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Review: “Convergence in Health Care” Webinar

8 Oct 2014

In-home patient monitoring with mobile devices can lead to significant cost savings on care for chronically ill patients, according to Alan Snell, MD, MMM, healthcare It consultant and faculty adviser to C-Suite Resources. 

“Give away the mobile device to the patient, because the outcome on that investment is going to be huge,” Snell told a recent Insight/Spiceworks webinar on “Convergence in Health Care.” 

In launching a readmission study at Indiana-based St. Vincent Health, the goal was to show how technology in the home, on a global platform, could reduce readmissions. The focus, Snell explained, was on chronic diseases. 

The readmission study measured the difference between the lower level of patient activation, or engagement with their own care, versus the highest-level of activation. 

“In other words, how well does the patient understand their disease process and how to manage that disease process,” saiSnell. “The result was a 21 percent difference in cost.”

He said that per capita spending increases once a patient has four or five of the six chronic diseases responsible for the better part of Medicare expenditures. More chronic diseases afflicting a patient
translate to more physicians and providers, more visits and more procedures, Snell observed. 

“This has become a big target area,” he said. “And when we talk about managing population health, we really want to talk about how we focus-in on this population that has these chronic diseases that are costing us so much.” 

The driver behind the St. Vincent study, he explained, was a Centers for Medicare and Medicaid Services rule eliminating hospital reimbursements for patients readmitted within 30 days of inpatient

The idea was to see how patients could be made to better engage their own health care through a remote device in the home and measure it’s potential impact on the bottom line. 

The researchers chose a device by Intel GE (later spun-off as Care Innovations); a first generation state-of-the-art mobile device in 2010, costing about $2,000 a piece, said Snell. 

The device collected “biometrics” (blood pressure reading, a blue tooth weight reading, oxygen tension) and permitted the daily querying of patients.

“We wanted to know, subjectively, how were they doing compared to previous days?” said Snell. 

One patient, a 53-year old woman with six chronic diseases labeled “noncompliant” by care providers when it came to following-up on appointments and taking medication, saw her care costs reduced from
$156,000 in 2011 to $2,500 in 2012. 

“The patient actively participated in remote care during 2012,” he explained “recording daily vitals, completing all nurse-conference videos and educational videos as advised. She complied with physician visits and the medicinal regimen.”

Home-based technologies are efficient, Snell observed, but must be integrated with electronic health records and health information exchanges. 

“We are on the cusp of this explosion in the IT world, but we need to figure out how data flows, what work flows are, how the providers are going to manage information,” he said. 

Big players in the converged environment will be pharmaceutical retailers such as CVS, Walmart and Walgreens. They are developing retail care clinics and have ample infrastructure to house them. 

Wireless carriers all have health care strategies, said Snell, focusing mainly on technology and developing a business model. “When you have a lot of devices in the home, and are using up minutes,
that’s a good thing for them,” he noted. 

Manufacturers of devices and the designers of applications will also have enhanced roles under the new order. 

“The big question is when do you shift from the volume-based to value-based model while you have a foot in each world?” said Chuck Appleby, a healthcare journalist and partner with C-Suite Resources. 

Appleby said healthcare executives believe that the tipping point for going into risk and accountable care is when 25 to 30 percent of payments become risk-arrangements. 

“Health systems are starting to get there,” he said. “In the next couple of years, this is going to happen.” 

Asked what it all means for IT managers in hospitals and health care systems organizations, Snell responded, “If I were a chief information officer, I’d start thinking about how I’m going to manage
my shop with a lot of applications and programs being remotely hosted.

“No way an IT shop in a hospital will be able to put people out in the field to deal with technology issues in the home,” said Snell. “As we spread out beyond the traditional health care facility, we have to rethink how we’re going to provide technology and infrastructure.”

Mark Heuser, director and GM, U.S. HealthCare Sales, Insightnoted that, “Home hospice organizations are already blazing that trail. They’re figuring it out as they go. That’s where you can look to see how it is beginning to operate.”

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