- mHealth programs are often hailed as a means of improving access to care for underserved populations, but how do those mobile health platforms reach those people? After all, they’re underserved for a reason.
The first step, experts say, lies in understanding why certain people are underserved: do they choose not to access healthcare, or are there cultural, financial or physical barriers in their way? Once that point has been established, healthcare providers need to fashion an mHealth strategy that tackles those issues.
For the makers of Babyscripts, an mHealth platform designed to help expectant mothers access prenatal care management tips, the pivot toward a new population required a change of tactics.
Juan Pablo Segura, the mHealth company’s co-founder and president, says Babyscripts was designed to help pregnant women who wanted that help, by giving them more touchpoints between visits to the doctor’s office. The assumption was that these women had the means to access care, but needed the motivation to improve their own care management.
That’s not true of the population accessing care through Medicaid – a population responsible for about half the pregnancies in the US. Federal guidelines call for a pregnant woman to see a doctor at least six times prior to birth, but those on Medicaid average only two or three visits.
“That’s where the bad outcomes are coming from,” Segura says. “They need access to prenatal care, and they aren’t getting it.”
A little more than a year ago, Wisconsin-based Aurora Health Care asked Babyscripts to develop a strategy to reach that population.
“We literally had built a unique and completely different experience for our commercial product,” Segura says, noting the national average for pregnant mothers in that market is 14 visits with a doctor. “We realized we had to stop running for a second a take a step back.”
Segura says they realized they had to focus on the technology, and target ease of access (via smartphone) and anonymity (through text messaging) for women having trouble getting healthcare and dealing with the stigmas attached to the Medicaid population.
“Technology can liberate patients to be able to get care remotely,” he says. “And in that technology, you can start to understand the issues around why they aren’t getting that care” – such as low income, working more than one job, having to decide between food and healthcare, cultural issues and abusive relationships.
In addition, Segura says, Babyscripts looked to work more closely with healthcare providers. Whereas the commercial product was something that a hospital or clinic might recommend to its patients, a product targeting underserved communities has to become part of the care provider’s toolkit. And it has to be made available not only to health systems and hospitals, but to health clinics, community health centers and practitioners serving those communities.
“They’re the gatekeepers for prenatal care,” Segura says. And when dealing with underserved populations, those gates need to be opened as wide as possible.
Recently, Babyscripts unveiled its new platform, called Care Navigator. Through the HIPAA compliant, bi-directional messaging platform, pregnant women can access automated daily tips, education and messages of support from a pregnancy coach. They can also communicate with an assigned social worker.
Segura says the platform was tested through Aurora Health Care, and helped push the average number of doctor’s visits for women in the health system’s Medicaid community from three to seven. It’s now being adopted by the Washington, DC-based Teen Alliance for Prepared Parenting program, which connects social workers with pregnant women under 21.
“There are inherent barriers set up that prevent (underserved populations) from getting access to the care they need,” says Segura, who notes that most successful and sustained mHealth apps go straight to a commercial model because the money can be found there, rather than in Medicare and Medicaid programs with uncertain reimbursement possibilities.
In launching Care Navigator, Segura is hoping to gather clinical data that supports more mHealth interventions. If mHealth can demonstrate improved clinical outcomes in underserved populations, he says, more providers will adopt mHealth platforms, and federal regulators might loosen the purse strings for more reimbursement.
mHealth technology “can change that,” he says. “In the past six to 12 months we’ve found that we no longer have to convince doctors that mobile health technology is good. They can now see that for themselves.”