Usability, finances, lack of scientific evidence holds back home health tech

By Neil Versel
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As any reader of MobiHealthNews should know, the market for home care is gradually shifting from durable medical equipment to Internet-enabled, connected technologies. But acceleration of that change is hamstrung by finances, accessibility of the technology and lack of scientific evidence showing that wireless monitors and the like can save money and improve outcomes.

"We see substantial growth potential in technology-enabled home health care. An aging population and an increasing chronic-disease burden point to a large and growing market," researchers from consulting firm McKinsey & Co. write in the fall edition of the McKinsey Quarterly. "But home care stakeholders must get the reimbursement models right and ensure that the technologies coming to market truly make a difference for patients and the bottom line alike."

Home care today is a $68 billion industry, representing about 3 percent of U.S. healthcare spending, and it's growing at an annual rate of 9 percent, according to McKinsey. The researchers, Basel Kayyali, Dr. Zeb Kimmel and Steve van Kuiken, note that home-monitoring technology is a tiny part of that, especially considering that two-thirds of cost of home health is related to labor.

"What’s holding the market back? We observe a daunting array of financial and operational barriers, including the misalignment of incentives between payers and providers, the need to demonstrate a strong clinical value proposition and the problem of designing attractive, easy-to-use products that facilitate adoption by patients," the article says.

Kimmel, a former visiting fellow in the Office of the National Coordinator for Health Information Technology, and his McKinsey colleagues say that any sustainable business model for home healthcare technology must meet eight "key success factors":

  1. There must be alignment between payers and providers.
  2. Patients and purchasers need to see clear value.
  3. The technology should have a "significant impact" on care.
  4. There must be a way for a human or device to initiate a medical intervention when a sensor detects a problem.
  5. The technology must be timely in guiding medical decisions, such as an accelerometer that can automatically detect a fall.
  6. There needs to be a "closed feedback loop" to help measure the effectiveness of the device.
  7. The technology should be easy to use.
  8. Devices should be used frequently—at least daily—to reinforce positive behaviors for managing diseases.

"Entrants into the home care technology market should cast a critical eye upon their offerings to verify that all eight success factors have been satisfied. Failure to meet even one can cripple an otherwise-promising business model," Kayyali, Kimmel and van Kuiken write.

There are both financial and moral imperatives to get this right, according to the authors. Home care supported by technology certainly "offers a promising pathway to bend the cost curve," an oft-cited goal of healthcare reform, they say. But it also could facilitate more aging in place.

"Independent of the economic benefit, the moral value of enabling older members of society to live in grace and dignity in their own homes, with a ripple effect on their caregivers, is arguably the most important—if unquantifiable—benefit of home care," the McKinsey team writes. An added side effect is that home care can prevent or at least delay expensive inpatient and long-term care for patients with chronic, nonintensive ailments.

"[This market] will move ahead, however, only if stakeholders develop more equitable reimbursement models that create greater incentives to participate in the technology-enabled home health market. In addition, medical-device makers must focus on technologies that are easier to use, have a real impact on patients' conditions, and make it possible to measure results."