Delivering Accountable Care with Remote Monitoring for Chronic Disease Management

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Figure 1: Reduced Hospital Readmissions Using Remote Monitoring Solutions

Geisinger Health Plan*

44%

Spectrum Health**
0%

73%
10% 20% 30% 40% 50% 60% 70% 80%

Readmissions Reduction (%)

*Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population, Med Care, 2012 **Virtual Monitoring Reduces Hospital Readmissions for Spectrum Health Heart Patients, 2010

ealth expenditures in the United States neared $2.6 trillion in 2010, accounting for 17.9 percent of the U.S. Gross Domestic Product (GDP)1, with chronic disease capturing the lions share of the cost. Nearly 1 out of every 2 adults, or 133 million Americans, had at least one chronic illness in 20052, and every year, chronic disease, which includes cancer, diabetes, heart disease and stroke, causes 70 percent of deaths in the U.S. and comprises approximately 75 percent of medical care spend.3 The explosion of chronic disease is not just an American phenomenon; it is the leading cause of mortality in the world, responsible for 63 percent of all deaths.4 In 2008 alone, 36 million people died from chronic disease, according to the World Health Organization.
In an effort to bend the cost curve and address chronic conditions, leading healthcare organizations have implemented various solutions. Remote monitoring for chronic disease management has been widely deployed because it targets the area of greatest spend. It also affords convenience for both patients and clinicians, enabling the former to track and self-manage their conditions within their daily lives and the latter to receive critical information anywhere and anytime in order to provide real-time quality care. Numerous studies have quantied both the clinical and nancial value of implementing such programs (See Table 1 and Figures 1-3).

Figure 2: NEHIs Detailed Technology Analysis Home Telehealth (2009)*

Average Decrease in Hospitalizations Decrease in Mortality Rates Average Decrease in ED Use
0%

49%

69%

69%
10% 20% 30% 40% 50% 60% 70% 80%

Accountable Care: Changing the Dynamics for Managing Chronic Diseases

Despite documented successes, in general remote monitoring for chronic disease management has been stuck in pilot mode. While there are a handful of reasons for this inertia, the main driver is lack of economic incentive, according to Donald Jones, vice president of global strategy and market development for global telecommunications leader Qualcomm Life. What really drives healthcare is when workow can be improved, direct and measurable costs can be reduced, or market share can be increased, he said. At the end of the day, quality usually has to be hand in hand with one of these drivers in order for something to be implemented. As the path to unsustainability grows ever shorter, new accountable care models are being developed to replace the current fee-for-service model, moving from pay for volume to pay for quality, which contributes to a more receptive environment for remote monitoring. 69% The passage of the Affordable Care Act (ACA) has moved up the timeline for implementing new payment models. The ACA incorporated provisions for participation in accountable care organizations (ACOs), which tie provider reimbursements to quality metrics and reduced cost for an assigned patient population. Under the Medicare Shared Savings Program, which began in January 2012, participating entities that meet quality and performance standards are eligible to receive payments for shared savings. Also under ACA, the Hospital Readmission Reduction Pro1. Centers for Medicare and Medicaid Services 2. Rand Health 3. Centers for Disease Control and Prevention 4. World Health Organization

*Analysis comparing five independent clinical studies demonstrating the effectiveness of home health monitoring across a combined 17,917 patients.

Figure 3: Results of 3 Million Lives - Whole System Demonstrator (UK) trials (2012)*
Reductions in:

Elective Admissions A&E Visits Emergency Admissions Mortality Rates

0.0

14% 15% 20% 45%

5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Reductions (%)

*The largest randomized control trial of telecare and telehealth in the world.

Chronic Condition

Program, Study Noninvasive Home Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death, Journal of the American College of Cardiology, 2005 The Veterans Healthcare Administration, Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions, Telemedicine and e-HEALTH, 2008

Benets 35% drop in inpatient length of stay; 10% reduction in ofce visits; 65% drop in home health visits

Congestive heart failure (CHF)

CHF

Decreased utilization of healthcare services by 26% in patients with congestive heart failure

CHF

Cleveland Clinic/Microsoft Pilot Project, Cleveland Clinic, 2010

CHF patients visited their doctors more often, decreasing the number of days between visits by 27%, which enabled timely intervention when complications arose and prevented serious problems potentially requiring ED visits or readmissions. 60% reduction in hospital readmissions compared to standard care and a 50% reduction in hospital readmissions compared to disease management programs without remote monitoring. Remote patient monitoring has the potential to prevent between 460,000 and 627,000 heart failure-related hospital readmissions each year, resulting in an estimated annual national cost savings of up to $6.4 billion. Reduced hospital admissions by 50%; acute home exacerbations by 55%; hospital costs by 17%

CHF

NEHI, Remote Physiological Monitoring: Innovation in the Management of Heart Failure, 2009 update of 2004 analysis

Chronic obstructive pulmonary disease (COPD)

Telehomecare and Remote Monitoring: An Outcomes Overview, Advanced Medical Technology Association, 2007

COPD

The Veterans Healthcare Administration Care Coordination/Home Telehealth program

Decreased utilization of healthcare services by 21% in patients with COPD.

