"The time for connected health really is now," The Center for Connected Health's Founder and Director Dr. Joseph Kvedar told attendees during a presentation at MassMEDIC last week.
Make the case for technology
Kvedar said that connected health technology companies have to make the case to providers that their solutions work better and save more money than a medical home solution that uses little technology and requires some traveling nurses: "It's a matter of changing provider mindsets to be thinking more [about connected health] and then marketing this solution to them," Kvedar said, "because [providers] will come back with: 'We just need the medical home, a couple of nurses, a pharmacist and we'll be fine... we don't need any tech.' And if we don't make the case, we will miss our opportunity for this."
"Providers will be picking up on [connected health solutions], but I want to mention that we have to make our case. The time is now, the market is ready," Kvedar said. "There are already people and thought leaders and organizations ... trying to solve these problems ... and they want to solve them without using technology. We need to get the message out" that some of these connected health solutions really are the best way to manage costs.
Payers are "breathing down providers necks"
Kvedar explained that the connected health market is being driven by a number of forces but two of them: care coordination and capitation are key. Care coordination has two large sub-sectors, Kvedar explained, what employers need to do to make sure their costs are met and what they need to do to make sure their employees are well cared for. For capitation, Kvedar noted that Blue Cross Blue Shield of Mass is "really breathing down care providers necks" to make sure they are managing costs. Capitation is where the insurance provider pays care providers a flat rate for a year to care for patients and the care provider then has to do its best to control costs within that context. Kvedar said that in the next three years maybe 50 percent of Partners revenue will be capitated.
Ingredients for a connected health approach
Kvedar detailed his center's congestive heart failure pilots as well as its diabetes programs. At the core of each of the center's programs are a few principle: accurate physiological data preferably automatically gathers and uploaded from medical sensors, analytical patient data for patient review and, finally, a coaching component that nudges the patient in the right direction when necessary.
"If you blend those three elements together, you start to see the magic and how these programs affect clinical outcomes," Kvedar said.
Connected Cardiac Care program for CHF
Kvedar said that the center's Connected Cardiac Care, congestive heart failure monitoring program will reach scale this year. One third of Partners' discharges are good candidates for the program and Kvedar expects to admit about 1,000 people into it by the end of this year. The pilot is currently overseen by three nurses and has patients answering yes/no questions on a touchscreen. They get a phone call fro a nurse if they don't answer their questions or upload their pulse oximeter data and other metrics. There is an expectation of involvement on the patient's side and an expectation from the patient that they will get a call at the first signs of health decline. Initial pilot results showed about 50 percent less readmissions for participants in the program.
The Fed's 30 day rule
That's key since Kvedar said the federal government recently told providers it would soon no longer pay for people readmitted for the same diagnosis 30 days after discharge. In a fee for service setting, the program has a slim return on investment "at best," Kvedar said. For a total of 1,600 eligible participants, 1,200 of whom are Medicare patients and 300 are readmitted within 30 days the previous year -- that's a $2 million effect on costs if the government won't pay for those readmissions. If providers can manage to keep those readmissions out through a remote monitoring program, it could save on those costs. Furthermore, those beds would then be open and could make for about a $2 million upside, Kvedar said.
Usability: The final challenge?
ROI aside, these technologies still need to reach a level of usability that make than accessible to more patients: About 33 percent of the people the Center for Connected Health gives the technology to for programs need a phone call to have someone walk them through an install that's almost as simple as an iPod install, Kvedar said. It's getting simple, but not simple enough.