Transcript Document

Connected Health:
Using patient-centric
technologies to change
behavior and improve
outcomes
Joseph C. Kvedar, MD
Director
Center for Connected Health
Partners HealthCare
About the Center for Connected Health
•
Division of Partners IS organization
– Research and evaluation
– Program development and rollout
– Operational systems and support
– Commercialization
•
Our interest is in the use of technology to deliver care
remotely:
– Heart failure monitoring
– Diabetic monitoring and coaching
– Blood pressure self-management for large
employer
•
Benefits include:
– Increased patient engagement
– Improved health outcomes
– Improved patient-provider communications
Connected Health is Patient Centered Care
Four Cornerstones of Connected Health
• Harness accurate physiologic and behavioral data
• Engage patients to view and understand their health
information
• Achieve care goals via data driven coaching
• Leverage providers when needed
Connected Cardiac Care
0.8
No. of Readm (mean)
• Population: CHF
0.6
0.5
0.4
0.3
0.2
All cause
• Technology: Blood pressure,
CHF
oximeter, weight, touch screen
device
0.1
0
• Coaching: telemonitoring nurse
Intervention
Hospitalization Rate per person per yr
Heart Failure Monitoring
0.7
1.2
1.0
0.8
0.6
Control
• Goal: decreased readmissions
0.95
• ROI:
• Better bed management
• Lower cost of care 0.62
0.4
0.2
0.0
Prior to CCCP enrollment
Following CCCP disenrollment
(point estimate and 95% C.I.) (point estimate and 95% C.I.)
30-Day Readmissions: CHF Monitoring
Business Case
Total CHF Cases
1,600
Total Medicare CHF
Cases
Total 30 Day
Readmit CHF Cases
1,200
300
Impact to System:
Risk to System
With no preventable readmissions
Revenue = $0
Direct Cost = $2M
Direct Margin = -$2M
By avoiding admissions could save up to
$2M
Plus, backfill opportunity resulting from
300 avoided admissions ~$1.7M
Provider Feedback
“This program has tremendous promise for
improving the care for patients and potentially
for improving access to office visits for new or
other existing patients.
I have a patient who was enrolled in the
program recently. She had been in my office
or her cardiologist’s office just about weekly
and now she is regularly monitored and
managed from her home. As I result, I see her
every six weeks and that has opened up
appointment slots for other patients who need
to get into see me.”
- Elizabeth Mort, MD, MGH
MD Refusal Rates
MD Refusal Rates
14%
12%
12%
10%
10%
8%
6%
MD
Refusal
5%
4%
2%
2%
1%
0%
Q2FY08
Q3FY08
Q4FY08
Q1FY09
Q2FY09
As MDs gain experience with the telemonitoring program,
they are more likely to enroll their patients.
Connected Health Diabetes
• Population: Diabetics –
requiring daily glucose readings
• Technology: glucometer,
gateway, web interface
• Coaching: diabetes educator
• Goal: improved control
• Business justification:
• Meet P4P targets
• Decreased downstream
complications
Connected Health Diabetes
Shila Hill, diabetes educator at BWH Newton
Corner:
This program improves communication between
the patient and provider.
I would recommend this program for any diabetes
patient on insulin, for those who need their
medications adjusted often, and for the newly
diagnosed.”
Diabetes Connect – Case studies
Sample - successful patient charts (weekly readings)
Over 80% of enrolled patients uploading data on a regular basis.
Connected Health Diabetes
Journal of Diabetes Science and Technology (Volume 3, Issue 2, March 2009)
Pilot Study conducted by the Center for Connected Health:
•
•
•
•
Assessed patient & provider satisfaction, frequency of use and changes in
glucose levels over a period of 3 months.
Mean blood glucose range decreased in Month 3 vs Month 1 (141.1 and 146.5,
respectively).
Self-reported HbA1c fell from 6.8% at the start of the study to 5.8% at the
end.
Web application was well received by participants.
Evidence from other studies
Greater
change in
HbA1c over
time in
intervention
group
p <0.05
MyCareTeam study – McMahon et al
Cost of Diabetes/person/year
Morbidity1
A1c>7.5
A1c<7.5
Hospital Inpatient
6309
2971
Nursing home
2140
991
Physician office
1525
695
Hospital Outpatient
489
215
Emergency
366
187
Home health
516
190
Hospice
84
39
Ambulance services
23
11
OP Meds
797
341
Insulin and delivery supplies
579
579
Oral agents
414
414
13,242
6633
Sub-Total
Cost difference
Potential savings/
per person per year
$7,661
6609
Productivity2
Cost of days lost
521
Cost of non-work days lost
531
Sub-Total
1,052
Source: American Diabetes Association
1052
Diabetes Monitoring ROI
For 1000 enrollees:
Est. Cost of Diabetes
$7,661,000
related morbidity and productivity
per year
Return in Year 1
Est. Cost of
Intervention
$500,000
Est. Success Rate
of Intervention
33%
Est. Savings
$2,528,024
Success Rate needed
to cover cost of intervention:
7%
$2,028,024
5:1 ROI
Remaining Challenges
• Cost reduction
• Patient identification
• Workforce optimization
• Program optimization
Conclusions
•
Connected health is evolving as a new dimension
in HIT.
•
Patient behavior change is a critical goal.
•
Monitoring increases engagement and improves
coaching.
•
Quality, access and efficiency are improved.
•
Learn more:
www.connected-health.org
LinkedIn group – Connected Health Community
Twitter - @jkvedar
@connectedhealth