Diabetes

Telehomecare and Remote Monitoring: An Outcomes Overview

42% drop in overall cost per diabetic patient (post discharge remote monitoring)

Diabetes

The Veterans Healthcare Administration Care Coordination/Home Telehealth program

Decreased utilization of healthcare services by 20% in patients with diabetes.

Diabetes

Cleveland Clinic/Microsoft Pilot

Diabetic patients made doctors ofce visits less often, increasing the number of days between appointments by 71%, indicating that patients had better control of their conditions

Hypertension

The Veterans Healthcare Administration Care Coordination/Home Telehealth program

Decreased utilization of healthcare services by 30% in hypertension

Hypertension

Cleveland Clinic/Microsoft Pilot

Hypertensive patients made doctors ofce visits less often, increasing the number of days between appointments by 26%, indicating that patients had better control of their conditions.

Table 1

What really drives healthcare is when workow can be improved, direct and measurable costs can be reduced, or market share can be increased.
Donald Jones
Vice President, Global Strategy and Market Development Qualcomm Life
gram, which took effect October 1, 2012, reduces payment rates for excess readmissions within 30 days for Medicare patients. Participation and compliance with these programs will drive hospitals and other healthcare organizations to revisit their successful pilots or build strategies around best practices of proven pilots for remote monitoring for chronic disease management. transmitted their glucose readings and other biometric data via their mobile phones, PCs or Macs. The 2net Hub and MyGlucoHealth meter have provided accessibility and convenience for patients, especially the elderly who are either home-bound or in assisted living facilities and may not have access to technology. The standalone home-monitoring solution automatically transmits the data. Across the board, its easier; you dont have to touch anything, said CEO Richard Strobridge. Patients can use the 2net Hub in conjunction with mobile apps, enabling caregivers to view alerts and send text messages and testing reminders. Staff can log onto the clinical portal and quickly identify which patients have not tested and uploaded their data. The system automatically triages those patients, so instead of trying to have a constant engagement with a thousand patients, they can see which 50 patients are in the most trouble right now and reach out to them, Strobridge explained. In the four months since the hub and blood glucose meter have been in production, the company already has seen better outcomes. Were seeing HbA1c levels starting to come down, and were seeing more engaged and motivated patients, he said. With more compliant patients, provider staff has seen a reduction in missed interactions and communications. Building on the success of the launch, Entra Health Systems is rolling out 2net for its products across the country and across Europe in November.

Unleashing Innovative Technology to Bring Greater Value

While successful pilots have been studied as early as 2005, technology developers continue to innovate and bring increasingly more robust solutions to market. In December 2011, Qualcomm unveiled both a new company Qualcomm Life, Inc. in the mobile health space and its cloud-based 2net Platform and Hub, which are both FDA Class 1 MDDS medical devices. The Platform is designed to aggregate data streams from non-interoperable medical devices, which can then be turned into apps for mobile devices or interface with electronic health records (EHRs). Qualcomm Life is moving to apply analytics engines to data streams and the resulting information can be recorded in mobile devices or turned into predictive models with the help of partners that help patients with therapy management. The 2net Hub is a plug-and-play gateway designed to plug into a wall socket and provide connectivity for a wide range of medical devices and to transport data from those devices to the cloud platform. Companies can access Qualcomm Lifes software development kit (SDK) to write software and pull data from the cloud and make for example, dashboards or web portals that transform information into clinical, patient management or caregiver offerings. Our focus is to take our expertise at developing platforms, software and systems, and radio frequency-based solutions, apply them to healthcare, increase connectivity so that information ows faster and better and is compliant with regulations, and then let the healthcare industry gure out how to get a value proposition out of that, Jones said. Qualcomms many longterm partners have taken the opportunity to derive value from collaboration.

