Mobilize mHealth in behavioral healthcare

Our culture has increasingly become dependent on mobile technology. Cell phones and other mobile devices have made our lives infinitely more convenient. The days of carrying spare change to make a call from a payphone are long gone. Today, our phones can give us turn-by-turn directions in unfamiliar locations and keep us connected to the rest of the world in real-time through social media. They can help us track our fitness, make restaurant reservations, keep up on the news, play games and draw pictures.

As technologies continue to advance, we must leverage them in unique and innovative ways to unlock their true potential.

In healthcare, the surge of wearable tech and the advancement of mobile health (mHealth) technologies can transform how we care for patients and help people manage complex conditions. Through mHealth, we can improve disease management by providing patients with helpful reminders, tools to cope with their conditions and instant access to case managers. We can enhance disease diagnosis by remotely monitoring social behaviors and analyzing routines, and we can build peer-support networks through mobile forums and connectivity apps.

Take, for instance, an individual diagnosed with depression who routinely visits a community-based behavioral health clinic or even the emergency room. What if we could actively, and passively, monitor his mood and emotional health and have a wellness coach or therapist intervene before he reaches the ER or clinic in a health crisis? This could save countless dollars in healthcare costs while providing an intimate level of care and attention. With the emergence of mHealth, this is not just possible, it’s reality.

mHealth in practice

At Centerstone, we recently implemented a three-month care program model called coactionHealth that used mHealth technologies to provide a high-tech, high-touch care model for individuals who had co-occurring severe mental and physical health disorders. What we found was that if you provide the right tools and the right support, individuals will be more engaged in their health, leading to improved outcomes and lower costs.

As part of this program, we equipped individuals with smartphones with pre-installed health apps, step and activity trackers and instant access to health and wellness coaches through HIPAA-compliant teleconference and communication tools. Apps were used to monitor and observe (with consent) patients’ activities and tendencies through active and passive data. This data complemented the routine in-person and mobile check-ins and allowed wellness coaches and program directors to get an entire picture of an individual’s health.

Active monitoring came in the form of brief, unobtrusive questionnaires that prompted individuals to report their current moods, feelings and overall health. So when a depressed patient was feeling negative or down, that would trigger an alert to program directors who could then decide a best course of action for an intervention. Passive data was collected through the individual’s call and SMS (text messaging) activity and the smartphone’s movement and location sensors. If the sensors indicated the phone was not moving for an inordinate amount of time or if there was no activity during a time when the individual would typically call or text others, that could point to an episode of depression where the individual was isolating himself in an unhealthy manner.

By observing and analyzing this data, we were able to accurately predict when and how to intervene with a patient and provide more effective care. With the right tools and services available, individuals were able to better manage their health. At just 30 days into the program, 100% of participants felt confident in managing their condition compared to no one (0%) feeling confident at intake. Eighty-eight percent felt connected to their care team compared to, again, none of them feeling that way at intake.

Through the three-month coactionHealth program, hospitalization days decreased by 61% and ER visits decreased by 32%. Additionally, annualized healthcare costs per individual were reduced by nearly $29,000 during the program. And after leaving the program, annual savings per year were approximately $23,000 per person. Clearly, introducing mHealth into behavioral health models works, and it continues to work even after a particular program is over. 

Strategic implementation

As providers look to integrate mHealth into existing or new care models, developing a strategic approach will help cut through the clutter of solutions available. On Android’s Google Play store, there are more than 1,600 apps to help deal with depression and more than 600 on Apple’s App Store. For anxiety, there are 1,300 apps for Android and 800 for Apple. And this merely scratches the surface of what’s available. The sheer numbers alone can be overwhelming.

Of course, the behavioral health app space is largely unregulated and many of the offerings should not be relied upon in a clinical setting. Providers, therefore, must be diligent in researching and evaluating which technologies to introduce into care models.

Through a partnership with the D.N. Batten Foundation, Centerstone developed the appImpact framework that guides providers in integrating mobile technology into behavioral healthcare. From selection and implementation to evaluation, appImpact offers a framework needed to realize improved outcomes and cost savings through the use of mobile technologies in healthcare.

The selection process is critical. It includes getting to know the app or technology developer, understanding the associated costs, asking key questions and properly piloting the technology. During implementation, providers should adequately train all staff who will interact with the technology, consider the needs of the target group (and, of course, obtain consent and ensure privacy) and formulate data monitoring and analysis. Finally, providers must measure and evaluate the technology’s effectiveness, which can inform possible program extensions and expansions.

The brave new world of mHealth

mHealth has enormous potential in behavioral healthcare. Learning and sharing best practices on implementing mHealth is the first step in widespread adoption throughout the industry. Successful programs can be expanded, tweaked and adapted throughout the country to reduce costs across the healthcare system.

In the United States, 90% of people own a cell phone, 64% of whom own smartphones. With this widespread accessibility of technology, mHealth will quickly play a pivotal and universal role in healthcare. Soon, it will be second nature, just as x-rays and MRIs are part of standard procedures today.

As an industry, behavioral health can get ahead of the trend and integrate these technologies into practice sooner rather than later to fully leverage their potential. Keeping pace with innovation is a constant struggle for healthcare, but one that should be embraced. These technologies have the ability to reduce cost while improving outcomes—moving both sides of the value equation. In an environment of healthcare reform and pay-per-performance as opposed to pay-per-service, mHealth can be the Holy Grail.

Tom Doub, PhD, is the CEO of Centerstone Research Institute, a not-for-profit organization that provides research, analytics and evaluation services that help bridge the gap between the scientific discovery of effective treatments and the implementation of these treatments into standard clinical practice