Humana-Omada Health diabetes prevention program could cut $3 bn in Medicare expense: study

A study performed by insurer Humana using the Omada Health program for diabetes prevention effectively lowered weight, improved cholesterol, blood glucose and mood. 500 volunteer subjects from Humana’s Medicare Advantage program, enrolled during 2015, lost an average of 13 to 14 pounds over a year (7.5 to 8 percent). They also saw improvements in cholesterol levels, blood glucose levels and subjective measures of moods and self-care. Individuals were chosen from administrative medical claims based on metabolic syndrome diagnosis or a combination of three of four of the following diagnoses: prediabetes, hypertension, dyslipidemia, and obesity. Based on the researchers’ calculations, this type of prevention program among this group if widely implemented among overweight adults could reduce Medicare costs by $3 bn over 10 years, not only for diabetes but also heart disease and high blood pressure.

Omada Health’s program included an online small group support, personalized health coaching, digital tracking tools, and a weekly behavior change curriculum. These one-hour lessons focused on a single topic were delivered via laptop, tablet, or smartphone, and included interactive games or exercises, written reflections, and goal-setting activities. The content was approved by the CDC Diabetes Prevention Recognition Program. Data was gathered via wireless scale, pedometer for physical activity, online food intake logging and standard lab results. “In conclusion, this study demonstrated that older adults who agreed to participate in this program were able to engage meaningfully and gain important health and wellness benefits during a relatively short time frame.”

While the cost reduction estimate is exactly that, other studies directionally confirm health improvement and savings: the National Diabetes Prevention Program (NDPP) which is the model for the Omada program, the BMJ/Noom Health study, and the Fruit Street/VSee telehealth program being used by St. Jude Children’s Research Hospital, University of South Florida and University of Michigan. mHealth Intelligence, study (full text in Journal of Aging and Health/Sage Journals)

Widespread remote GP consultations getting closer; no shortage of implementation advice

Following our previous item on the topic, on January 16th, Tim Kelsey made it very clear to this editor at a PICTFOR event that the £1b promised to GPs for premises improvement included a strong requirement that GPs also invest in electronic support, including remote consultation technology.

It is therefore particularly pleasing to see in yesterday’s Pulse Today, an item on a Skype trial in Central London that both patients and GPs seem to love. Some key quotes:

Almost all patients surveyed about their experience of the remote consultation service said they ‘would use it again’ (95%).

Although patients were warned that ‘the security of Skype isn’t 100%’, 83% also said (more…)

Healthcare Apps 2014 – a few impressions

This event was held on April 28th-30th in Victoria in London. It was organised by Pharma IQ and clearly had a strong pharma focus (including the charge which at £1995 for industry attendees clearly discriminated in favour of those with big-pharma sized budgets). It was also held just a few days after the significantly lower-priced Royal Society of Medicine event, and in the middle of a London Tube strike, all of which doubtless contributed to the relatively modest attendance (26 paid). I am most grateful to the organisers for kindly inviting me as one of speaker Alex Wyke’s guests.

As mentioned in an earlier post, there was a similarity with the RSM agenda, so I won’t repeat comments made by the same speaker before. The first up was the 3G Doctor, David Doherty, who gave another of his excellent presentations, although the sound engineer sadly made some of it inaudible. After a review of how we had got to where we are, he suggested that the Internet is about to become a device-dominated network. He drew a parallel between (more…)

WSD QALY paper published – cost worse than expected (UK)

Since one of the Whole Systems Demonstrator (WSD) let drop at the King’s Fund conference last March that the telehealth Quality Adjusted Life Years (QALY) cost calculation was coming out at £80,000 the actual paper has been ‘eagerly’ awaited, with speculation and concern that the calculation included management and other study-related costs that would not apply in a normal service setting. The paper is published by the BMJ today and a) such costs were excluded and b) the QALY figure is actually £92,000. Well, that’s the headline figure that is already being headlined by Pulse but, of course, the calculations are more nuanced. Foe example:

Whether telehealth is considered to be cost effective will depend on the willingness to pay for the outcomes generated. Figure 1 presents the probability that telehealth would be seen as cost effective as an addition to usual care, using an acceptability curve for different values of willingness to pay. At the £30,000 threshold (associated with NICE recommendations), the probability of cost effectiveness was 11%. Figure 1 also shows the probability of cost effectiveness if costs related to project management were excluded: at the £30,000 threshold, the probability of cost effectiveness was 17%. Indeed, this probability including management costs only exceeded 50% at threshold values of willingness to pay above £90,000. Excluding project management costs, the probability exceeded 50% only at values above about £79,000.

The discussion is also worth reading carefully, as is the final conclusion:

A community based, telehealth intervention is unlikely to be cost effective, based on health and social care costs and outcomes after 12 months and the willingness to pay threshold of £30,000 per QALY recommended by NICE. A reduced cost of telehealth per QALY may be possible by combining the effects of equipment price reductions and increased working capacity of services; On the assumption of reduced equipment costs and increased working capacity, the probability that telehealth is cost effective would be about 61%, assuming a willingness to pay threshold of £30,000 per QALY.

BMJ paper: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial BMJ 2013;346:f1035

Related items
Mike Clark’s Updated list of WSD results papers.
Interview with Professor Martin Knapp As “telehealth” grows, experts question cost benefits Reuters.
David Brindle, in The Guardian anticipated these results last month and, in a follow up article commented “Fourteen months on from its launch, 3millionlives seems to be going nowhere. Intuitively, telecare/telehealth feels like a key pillar of the future care system. To be that, however, it does need a credible evidence base.”
3millionlives press release: 3millionlives – enabling change to benefit patients and carers. (PDF)
GP Online Telehealth ‘not good use of NHS money’, finds DH-backed study.
NHS Choices Are benefits of telehealth care worth the cost?