enhancing communication and nurturing one-on-one relationships. Connecting with patients via mHealth is a manner in which they’re already familiar and can help to ensure a good fit.

Carter A, Liddle J, Hall W, Chenery H. Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions. JMIR Mhealth Uhealth. 2015 Oct 16;3(4):e95. doi: 10.2196/mhealth.4538.

3. de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007459. doi: 10.1002/14651858.CD007459.pub2

Christa Eans earned her Bachelor of Science in Pharmaceutical Sciences and Doctor of Pharmacy degrees from the University of Pittsburgh. She is currently enrolled in the Master of Science in Pharmacy Business Administration (MSPBA) at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Christa has spent the last 5 years working in Specialty Pharmacy, initially as a clinical pharmacist and most recently as the Manager of Clinical Programs. Christa is credentialed as a HIV Pharmacist (AAHIVP) through the American Academy of HIV Medicine. 

Articles

Mobile technology has helped to facilitate communication between pharmacists, patients, and their caregivers.
