The Collaborative Forum

The results from the National Institutes of Health (NIH)-sponsored Tele-HF trial are in, and the findings are worth considering . The results are counter to most of the findings of other studies examining telemonitoring for heart failure and at face value are disappointing to us, and the industry. Upon closer examination, however, this study offers us an excellent opportunity for further innovation, refinement of solutions and continuous improvement. It also provides a snapshot of how significant the challenges remain in transforming U.S. healthcare – from a system that is episodic, reactive, acute care based to a system of care that incorporates proactive, interactive, continuum-based chronic care management.

The genesis for this study stretches back nearly 10 years, from conceptualization to the results we see reported today. This randomized, controlled multi-centered trial was designed to compare an automated, daily symptom and self-reported weight monitoring technology with “usual care” in reducing hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The boldness of vision should not be underrepresented: Tele-HF is the largest study of a non-pharmacological intervention for heart failure ever conducted.

At a high level, the results showed “no significant differences” between the group receiving usual care and the group randomized to receive telemonitoring. I cannot say that these are the results we were hoping for. However, I urge those in our industry and other key stakeholders to take a closer, more informed view, and to reach their own conclusions and insights.

The Details

First, I want to thank and acknowledge the great work of the investigators, study sites and everyone involved in this trial. It was a long process and everyone worked with the utmost integrity and professionalism. We were privileged to have been selected for participation.  I also want to acknowledge the value of conducting large, multi-centered, randomized, controlled trials in terms of advancing medical science.

The patient interventions in this study took place in 2006-09 and omit many of the processes and techniques Pharos uses today to achieve the necessary critical mass of physician and patient involvement. Here are the limitations of this particular study – from my perspective: Read the rest of this entry →

A couple of weeks ago, I had the pleasure and honor of moderating a webinar, sponsored by the Care Continuum Alliance, which included Aaron McKethan, PhD, Beacon Community director, Department of Health and Human Services, Office of the National Coordinator for HIT; and Patrick Gordon, Colorado Beacon Consortium director. I wrote favorably about the Beacon Community Program when it was announced in May, because I view this program as a true Beacon for change in healthcare IT in this country.

As a quick refresher, the Beacon Community Cooperative Agreement Program provides funding to selected communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities. The program supports these communities at the cutting edge of electronic health record (EHR) adoption and health information exchange to push them to a new level of sustainable health care quality and efficiency. The program also will show how other communities can use health IT to achieve similar goals.

 The purpose of this federally-funded pilot is to provide selected members of the healthcare community with the potential to define HIT’s influence on the future of healthcare delivery as we push toward accountable, evidence- based, community-focused care. During the webinar which discussed the program at length both from an administrative perspective as well as an “on the ground” perspective, I was particularly struck by one of Dr. McKethan’s slides: Read the rest of this entry →

Very recently, I wrote about remote patient monitoring (RPM) systems and how they are gaining traction with healthcare payers, such as insurance companies.  Historically, health plans have under-invested in optimizing the management of medical expenses, choosing instead to maximize rates where possible. As a result, they’ve experienced high medical losses and have triggered financial pressure and constraints on revenue growth.

Health plans can and are beginning to consistently and sustainably improve outcomes and reduce medical losses by monitoring the daily status of at-risk members through RPM. We’ve just released the results of an evaluation of a large national Medicare Advantage plan that partnered with Pharos Innovations to improve the hospitalization costs in their population. The results speak directly to why RPM systems like  Tel-Assurance can play a key role in our healthcare system going forward.

Nationally, 10% to 14% of Medicare Advantage members have heart failure (HF), and they account for 15% of Medicare Advantage plan hospitalizations. Additionally, 25% of those hospitalized are readmitted within 30 days. This is the cycle that RPM can break.

The evaluation results just released covered Medicare Advantage members for a 17-month period from January 1, 2008 to May 31, 2009. The HF cohort experienced 1,639 admissions per 1,000 during the 12-month baseline period.  A matched member cohort studied simultaneously experienced no decrease compared to the baseline rate.  However, during the same period, Tel-Assurance enrollees experienced an all cause hospital admission rate of only 351 per 1,000, a 79% decrease compared to the baseline period. Read the rest of this entry →