Last year Washington DC-based George Washington Medical Center teamed up with WellDoc and Medicaid PPO clinic, Chartered Health Family Clinic to determine the efficacy of an intensive mobile phone based program for Medicaid patients with diabetes. The program is currently underway.
"I was told if we could get this to work with this population, we could probably do it anywhere," Dr. Richard Katz of the George Washington Medical Center said during his presentation at the mHI event in Washington D.C.
Katz said the program aims to cut down on emergency department visits and hospitalizations, improve diabetes HEDIS goals, reduce A1c, improve self-management of co-morbities, improve medical adherence, decrease medical errors and enhance medical information exchange.
In Washington D.C. if a patient is discharged from the hospital and goes to a city clinic, there is only a one in ten chance that the clinic has any information about that discharge, Katz said. That is a health information exchange problem, but if that data was residing on a cell phone app or personal health record -- that HIE problem begins to go away.
I would like to say that this program has cost effectiveness and sustainability, but better health may be more efficient but not necessarily more cost effective. There are going to be more costs, but hopefully they are not excessive, Katz said. The current mobile phone-based diabetes program Katz's team is facilitating cost under $200,000 to implement, he said.
Katz explained that early attempts to recruit 150 patients with diabetes at the DC clinic proved difficult: His initial seven scheduled interviews produced seven no-shows. So, he upped the incentive.
"This system requires a smartphone," Katz said. "We are not just going to send text messages -- It is what it is."
Some 27 percent of the people who own mobile phones in the U.S. use smartphones and within the Medicaid population smartphone adoption is very small, Katz said. Most use prepaid phones and services. Katz decided to offer participants in the program an upgrade to a web-enabled phone at a subsidized rate. He called it "Medical Minutes."
Participants could either upgrade to a $40 a month prepaid plan from Sprint that included a free web enabled handset, unlimited text messaging and web with 200 peak minutes of talk time, but the program would cover $20 per month of the costs -- the user paid the other $20/month. Patients could also opt for a $47 a month plan that included 450 peak minutes per month, unlimited texts and web. The program would cover $20 a month from that plan so users only paid $27 per month. Patients who already had a web enabled plan but no web plan could upgrade for just $10 more a month.
Katz's program is still underway, but he believes that the time is right to begin discussing multi-center trials. He noted that he had briefly discussed this with Boston-based Partners Healthcare's Center for Connected Health director Dr. Joseph Kvedar. Katz also mentioned the Centers for Medicaid and Medicare Systems and the National Institutes of Health as potential partners.
"I am not sure we are ready, but it might be time to do a multi-center trial rather than just doing pilot, pilot pilot," Katz said. We need to push this out to show that something works. We don't necessarily expect perfection before it is adopted. Smartphone availability is not out there yet for a wide number of people, but it is getting there soon. We should strike now while there is all this enthusiasm."
