New Mobile Healthcare Policy Report: Insights From Maanasa Kona of Georgetown University’s Center on Health Insurance Reforms

Why is mobile healthcare so fragmented?  Why isn’t it available everywhere yet? What can policymakers do to help?  “From Evidence to Implementation: Federal and State Policy Pathways for Scaling Mobile Health” is a new report from Georgetown University’s Center on Health Insurance Reforms that touches on these questions and more. It reviews federal and state policy since 2015, revealing what has helped, what has not, and how to sustain and grow mobile healthcare. The full report is available here and we encourage you to register for a webinar at 1:00 p.m. ET this Friday, Feb. 13 to learn more. 

For Driving Health Forward’s latest blog post below, we were delighted to speak with a co-author of the report, Georgetown Associate Research Professor Maanasa Kona. Here’s what she had to say about the report’s findings, policy recommendations, and what Driving Health Forward and others can do to boost mobile healthcare.

---

Welcome Maanasa!  What are the major issues, themes and findings highlighted in your mobile healthcare policy report and webinar?

One of the key takeaways from our work on this report is that even though mobile health has a strong and growing evidence base for improving access to care, the policy infrastructure has not caught up in a consistent way. We reviewed federal and state policy actions since 2015 and found that most mobile health policies have developed in response to specific pressures (like COVID-19 service delivery needs, the behavioral health and opioid crises, and strain on 911 and emergency departments). The result is a patchwork of model-specific rules and time-limited investments, rather than a cohesive approach that treats mobile as a durable part of the health care delivery system.

For this effective and affordable model to scale, policymakers need to line up a few key building blocks at the same time. Across states, we consistently saw four policy buckets that determine whether mobile programs can launch, operate, and sustain: (1) clear regulatory recognition and appropriate oversight that makes mobile “visible” to states, payers, and partners; (2) capital and operating investment that can serve as a ramp to long-term sustainability (not just one-time vehicle funding); (3) reimbursement pathways that make mobile services straightforward to bill and adequately paid over time; and (4) building capacity at the state level to understand and support mobile health delivery, while matching delivery with community needs and integrating it into the existing delivery system. To help mobile health move past the pilot stage, we need regulation, financing, reimbursement and system integration to be designed together rather than piecemeal.

How does your recent focus on mobile healthcare fit into CHIR's work? And what kind of feedback have you gotten from stakeholders?

When CHIR launched, its focus was primarily on improving private health insurance coverage. Over the years, we’ve learned that while having good coverage is critical, it does not always translate into access to affordable, accessible health care services. In recognition of that, our focus has expanded to related areas such as health care cost containment, medical debt mitigation, and exploring delivery system reforms—to bridge that gap between having coverage and actually being able to access affordable and high-quality health care. The value of mobile health care and its underutilization in the health care delivery system has always stood out to me as a missed opportunity for enhancing access to health care for underserved communities, and when I got the opportunity to take a deeper dive on ways to better integrate mobile into routine health care delivery, I took it.

We have gotten an enthusiastic response to our work from both federal and state policymakers, on both sides of the political aisle. Traditional models of care, where a patient travels to a doctor’s office, are failing, especially in rural areas, and policymakers are very aware of the struggles many in their districts face in finding care. They are excited about the potential of mobile, alongside telehealth and digital health approaches, to improve the status quo.

Looking ahead, with 48 states including mobile in their RHTP applications, what policy issues will individual states have to address head-on to achieve meaningful impact on access to care?

My colleagues, Julia Burleson and Leila Sullivan, recently published an excellent deep dive into state RHTP applications to understand how states are planning on using the funds to support mobile health. Their analysis highlights a spectrum in how states are thinking about mobile in the context of rural health care delivery. Only a handful of states have actually spelled out the kinds of systems-building work that will need to take place to support and sustainably expand mobile health.

To meaningfully support mobile health, states need to move away from ad hoc earmarks for specific mobile programs and grant funding that simply gives mobile programs startup capital. They need to build a baseline regulatory framework to make mobile visible in the health care system, and pair capital funding with technical assistance that can help programs achieve long-term financial sustainability and better integration with other health care providers, payers, technological/EHR infrastructure, and other state systems, such as crisis response or EMS systems.

How can initiatives like Driving Health Forward help address mobile healthcare policy challenges? 

Mobile health has existed in pockets across the country for decades thanks to the tireless work of many dedicated community leaders and health care providers. In my work as a health policy researcher, however, I have learned that relying solely on individual champions is both (1) unrealistic in terms of helping a health care model achieve scale, and (2) places an inordinate burden on the champions and providers themselves to cobble together a way to sustain their model, when what they would rather be doing is focusing on delivering health care and serving their community.

Groups like Driving Health Forward can do the important yeoman’s work of bringing together these different programs and their champions, provide critical institutional support, offer peer learning opportunities, and advocate for their interests as a group.

Where should policy research on mobile healthcare go from here?

What our policy scan does is give you the broader map of how mobile health is currently treated in federal and state policy and gives you a taste of how policymakers can help support and expand mobile in the future. However, there’s a lot more nuance within each of the sections we’ve discussed that needs to be explored. For example, there’s a lot more to learn from the burgeoning state efforts to support mobile in Oregon and South Carolina. This report tells you what we see on paper, but I have found that it’s always helpful to go to the frontlines to see exactly how these various state and federal policies are enabling or constraining mobile service delivery on the ground. This future policy work will be critical to further refine the policy map and recommendations laid out in our scan.

###