Bringing digital tools into health systems may be welcomed for the improved continuity of care and patient engagement, but adding value in a way that improves the financial bottom line is an unavoidable necessity as well.
On a panel discussing the business case for digital and connected health at HIMSS 17 in Orlando, speakers from various backgrounds and specialties shared how their organizations approach, implement and evaluate such technological infusions into their work.
“We’re always starting with a business problem and looking at where we can apply this type of technology, where do mobile apps or text messaging or wearables or data from remote monitoring fit? Sometimes, we figure out they don’t fit and we have to say 'This is not a problem that has a digital solution',” said Chanin Wendling, Assistant Vice President of Informatics at Geisinger Health System.
That being said, Wendling went on, as long as the clinical outcome is in mind when a digital approach is being considered, the solution is more likely to be successful.
“One of the key things you have to remember when you are trying to solve a problem, everyone gets excited about all these wearables and sensor technology and sexy consumer devices things, but I think if you hold onto what clinical outcome or cost outcome you are trying to solve, you sort of clear away all that noise,” she said. “I think for healthcare people, ROI can be scary when you are talking to the CFO, but when you think in terms of clinical value, you can be more focused.”
In her experience at Geisinger, Wendling was part of a program that sent text messages to new diabetic patients, and those who were enrolled in the program were able to lower their A1c levels by 0.5 percent, which is considered significant.
“I thought, heck, I've just saved a pharmaceutical company lots of money, and the consumers as well, because of a text message,” she said. “But the goal was to lower the A1c level. It wasn't about whether text messages were valuable or interesting, but it happened in the right solution.”
For Ed Martinez, Chief Information Officer for Miami Children’s Hospital, the value added from a mobile messaging program was easily measured.
“Where we've invested a lot of time and money and energy in is mobility and the patient experience and patient engagement. We believe that mobile tools have really shifted things for the types of patients, mom and dads that we serve and the age groups that we deal with,” Martinez said.
“Empowering them to use mobile tools, whether it is social media type tools or apps or something similar, it has helped not only drive the experience and engagement, but without a doubt, it has improved our profit margins. We went from 2 to 3 percent profit margins to 7 to 10 percent profit margins by having the constant engagement and feedback. So, talking well before the visit, during the stay and after the stay, we're going to engage with the patient not with the portal, not with the app but with real-time text messages.”
Moving onto the tools that capture, store and analyze data from mobile solutions, Medtronic General Manager Chris Landon said his company sees a lot of value from remote monitoring and the platforms that support all the data flow.
“With cardiac monitoring we see a great opportunity to deploy these sensors and corresponding cardiac monitoring,” Landon said. “We can speed up the time to diagnosis for patient who might be asymptomatic or they might not be a patient and all, as well as potentially improving outcomes, and not just time to diagnosis, but also helping to manage that patient's diagnosis.”
Drew Schiller, CEO of patient-generated health data collection platform Validic, explained how they see a return from digital interventions in a number of ways. “We’ve seen really great examples of ROI on readmissions, but there is also a tremendous opportunity to improve patient care and experience which ultimately leads to improved outcomes and cost savings.”
Schiller expanded on a program Validic is working on with Sutter Health for people with hypertension and diabetes, where patients were given connected blood pressure monitors, activity trackers and connected scales. Data generated from those devices feeds to a dashboard.
“There, the last care coordinator can really understand which patient to reach reach out to today?” Schiller said. “Who is having trouble with monitoring their condition, who is maybe falling out of compliance with their medication, versus who is doing great, who do we not need to reach out to? So, there is a real ROI there in terms of understanding which patients need to be brought in there for a visit, which patients are ok versus, ok, I have 2,500 patients, that's a big panel size, how do I spend my time to be most effective to my healthcare system?"
Schiller also shared results from a pilot with remote patient engagement platform IGetBetter. They worked with a hospital to assess if they could influence readmission rates for people with heart failure by giving them connected scales and heart monitors. With the initial, small pilot of 30 people, they expected about eight patients to be readmitted, but they ended up having zero.
“That’s a $216,000 cost savings immediately that was realized in the hospital system,” said Schiller. “As they further expanded on that system – and they now have more data that is pending publishing – they’ve seen similar results in heart failure patients from larger panel sizes as well as people with COPD, which is a very challenging condition.”
Expanding on the growing patient-to-doctor ratio, which some estimate to reach 5,000 to one in the next decade, Schiller said having systems to help quantify what is happening with all those patients – and all that data – is of paramount importance.
“This is just going to become a fiscal reality,” he said. “We need to not just have connected devices to bring in the data, but we need to have the ability to understand what the data actually means.”
Landon of Medtronic sees a similar challenge, which can be a roadblock to implementing a digital approach for some health systems. So what Medtronic is currently working on is building out a monitoring system that is specific to different health conditions, then manage those different data streams with cloud-based analytics systems to move insights to healthcare provider partners.
“When we look at business models for digital health, there is the obvious idea of putting sensors on people and trying to do something valuable with that data, but the cost and the roadblock of trying to imagine all the massive amounts of data is a barrier,” said Landon. “So, if we can make an additional, up-front investment that allows us to scale the monitoring infrastructure of multiple streams of data coming in, we can re-leverage that investment by creating more services and value on top of each data stream.”
As that happens, the panel all concurred, there will be more opportunity for vendors offering predictive analytics and interoperability between solutions.
While CEOs obviously want to see the bottom line increasing, ROI can be measured in multiple ways, added moderator John Sharp, senior manager at the Personal and Connected Health Alliance.
For Martinez, they saw value in the form of engaged and satisfied patients from little things like offering discharge instructions in the form of a text, rather than a ream of paper, that included features like a note for the child’s school. Additionally, that reduces some of the backend paperwork that nurses have to contend with.
“First, there is the return on the monies, the hard numbers. When you have engagement factor and you are bringing them back, you're not losing any of the market share, you know what your numbers are doing. We see that as a return on the bottom line of attracting and retaining,” he said. “And people have a lot of choices, so, unless you are giving them something that is value-added, you can embrace and use that as a secondary care, and a lot of consumers look for convenience factor, for engagement factor to make sure physicians are quality, but when you add a little extra oomph to it, you can be taken care of with your family, you know what's going on, you retain that patient and for a longer time.”
Once a health system knows it wants to deploy a digital or tech-enabled program, the panel said it helps to work with providers and partners who are entrepreneurial in spirit and willing to conduct pilots and small studies along the way.
“Consumers can adapt very quickly, and in our case, we have been able to see utilization from their end climb fairly fast, but the problem was physicians,” said Martinez. “There is resistance. They’ve been doing the same thing for 30 years and they don’t want to. Unless they see value immediately, they aren’t going to get onboard, so it’s taken us more than a year to get them to adopt something that consumers will do pretty much immediately.”
To address that, innovators need to make things easy for clinicians. While programs can take a few months to a year to show their worth, it shouldn’t be painful in the meantime.
“We’re very challenged when someone comes to us with a solution for one condition,” said Wendling. “I can’t possibly integrate 30 different things with an EMR, so we need a platform that can be used several things, that can be plugged and played with different solutions. You should not have to go looking for data and ferret out what should and shouldn’t be there.”