It’s no secret that mobile devices like smartphones and tablets have emerged as a primary and preferred channel for communication. That’s why many health insurance providers are adapting to reflect members’ devotion to all things mobile.

In 2015, Blue Cross and Blue Shield of Nebraska (BCBSNE) identified just such an opportunity. The goal: to improve its approach to care management by incorporating mobile technology, instead of relying solely on telephone outreach.

Susan Beaton, RN, vice president of provider services at BCBSNE, shared the company’s story at AHIP’s recent Consumer Experience & Digital Health Forum in Nashville.

Existing telephone-based technology posed significant barriers, including missing or outdated patient phone numbers and limited time with patients due to excessive administrative processes. “Case managers felt unable to sustain relationships with patients beyond a few conversations,” Beaton said. “As a result, patient engagement in self-care and care management was limited.”

The Move to Mobile

BCBSNE partnered with a mobile care management provider that relies on HIPAA-compliant two-way messaging between a mobile app and a care team dashboard. Care managers begin the cycle by delivering personalized, interactive care via the app. Patients use the app to record their health status, read educational content, receive reminders, and ask questions related to their care.

The mobile platform prioritizes patients based on clinical need to facilitate work flow among the care team. Each care manager then provides support via mobile to patients as needed. Real-time exchanges build patient interest and engagement, but the system also allows patients to communicate when they choose, even when care managers are off duty.

This cycle repeats continuously and as needed for each individual patient.

According to Beaton, BCBSNE’s priority was to build on, not disrupt, existing work flows. Today BCBSNE uses the mobile platform for services ranging from post-hospital discharge care management to health coaching.

Measuring Effectiveness

BCBSNE reviews quantitative and qualitative data regularly from both patients and care managers, Beaton explained. For patients, they review metrics like mobile engagement, care plan adherence, program retention, and behavior trends. For care managers, key metrics include average time spent with a patient, caseload per manager, interaction frequency, and care plan customization rate.

Of course, the bottom line is also important. The company monitors utilization patterns and cost savings. It compares patients in mobile care management with those in telephonic care and those outside the care management program.

For patient engagement, BCBSNE has found that enrolled patients receive four or five mobile messages per week, compared with one to five phone calls per month. And about two-thirds of mobile patients engage with their care plan each week.

This engagement takes different forms. On average, patients completed 2.3 surveys and assessments per week and consumed about four educational articles or videos per week. About three-quarters of patients attended a follow-up visit within two weeks of hospital discharge.

More Good News

From the care management perspective, the results are noteworthy. Despite increased patient engagement, care manager time per patient has actually dropped from 8.5 minutes with telephonic care management to 3 minutes with mobile.

“Time with patients is now used to work through a care plan, rather than collecting data on patient behaviors, since that data is self-reported daily,” Beaton said. “And this does not include time saved by avoiding phone number look-ups and missed calls.”

Additionally, mobile care management patients incurred post-hospitalization costs that were 41 percent lower than those not enrolled in care management. This compares with a 17 percent reduction for telephonic care management patients. Patterns of care utilization improved with mobile, too, with an increase in primary care visits and a decrease in hospital readmissions.

BCBSNE Key Takeaways

Beaton shared six pieces of advice to health plans considering a switch to mobile patient engagement programs.

    • Leadership buy-in: It’s important to have senior management communicate the mobile vision and lead the internal changes needed to make the mobile initiative thrive.
    • Include innovation in all program metrics: Use evaluation metrics to ensure that care managers adopt the new technology and remain open to innovation.
    • Work flow evolution: Foster openness so that new work flows quickly become accepted as team operations evolve.
    • Evaluate impact: As with any program, regular measurement can inform focus areas. Key metrics facilitate leadership reviews and staffing requests.
    • Continuous improvement: Build in regular check-ins for data review, qualitative feedback review, and to discuss current opportunities and challenges.
    • Partnership mindset: BCBSNE established a true partner in developing its mobile care management program, rather than “just” a vendor.

For BCBSNE, mobile complements its existing clinical programs while improving patient outcomes.

“With mobile, care management is a strategic center for value within the company,” Beaton said. “Mobile is the most effective way to reach and support patients.”