Can mHealth Bend the Iron Triangle?


Can mHealth Bend the Iron Triangle?

The Growing Promise of Digital Tools and Better Outcomes

For any health care stakeholder, the iron triangle represents the tradeoff between quality, access, and the cost of care. The idea behind the iron triangle is that quality, access and costs are components of the health care system that exist in a positive feedback loop. When implementing a health intervention, providers and policymakers face a set of decisions that involve increasing quality and access at the risk of increasing costs. As such, providers and policymakers aim to use the most cost-effective methods to minimize the effects of the iron triangle.

Moses Flash
SUMR Scholar, Hillary Bonuedie is rising junior at Columbia University where she is pursuing a degree in Economics.

Vulnerable populations
Access to care is one of the primary concerns for vulnerable populations today. Vulnerable populations have difficulty accessing care for a number of reasons; the biggest barrier being cost. There are primary costs of seeing a health care provider, such as the co-pay or the full expense for the uninsured. There are also secondary costs such as transportation fees and the opportunity cost of missing work to make it to an appointment. The secondary costs are often underestimated, but for vulnerable populations these costs can be nearly as important as the primary costs. To better serve this population, there is a need for a platform that works to increase access without increasing cost. An example of such a platform is the mHealth initiative.

The World Health Organization defines mHealth as “medical or public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.” Ninety per cent of adults in the US own a mobile device and 58% of adults own a smartphone. For this reason, mHealth interventions have the potential to reach a large number of people and increase access. A unique feature of using mobile technology is that care can be delivered remotely. Remotely providing care can help alleviate some of the secondary costs of receiving health care.

Free mobile game
Additionally, many mHealth interventions that can assist with increasing access to care are available for free. One such example is the mobile game Wellapets pioneered by past SUMR scholar Alexander Ryu. As a SUMR scholar, Ryu worked on a project looking at asthma medication adherence. Now as the CEO of Wellapets, Ryu has been a key figure in creating an asthma management platform for children. By allowing Wellapets to be free, he believes “it works for the best of everybody in that regard. Just getting users in the door, even if they’re not paying, is beneficial…It helps spread the word about the game [and] it gets more people engaged.”

Still, there are costly investments to be made when using mHealth. In the case of Wellapets, Ryu cites the cost of product development. Substantial initial investment is needed to create the physical app, to organize focus groups with various stakeholders, and to increase visibility through social media. At the same time, eliciting the desired health outcome may be enough to equalize or minimize the cost of the initial investment. In the case of asthma, reducing the number of hospitalizations each year from asthma attacks could significantly decrease health care costs for health care institutions and the people they serve.

Discovering the future
Although mHealth has the potential to increase access to care without increasing costs significantly, there is very little literature on how mHealth directly affects health outcomes. Available literature reveals that mHealth helps in improving patient satisfaction, knowledge, and overall confidence levels. We already know much of what mHealth is doing right. At this point there is only more to discover.