Published on November 6, 2008
New Models of Disease Management: Improving Quality and Access through Remote Health Monitoring Technology Presented by: Steve Brown President and CEO Health Hero Network Inc. Saturday, October 26, 2002 DMAA Annual Meeting, San Antonio TX
Technology Advances… “In the old days we would do nothing and he had a 50-50 chance. With all this high tech equipment the odds are even.” From OKBridge HMO DMAA Keynote - Health Hero Network 2
The Promise • A better model of care is possible • Crisis care Coordinated care • Higher quality with lower cost DMAA Keynote - Health Hero Network 3
Role of Technology • Move the point of service closer to the user - Convenience - Timeliness - Access • Increase productivity of service providers - Timely, relevant, actionable information - Process improvement - Quality assurance • Change behavior - Better self-care - Better treatment compliance - More appropriate utilization DMAA Keynote - Health Hero Network 4
Changing Behavior… DMAA Keynote - Health Hero Network 5
Health Hero Network Example: Internet- Based Services for Disease Managers Secure Data Center DMAA Keynote - Health Hero Network 6
Health Hero Network Example: Daily Dialogues with the Patient DMAA Keynote - Health Hero Network 7
Health Hero Network Example: Patient Stratification and Management Tools DMAA Keynote - Health Hero Network 8
AMAC Example: Disease Management with Personal Emergency Response *Licensee of Health Hero Network DMAA Keynote - Health Hero Network 9
Philips Example: Comprehensive CHF Solution with Peripheral Devices * *Licensee of Health Hero Network DMAA Keynote - Health Hero Network 10
TheraSense Example: FreeStyle Tracker Diabetes Management System *Licensee of Health Hero Network DMAA Keynote - Health Hero Network 11
Some Results DMAA Keynote - Health Hero Network 12
Oakland Asthma Study • Oakland Children’s Hospital, Oakland, California • Asthma self-management program using telemedicine technology for high-risk population with asthma • Randomized controlled trial compared to traditional patient education for 90 day intervention • 66 patients in intervention group, 68 in control group, ages 8-16 DMAA Keynote - Health Hero Network 13
Oakland Asthma Results • Significant reduction in Activity Limitation (p = .03) • Significant reduction in reported high peak flow readings (p = .01) • Significant reduction in urgent calls to hospital (p = .05) • Improved self-care behaviors • Published in: Arch Pediatr Adolesc Med. 2002; 156:114-120 DMAA Keynote - Health Hero Network 14
Veterans Demonstration • Veterans Health Administration Community Care Coordination Service, Florida • Telemedicine-based care coordination demonstration project • 791 veterans enrolled for 1 year, compared to comparison group data • Elderly, high-risk, high-cost veterans with hypertension, heart failure, COPD, and diabetes DMAA Keynote - Health Hero Network 15
Veterans Results • 40% reduction in Emergency Room visits • 63% reduction in Hospital Admissions • 60% reduction in hospital bed days of care • 64% reduction in nursing home admissions • 88% reduction in nursing home bed days of care • Significant improvement in Quality of Life SF36V • Published in: Disease Management, Volume 5, Number 2, 2002 DMAA Keynote - Health Hero Network 16
Mercy Diabetes Study • Mercy Health System in Laredo, Texas • Home-based telemedicine program for uninsured, high- risk, underserved population with diabetes • One year study period using comparative cohort data from previous calendar year • Total of 169 patients - 130 females and 39 males with average age of 53 years in both genders DMAA Keynote - Health Hero Network 17
Mercy Diabetes Results • Inpatient Admissions reduced 32% (p < 0.07) • Emergency Room Encounters reduced 34% (p < 0.06) • Outpatient visits reduced 49% (p < 0.001) • In press: Diabetes Technology & Therapeutics Journal, December 2002 DMAA Keynote - Health Hero Network 18
Mercy Results: Patient Satisfaction DMAA Keynote - Health Hero Network 19
Mercy Results: Patient Compliance DMAA Keynote - Health Hero Network 20
Traditional Process • Scheduled calls based on diagnosis and initial assessment: “hit or miss” • Technology used for scheduling, documentation, reporting • More time spent on assessment than on intervention: - Care manager with 100 patients - Scheduled call once per week to assess patient status and needs - 20 successful calls per day - 20 – 30 minutes per call, including set-up, rapport building, etc. - 7 – 10 hours per day, no time for lunch DMAA Keynote - Health Hero Network 21
Technology-enabled Process • Communicate with patients daily, especially those with complex conditions and the frail elderly • Encourage, teach, reinforce, and remind patients to improve self-care and change behavior • Stratify patients by risk and need in order to and target calls and interventions on those most in need: - Care manager with 400 patients - Monitor once per day and risk stratify results - 20 - 40 calls per day to check in with patients who report elevated risk - 3 - 6 minutes per call because most patients have already taken action - 2 – 4 hour job to coordinate care DMAA Keynote - Health Hero Network 22
Criteria for Success Simplicity and Focus [Remember who needs care the most] Personal, Relevant, Actionable Information [What matters most to care providers] Support Self-Care and Behavior Change [What makes the biggest difference to quality of life and overall outcomes] DMAA Keynote - Health Hero Network 23
DM and Technology: Empower Patients and the People Who Care for Them DMAA Keynote - Health Hero Network 24
Calcification Inhibitors in CKD and Dialysis Patients
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