Home telehealth now focused on the ‘superusers’ of healthcare

A noticeable trend in telehealth has to do with focusing less on the generic virtues of at-home vital signs monitoring for routine patient care and more on managing specific high-cost populations to avoid or reduce costs. Some of the impetus in the US has come from new regulations by CMS (Center for Medicare and Medicaid Services) intended to move Medicare fee-for-service (FFS) patients into a reimbursed chronic care management (CCM) model. Banner Health is Arizona’s largest private employer (which does say something about Arizona as a retirement haven) and since 2006 has been experimenting with remote monitoring since 2006. Starting in 2013 Banner piloted Philips‘ post-discharge program now called ‘Hospital to Home’ as Banner iCare, combined with Philips Lifeline PERS, but made it available to those only with a stunning five+ chronic conditions–the top 5 percent that is reputed to account for 50 percent of healthcare spend. Banner combined the tech with intense support by a multi-layered care team. At ATA they announced the following results with the initial cohort of 135 patients, now up to 500:

  • 27% reduction in cost of care
  • 32% reduction in acute and long term care costs
  • 45% reduction in hospitalizations

The article in Forbes is a bit breathless in profiling the program and the ‘superusers’ of healthcare (with a windy but false analogy from John Sculley) but provides a level of detail in the program that most articles do not. One wonders how Philips makes money on supplying what is at least $2,500 worth of kit, with peripherals that must all be Bluetooth LE. It’s also not stated, but the TeleICU and TeleAcute programs also appear to be Philips’. Video

Short takes for a spring Friday: wounds, babies and ‘frequent fliers’

Starting off your spring weekend….WoundMatrix, which uses generally older model smartphones to take pictures of wounds which are uploaded either to their own or to a destination clinical platform, with proprietary software that helps a clinician analyze the wound remotely and then to track healing progress, has gone international with Honduras’s La Entrada Medical and Dental facility run by non-profit Serving at the Crossroads, and in Rwanda in the care of nearly 1000 patients by the Rwanda Human Resources for Health Program, established by their Ministry of Health with the cooperation of several American universities. At ATA they also announced a new release of software. Release (PDF attached)….A BMJ (British Medical Journal) article critiquing the surge in what we call ‘telehealth for the bassinet set‘ scores the Mimo onesie (Rest Devices), the Owlet sock and the Sproutling band as taking advantage of concerned parents. It’s too much continuous monitoring of vital signs that can vary and yet be quite normal, and no published studies on benefit. A reviewer did find that Owlet is in clinical tests at Seattle Childrens and University of Arizona. MedPageToday (BMJ requires paid access)….A surprise from Philips, which we in the US associate with the Lifeline PERS. They have quietly moved into telehealth focusing on post-discharge programs that target the most costly patients, often dubbed ‘frequent fliers’ based on their frequent stays in hospital. The ‘Hospital to Home’ telehealth pilot with Banner Health in Arizona, dubbed for them the Intensive Ambulatory Care (IAC) program, focuses on the top 5 percent of complex patients which are the highest cost and most care intensive. IAC results among 135 patients over six months reduced hospitalizations by 45 percent, acute and long-term care costs decreased by 32 percent and overall cost of care by 27 percent. However, is this program continuing–or transitioning their patients?  iHealthBeat, PR Newswire