10 key insights into mobile messaging and Medicaid managed care

From big data to apps to sensors, mobile technology has exploded globally over the past three to five years, and its rise has made a significant impact on all types of industries, not excluding healthcare.

The explosive growth of mobile technology coupled with the onset of the Affordable Care Act (ACA) has essentially forced healthcare payers and providers, specifically Medicaid managed care organizations, to reassess how they are engaging with their members.

Daily client operations, observations and conversations with health plan and hospital executives led to the culmination of these 10 key insights into how the industry has evolved:

1. Readiness

Mobile messaging has become a C-level priority for Medicaid plans. The mindset has changed from tactical buy to strategic investment. Why? First, it's an established fact that Medicaid beneficiaries have mobile phones. Very often, it's their only phone. Second, mobile messaging is ubiquitous. Everyone's got it, everyone uses it. Perhaps the clearest indicator of readiness is that Medicaid health plan executives are now much savvier buyers than before, from their vendor evaluations to the mobile strategies they share.

2. Member validation

While some states are more conservative than others, we are seeing a turning point. The year 2013 largely established a few key fundamental building blocks. The first is that Medicaid plan members want to communicate using mobile messaging, as evidenced by their participation and the spectrum of text conversations. Second, they are willing to use their personal text message plan to communicate with their health plan, even with disclaimers that messaging rates may apply.

3. HEDIS+

About 90% of health plans that deploy mobile messaging target HEDIS improvement as Phase I of their implementation. This is likely because the use case is low risk and quick to deliver early results (if structured correctly). Furthermore, as compared to a mailing that may cost over $10,000 per batch, mobile messaging offers cost-effective year-round engagement. Why HEDIS+? Numbers show that members are demonstrating a very strong inclination to use texting for a myriad of other health plan communications.

4. TCPA

The Federal Communications Commission's changes to the Telephone Consumer Protection Act (TCPA) took effect on October 16, 2013. The highlights are a new “Prior Express Written Consent” requirement and the elimination of the “Established Business Relationship” exemption. However, the HIPAA exemption was reaffirmed, meaning that if a communication to the member is HIPAA-covered or involves the delivery care, then the HIPAA rule supersedes.

5. HIPAA

There were positive posture changes at the Department of Health and Human Services last year. The language in the preamble to the final rules states that if a health plan (or other covered entity) notifies a member of the risks of sending unencrypted PHI via email or text, and the member provides consent, then the health plan will not be held responsible if the information is breached in transit.

6. ACA

With the advent of the ACA, we started to see nascent demand for mobile messaging not only as an engagement solution, but also for education, eligibility and enrollment, or more aptly, member acquisition and retention. Moving forward, we expect to see health plans use mobile messaging in creative ways, including to administer reduced HRAs as a first level risk profiling mechanism.

7. Enterprise

As it becomes more apparent that mobile-whether messaging, web, chat or apps-will ultimately be a mainstream member engagement channel, health plan executives are paying more attention to scale and robustness. Rightfully so, as it's important to make sure that adopted solutions are enterprise-grade, scaling gracefully from pilot to multi-state implementations.

8. Integration

While a SaaS-based (software as a service) offering allows health plans to rapidly leverage the benefits of a solution with minimal IT investment, the need for more elegant and real-time data exchange is now surfacing as they expand beyond pilot programs. Moving forward, health plans will require that vendors increasingly integrate with their member services systems.

9. Lifeline phones

There was a time when Lifeline phones seemed to be the natural facilitator of member engagement. After all, it made perfect sense, that is, until we were proven wrong by burdensome hurdles and low uptake rates. While these phones have and continue to play an important role, the key takeaway: entitlement does not equal engagement.

10. Multimodal

It’s no secret that member engagement is a multipronged approach. However, while health plans have been using multiple modalities for outreach and engagement for quite some time, there is still not a true single solution for patient relationship management on the market today. At the same time, health plans know that they are entering a new world where health happens everywhere, hence, the need to holistically track every single interaction and touchpoint with a member.

The industry has and will continue to evolve. As we expect to see great progress for the year ahead, the best is yet to come.

Neng Bing Doh is the co-founder and CEO of HealthCrowd.