Connected Health Using patientcentric technologies to change behavior

Connected Health: Using patient-centric technologies to change behavior and improve outcomes Joseph C. Kvedar, MD Director Center for Connected Health Partners Health. Care

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

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

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

30 -Day Readmissions: CHF Monitoring Business Case Total CHF Cases 1, 600 Total Medicare CHF Cases Total 30 Day Readmit CHF Cases 1, 200 300 Impact to System: Risk to System With no preventable readmissions Revenue = $0 Direct Cost = $2 M Direct Margin = -$2 M By avoiding admissions could save up to $2 M Plus, backfill opportunity resulting from 300 avoided admissions ~$1. 7 M

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

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

Connected Health Diabetes • Population: Diabetics – requiring daily glucose readings • Technology: glucometer, gateway, web interface • Coaching: diabetes educator • Goal: improved control • Business justification: • Meet P 4 P targets • Decreased downstream complications

Connected Health Diabetes 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. ”

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

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 Hb. A 1 c fell from 6. 8% at the start of the study to 5. 8% at the end. Web application was well received by participants.

Evidence from other studies Greater change in Hb. A 1 c over time in intervention group p <0. 05 My. Care. Team study – Mc. Mahon et al

Cost of Diabetes/person/year Morbidity 1 A 1 c>7. 5 A 1 c<7. 5 Hospital Inpatient 6309 2971 Nursing home 2140 991 Physician office 1525 695 Hospital Outpatient 489 215 Emergency 366 187 Home health 516 190 Hospice 84 39 Ambulance services 23 11 OP Meds 797 341 Insulin and delivery supplies 579 Oral agents 414 13, 242 6633 Sub-Total Cost difference Potential savings/ person per year $7, 661 6609 Productivity 2 Cost of days lost 521 Cost of non-work days lost 531 Sub-Total 1, 052 Source: American Diabetes Association 1052

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

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

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. org Linked. In group – Connected Health Community Twitter - @jkvedar @connectedhealth