Examining How Mobile Apps Can Help Bend the Cost Curve

No one wants to develop a debilitating disease, an aggressive cancer or a chronic condition such as diabetes that requires constant care to manage. Neither does anyone want to get into a horrific accident or have a congenital defect that brings a lifetime of consultations, treatments and surgeries.

But these events occur every day, which is why health insurance is so important to Americans.

Despite spending twice as much compared with 10 other high-income countries as a percentage of the GDP, however, Americans have the lowest estimated lifespan and the highest infant mortality rates. Americans access healthcare at the same rate as people in other countries, according to a study in JAMA. Across the board, however, prices are higher in the U.S. for prescription drugs, surgeries, scans, provider salaries, and administrative costs.¹

In the wake of the Affordable Care Act and state expansion of Medicaid, the uninsured rate dropped to 8.8% in 2017. ² But having insurance doesn’t necessarily mean that one can afford to become sick or injured. Ten percent of all Americans report delaying or avoiding care because of cost. But nearly 2 times as many (19%) who describe their health as less than “good” say they will skip care. People with low incomes and uninsured adults are also more likely to delay or skip care.³

As costs continue to spiral, companies are working with brokers to maximize the value of their healthcare dollars, focusing on preventive care and increased use of the most-appropriate care setting based on a worker’s illness or injury.

Access to in-network care and appropriateness of the care setting can influence worker costs, making education and engagement paramount. When deployed as part of a member’s health plan, mobile apps can direct patients to the most cost-effective and appropriate care, be it a physician, specialty provider, urgent care clinic, telehealth visit or hospital. Apps can also help members manage their chronic conditions, receive cost estimates and ensure providers and facilities are in-network.

The results are better, more appropriate healthcare usage, better-informed patients and lower costs for employers.

Costs continue to spiral

In addition, the reliance on self-insurance increases as employee headcount does. Sixty-one percent of covered workers overall are in partially or wholly self-funded health plans, with 87% of workers in companies with 1000-4999 employees and 91% of those in companies with more than 5000 workers in self-funded plans.⁵

Companies that offer insurance walk a fine line between keeping costs low enough to retain employees while containing a semblance of control over usage. Working with brokers, companies can design plans that reward appropriate use, offering self-service tools such as mobile apps to provide guidance. Such plans can also offer extra support to those with chronic illnesses such as diabetes to keep manageable conditions from becoming costly hospital stays.

As costs escalate to untenable levels, companies and insurers are offering less expensive plans that carry high deductibles before insurance kicks in—shifting more of the financial burden onto patients. A high-deductible insurance plan (HDHP) coupled with a health savings account (HSA) carries an individual deductible of between $1350-$6750, double that for family coverage. Employers often fund a portion of the HSA as well, which can be used for qualified medical expenses. Employee contributions up to a limit ($3500, individual; $7000, family) are counted as pre-tax dollars and can be rolled over into subsequent plan years. Those 55 and over can contribute an additional $1000.⁶

For the 2017 plan year, nearly 22 million people were enrolled in HDHP/HSAs, an 8% increase from the previous year.⁷

The high price of sick workers

Employers have a significant vested interest in keeping workers healthy to boost productivity and keep healthcare costs low. Productivity losses are estimated at $1685 per employee, or nearly $226 billion annually. Of those losses, two-thirds are attributed to presenteeism, employees who are on the job but not at their best. Presenteeism decreases productivity and contributes to workplace epidemics. Lost productivity due to chronic pain accounts for 5% of that total, or about $12 billion.⁸

Much of the productivity loss can be attributed to conditions that can be managed with proper care and monitoring.

Tobacco use remains the leading cause of preventable death, accounting for 20% of deaths each year. Treating heart attacks and strokes accounts for $1 out of every $6 spent on healthcare. Those who are overweight, obese, or have chronic health problems miss 450 million more days annually than healthy workers at a cost of $153 billion.⁹

Six in 10 Americans have at least 1 chronic disease, and 25% have 2 or more. For some, a pill or a lifestyle change is all that’s required to manage a chronic condition—assuming they have access to the proper medication and education. Treatment for others, such as diabetes, requires constant care to manage properly and keep costs from spiraling higher. The lifestyle risks for chronic conditions include tobacco use, poor nutrition, lack of physical activity, and excessive alcohol use.¹⁰

For an increasing number of employers, offering health insurance is the bare minimum. They want to invest in their employees to keep them healthy, help them manage chronic conditions and reduce lifestyle-related health burdens. The intent is not only altruistic, it is crucial to the bottom line. When deployed effectively throughout an organization, optimized healthcare access can also bring lower costs.

Patients want to be engaged in their health

Employers have wielded both the carrot and the stick to change employee behavior, with incentives for employees who agree to share biometric data (body mass index, blood pressure, cholesterol, etc.) as well as penalties for smokers. But what’s needed is an easier way for employees to take advantage of their benefits: to find in-network physicians, dentists, optometrists and other providers, a referral for smoking cessation, locations of local gyms in the benefit plan and other useful information.

