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Connected Health: Using patient-centric technologies to change behavior and improve outcomes

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

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Connected Health: Using patient-centric technologies to change behavior and improve outcomes

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  1. Connected Health: Using patient-centric technologies to change behavior and improve outcomes Joseph C. Kvedar, MDDirectorCenter for Connected HealthPartners HealthCare

  2. 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

  3. 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

  4. Connected Cardiac Care • Population: CHF • Technology: Blood pressure, oximeter, weight, touch screen device • Coaching: telemonitoring nurse • Goal: decreased readmissions • ROI: • Better bed management • Lower cost of care Heart Failure Monitoring

  5. 30-Day Readmissions: CHF Monitoring Business Case Total CHF Cases 1,600 Total Medicare CHF Cases 1,200 Total 30 Day Readmit CHF Cases 300

  6. 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

  7. MD Refusal Rates As MDs gain experience with the telemonitoring program, they are more likely to enroll their patients.

  8. 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

  9. 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.” Connected Health Diabetes

  10. Diabetes Connect – Case studies Sample - successful patient charts (weekly readings) Over 80% of enrolled patients uploading data on a regular basis.

  11. 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.

  12. Evidence from other studies Greater change in HbA1c over time in intervention group p <0.05 MyCareTeam study – McMahon et al

  13. Cost of Diabetes/person/year Morbidity1 A1c>7.5 A1c<7.5 Cost difference Hospital Inpatient 6309 2971 Nursing home 2140 991 Physician office 1525 695 Potential savings/ per person per year Hospital Outpatient 489 215 Emergency 366 187 Home health 516 190 Hospice 84 39 $7,661 Ambulance services 23 11 OP Meds 797 341 Insulin and delivery supplies 579 579 Oral agents 414 414 Sub-Total 13,242 6633 6609 Productivity2 Cost of days lost 521 Cost of non-work days lost 531 1,052 Sub-Total 1052 Source: American Diabetes Association

  14. Diabetes Monitoring ROI For 1000 enrollees: Est. Cost of Diabetes related morbidity and productivity per year $7,661,000 Return in Year 1 Est. Cost of Intervention $500,000 $2,028,024 5:1 ROI Est. Success Rate of Intervention 33% Est. Savings $2,528,024 Success Rate needed to cover cost of intervention: 7%

  15. Remaining Challenges • Cost reduction • Patient identification • Workforce optimization • Program optimization

  16. 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.orgLinkedIn group – Connected Health CommunityTwitter - @jkvedar @connectedhealth

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