This is really going to revolutionize healthcare. Making the world a healthier place is USPMs ultimate goal, and by leveraging Qualcomm Lifes wireless technology the company will be able to achieve its goal much more efciently.
Jason Fey
Director of Mobile Solutions U.S. Preventive Medicine

Partnering and Connecting to Improve Healthcare

Entra Health Systems, an applied technology company focused on improving healthcare management, deploys 2net as a transmission platform for the companys offerings, including the MyGlucoHealth meter, a blood glucose meter with a wireless BlueTooth module for diabetic patients. Previously, patients

When U.S. Preventive Medicine (USPM), developers of prevention, early detection and chronic condition management prod-

These are transformative times in the healthcare industry, and much of the transformation is going to be fueled by leveraging the power of prevention in the wireless world through mobile health and technology solutions.
Ron Loeppke MD, MPH, FACPM
Vice Chairman U.S. Preventive Medicine
ucts and services that improve health outcomes and reduce healthcare costs, decided to create its own mobile application, it partnered with Qualcomm Life. Qualcomm Life has a philosophy of using their technical expertise to make the world a healthier place, as do we, said Chairman and CEO Christopher Fey. The shared philosophy was the starting point for leveraging their respective core competencies to make healthcare more efcient. Clients of the companys online health management program, which is embedded in evidence-based clinical methodology, wanted to be able to interact with the program via their smartphones. Collaborating with Qualcomm Life and design rm Fjord, USPM built Macaw, an extension of its online program and a standalone full-featured app. Macaw integrates and lters data from third-party health and tness apps and wireless devices, and transforms it into evidence-based clinical recommendations for end users. By deploying Macaw into our population, as well as the new application in the disease management offering that were creating, users can manage their health in a way that theyve never been able to do before through the wireless connectivity of all of these different devices into a single dashboard, said Jason Fey, director of mobile solutions. Macaw also enables biometric data to be sent to physicians, care providers and other entities, giving them access to information that will help them more effectively manage their patient populations around different disease conditions. This is really going to revolutionize healthcare, he said. Making the world a healthier place is USPMs ultimate goal, and by leveraging Qualcomm Lifes wireless technology the company will be able to achieve its goal much more efciently, according to Fey. tions not taking full ownership to make sure it works, according to Jones. Often, a byproduct of lack of ownership is lack of buy-in from leadership on down to the end users, which can doom an implementation especially when it touches on multiple areas of the organizations, such as workow, procedures and job responsibilities, as remote monitoring does. Instead, Jones encourages hospitals and other healthcare organizations to think entrepreneurially. For example, hospitals with a system in place that monitors patients for the rst 30 days after being discharged in order to comply with federal mandates can leverage that system by offering services or devices to family members to purchase after the 30th day. Family members especially those who live remotely from the patient can continue to monitor their loved ones, patients can proactively manage their condition and hospitals can recoup their investment costs. This type of offering can differentiate healthcare organizations in todays increasingly competitive healthcare market. The traditional way of thinking about remote monitoring managing healthcare expenses down is a very limited way of thinking, Jones warned. Instead, lets improve the patients life and lifestyle help patients do better self-management and lets come up with new business models that are revenue producing or expense avoiding for healthcare providers, he said. While Jones anticipates that healthcare organizations will likely take anywhere between a year to two years to devise a strategy and meet mandates, early adopters of remote monitoring and entities that had assumed nancial risk before the passage of ACA already have a decisive market advantage. Through education of successful pilots and by adopting best practices, healthcare organizations can accelerate and level the playing eld as they roll out remote monitoring initiatives. These are transformative times in the healthcare industry, and a lot of the transformation is going to be fueled by the wireless world mobile health and technology solutions, acknowledged Ron Loeppke, MD, vice chairman of USPM. The bottom line is that its all about better health and better healthcare at lower costs - being able to empower an individual as they work with their provider to yield better health outcomes.

Moving Forward to True Accountable Care

With economic incentives and an innovative wireless infrastructure in place, the time is ideal for healthcare organizations to move past the pilot stage and roll out and scale remote monitoring for chronic disease management. While some organizations new to remote monitoring may consider doing a pilot rst, Jones argues against such a strategy. More often than not, when healthcare organizations decide to run a pilot they rely on vendors to help fund and implement the project, which results in organiza-

About Qualcomm Life

Qualcomm Life is dening and connecting the wireless health network to improve lives and advance the capabilities of medical devices. By focusing on device connectivity and data management, we empower medical device manufacturers and service providers to deliver wireless health quickly and easily to those who need it. Our mission is to mobilize healthcare.

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