For many, especially younger workers, the key is an employer- or health plan-branded mobile app linked to their benefit packages that can help them navigate the complexities of healthcare—from the mundane to the catastrophic. A worker with the flu should be able to make an appointment with his primary care provider or find a nearby urgent care clinic in a few clicks. Likewise, someone who’s just been diagnosed with cancer or needs an immediate hospital-based test should be able to explore viable options without having to access multiple websites.

Nearly three-quarters of adults already are using the internet to research health and wellness information. Among those online, over one-third are researching specific symptoms or health conditions.¹¹ A medically validated symptom checker can help triage symptoms and determine the appropriate level of care, rather than defaulting to the ER or ignoring the condition until it becomes critical.

Once diagnosed, just 40% of patients said they were somewhat knowledgeable, at best, about how to care for themselves in terms of their condition. Seventy percent of people with a chronic condition wanted more resources about their conditions and 91% wanted help to manage their conditions. About 40% said they needed help between medical appointments.¹²

Mobile is the way to go

Cellphone ownership has become ubiquitous, with smartphones accounting for more than three-quarters of overall ownership in the United States. Since 2013, smartphone use to access digital content has grown nearly 100%. By contrast, tablet use is up 26% while digital access through desktop computers has declined by 8%.^13-14

Within digital content, apps are increasingly the way to go. In terms of time spent on their smartphones, people use apps 87% of the time, compared to 13% of time spent on the mobile web. In fact, a survey showed that people use apps on their smartphones to complete 221 tasks per day.^15-16

Narrowing the focus to healthcare, a survey of insured patients showed that 71% of millennials want their healthcare providers to offer mobile apps for appointment scheduling and to help patients manage preventive care and share health data.¹⁷

Conclusion

Healthcare costs continue to escalate, prompting employers to shift more of the cost burden onto employees through high-deductible health plans and levy penalties for certain lifestyle choices. But to truly contain costs, workers need information at their fingertips to find the appropriate care, research health conditions or engage with a healthcare concierge who can help navigate the healthcare system. For an increasingly tech-savvy workforce, the information portal of choice is a mobile app.

References

1. Papanicolas, I, Woskie, L. Jha, A. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024-1039. doi:10.1001/jama.2018.1150.

2. United States Census Bureau. Health Insurance Coverage in the United States: 2017. https://www.census.gov/library/publications/2018/demo/p60-264.html. Accessed February 27, 2019.

3. Peterson-Kaiser Health System Tracker. How does cost affect access to care? https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care/#item-start. Accessed February 27, 2019.

4.Society for Human Resource Management. For 2019, Employers Adjust Health Benefits as Costs Near $15,000 per Employee. https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/employers-adjust-health-benefits-for-2019.aspx. Accessed February 27, 2019.

5. Henry J Kaiser Family Foundation. 2018 Employer Health Benefits Survey. https://www.kff.org/report-section/2018-employer-health-benefits-survey-section-10-plan-funding/. Accessed February 27, 2019.

6. Society for Human Resource Management. 2019 HSA Limits Rise, IRS Says. https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2019-hsa-contribution-limits-rise-irs-says.aspx. Accessed March 1, 2019.

7. America's Health Insurance Plans. Health Savings Accounts and Consumer-Directed Health Plans Grow as Valuable Financial Planning Tools. https://www.ahip.org/2017-survey-of-health-savings-accounts/. Accessed March 1, 2019.

8. CDC Foundation. Healthy Workforce. https://www.cdcfoundation.org/businesspulse/healthy-workforce-infographic. Accessed March 1, 2019.

9. Ibid.

10. Centers for Disease Control and Prevention. Chronic Diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm. Accessed March 1, 2019.

11. Kantar. Consumers turn to Facebook, Twitter for healthcare information. https://us.kantar.com/tech/social/2017/consumers-turn-to-facebook-and-twitter-for-healthcare-information/. Accessed March 1, 2019.

12. Healthcare Finance. Providers that help patients manage chronic conditions face fewer readmission penalties, study finds. https://www.healthcarefinancenews.com/news/providers-help-patients-manage-chronic-conditions-face-fewer-readmission-penalties-study-finds. Accessed March 1, 2019.

13. Pew Research Center. Mobile Fact Sheet. http://www.pewinternet.org/fact-sheet/mobile/. Accessed March 1, 2019.

14. Comscore. 2017 U.S. Cross-Platform Future in Focus. https://www.comscore.com/Insights/Presentations-and-Whitepapers/2017/2017-US-Cross-Platform-Future-in-Focus. Accessed March 1, 2019.

15. Comscore. The 2017 U.S. Mobile App Report. https://www.comscore.com/Insights/Presentations-and-Whitepapers/2017/The-2017-US-Mobile-App-Report. Accessed March 1, 2019.

16. Tecmark. Tecmark survey finds average user picks up their smartphone 221 times a day. https://www.tecmark.co.uk/blog/smartphone-usage-data-uk-2014. Accessed March 1, 2019.

17. Salesforce.com. The State of the Connected Patient 2015. https://www.salesforce.com/blog/2015/02/the-state-of-the-connected-patient-2015-infogrpahic.html. Accessed March 1, 2019.

For 2019, the average estimated cost of healthcare for employees and dependents, including premiums and out-of-pocket expenses, is $14,800, a 5% increase from the previous year. Large employers generally cover 70% of outlays, leaving employees responsible for more than $4000 in expenses.⁴