SummaryThe Centers for Medicare & Medicaid Services (CMS) is embracing digital health and virtual care in many ways.
In April, CMS finalized a regulation to expand access to telehealth. In March, CMS announced a competition encouraging health technology organizations to design solutions using artificial intelligence to improve health outcomes in Medicare. However, with significantly less attention in February, CMS released its first mobile application (app), “What’s Covered,” for Medicare beneficiaries.
The app provides information on Medicare Parts A and B (not Medicare Advantage) for specific medical items or services. The app is one piece of a new digital health strategy in the eMedicare program, with additional tools including, but not limited to: an out-of-pocket cost calculator, price transparency tools, and a webchat option in the Medicare Plan Finder.
The “What’s Covered” app and other components of the eMedicare program signal an exciting shift in the digital health space. As baby boomers rapidly age into Medicare, payers are thinking about new models to engage consumers who are increasingly comfortable with digital technologies. Historically, seniors have consistently had lower rates of technology adoption than the general public; however, this group is becoming more digitally connected now than ever before. As of 2017, 46% of Americans ages 65 and up own a smartphone, and that percentage is rising quickly. The growing Medicare population is becoming more reliant on digital health tools to help them make healthcare decisions and therefore innovation in this space must mirror the expectation of patients.
The “What’s Covered” app is no different than any other new development in the digital health space in that it should require a level of evaluation to assess its effectiveness based on patient engagement, quality, and safety. Below, we outline the tool’s characteristics relative to criterion established through the Commonwealth Fund framework:
While the “What’s Covered” app provides helpful educational information on coverage of services, there is room for enhancements that can better meet patients’ and caregivers’ needs. CMS has future opportunities to highlight and further articulate the value of the information provided to beneficiaries. For future iterations of the app, CMS could consider the following:
- Improved access to cost information. The desire for patients to access information about the costs of their medical care is evident: an estimated 63% of Americans report there is not enough information on the price tag of their medical services. In alignment with CMS’ commitment to cost transparency, the app might provide more detailed information on the price that the hospital is charging compared to what a hospital actually pays for the service. This might also include collaborating with pharmacy benefit management programs to specify how much patients pay out-of-pocket at the retail counter versus what is provided under Medicare prescription drug plans. Additionally, CMS might consider connecting this tool to other price transparency resources such as its Procedure Price Lookup tool so that consumers can access information on price transparency all in one place.
- Enhance patient and family engagement. It is unclear from the publicly released information how end users were engaged in the design, development, and improvement of this app. It does appear that before the app was launched, Medicare beneficiaries tested it and provided CMS with insights on its use. CMS has already released updates to the app to address feedback. Finally, CMS plans to offer more features in future versions of the app. To ensure end users feel as though the app is a meaningful resource, developers should consider qualitative research tools, such as group interviews and focus groups, to engage patients in the development of a future iteration. Input from patients and caregivers will provide valuable guidance to CMS for an enhanced version of this app.
Medicare enrollment is expected to reach 64 million Americans by 2020. This market growth presents an opportunity for CMS given the fact that many new consumers are technology adept. As a result, a future iteration of the app might also assess how competitors, such as private insurers, create user interfaces and provide content that meets all the expectations of a human-centered design process. CMS must draw on the input from patients and caregivers to design products and services that meet the needs of its beneficiaries, supports their decision-making, and enhances overall engagement with their care plans.
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