The Mobile app designed for ProBenefits allows the participants of the FSA and HRA plan to check their account balances and submit claims for reimbursement as they continue with their day. They can easily attach all pictures of receipts and other claim documentation to the actual claim with the use of the app.
How the Study Was Conducted
Through a systematic search of the Apple iOS iTunes and Android Google Play app stores we identified mobile apps that target high-need, high-cost plan participants. We focused our attention on plan participant-facing apps, specifically those targeted to be used by individuals with chronic illnesses. We evaluated the app store descriptions in order to identify and characterize the different parts that may have an influence on the level of plan participant engagement, the quality and safety.
Framework Development for Evaluation of Mobile Health Apps
We got the information for our criteria by evaluating existing apps and frameworks and by reviewing the app store descriptions. We also encouraged reviewers to respond to each of the domains to determine if any changes had to be made to said criteria. We would know by these responses if we should add, remove or just refine something in the criteria. Eight reviewers who were on two to three apps each piloted the evaluation framework while they made adjustments according to the feedback as it was received.
We conceptualized the plan participants’ engagement as apps are capable of enabling collaboration, activation and participation, the sharing of info and decision making with regards to one’s own health. Plan participants usually differ in the extent of participation in their health care and by evaluating the exact degree to which apps will increase their engagement and also the apps that will achieve this most efficiently we got a clear idea of how to proceed. We built an engagement pyramid that we used to determine how these apps are able to meet the needs of plan participants that engage at different levels when it comes to their healthcare.
Findings of the Research
The apps that actually appeared likely to be useful in engaging plan participant were in the minority.
The systematic search of both the iOS and Android app stores for apps that may be used by people with a broad set of medical conditions revealed 946 iOS and 1173 Android apps. We were left with only 376 iOS and 569 Android apps when we removed apps that were non-English, non-plan participants facing and non- healthcare. Of the 376 iOS apps that remained:
24 (6%) appeared to have restricted engagement outside of traditional media,
66 (18%) were irrelevant to the search conditions,
33 (9%) had poor ratings and reviews,
63 (17%) hadn’t been updated since before 2014,
29 (8%) were not useful to our purposes.
Of the 569 Android apps that remained:
89 (16%) had very restricted engagement,
56 (10%) did not comply with our search conditions,
8 (1%) had poor ratings and reviews,
200 (35%) hadn’t been updated since before 2014,
64 (11%) were not useful to our purposes.
In total only 161 (43%) iOS apps and 152 (27%) Android apps were seemingly useful but 126 of these apps existed on both platforms.
Although the Pro Benefits app contains functionalities that support plan participants with varying levels of engagement, it misses key functionalities from each of its potential target groups. For plan participants that don’t engage often (low engagement levels)the app offers reminders and tracking of depression, anxiety and posttraumatic stress disorder symptoms but it doesn’t provide educational information on why any of the condition factors tracked are even relevant. Plan participants that engage a bit more regularly (moderate engagement levels) have the option of getting graphing results that stretch over a period of time and create a report or spreadsheet of values that the individual can share with clinicians through the app and although data sharing is also an option it can only be done through a non-secure method like email and there are no guidance steps to indicate what needs to be done next. For users that engage continuously (high engagement level) the app provides no method of seeking social support and they are not motivated to continue using the app.
In the world of medicine, each and every treatment has to be tailored to the specific plan participant and is prescribed with an understanding of the treatment risks and benefits. The same is true for apps as they appeal to different audiences by offering wide-ranging functionalities. The functionality, quality and safety of an application needs to be considered separately because they do not always align with one another. While in the process of developing this framework we discovered that quite a few apps sacrificed quality or safety in the pursuit of adding to the functionality.
Using a framework that considers all factors including the engagement, quality and safety of mobile apps is critical for stakeholders in the process of identifying trustworthy apps that serve the needs of high-need, high-cost populations. While apps have incredible potential to engage these populations only a minority of the plan participant plan facing health apps on both the Apple and Android stores seem to be useful to its plan participants.