Julie Cheitlin Cherry, RN, MSN, director of clinical services, Intel-GE Care Innovations
Look to remote care-management technology as a future standard of care
As hospitals face the daunting task of caring for our aging population amidst new readmission penalties from CMS, being able to drive behavior change among patients and fa- cilitate effi cient, proactive care is essential to maintain positive margins. People 65 and older with multiple chronic conditions are 100 times more likely to have preventable hospitalizations than someone without chronic conditions, and that popula- tion is growing at record rates. Providing care at home is one way to address this need; it can be achieved effi ciently using a remote care-management (RCM) program that increases an individual’s interaction with health information and healthcare professionals at home. Using RCM technology, healthcare professionals can monitor patients’ vital signs, connect with patients through videoconferencing, send educational materials to patients and proactively teach patients how to manage their own conditions. Studies demonstrate that care models delivered by a clinician and facilitated by RCM technology may drive appropriate utilization of healthcare resources, reduce costly ER visits, improve self-management behaviors and keep people out of the hospital. Recently, St. Vincent Health, Indiana’s largest healthcare
employer, implemented a model of care using an RCM program to deliver care into the home setting. T e program incorporated technology, clinical protocols and educational materials to better manage patients with CHF and COPD. In less than two years, preliminary results show St. Vincent reduced readmissions to 5 percent – a 75 percent reduction compared to the control group (20 percent) and national average (20 percent). Reaching patients when they are outside the hospital should be a priority, and models of care using technology to reach into the home off er a cost-eff ective way to improve care and possibly reduce readmission rates.
Tom McGuinness, CEO, PatientPoint
Managing chronic disease and population health As the number of Americans with chronic disease continues to rise, disease management and population health manage- ment have become big challenges for physicians. But are an- nual doctor visits, mobile disease-management apps or other wellness tools alone suffi cient to improve outcomes and drive down costs associated with chronic disease? An eff ective disease-management program needs to be multi-faceted, engaging patients beyond the offi ce visit. Main- taining an ongoing, interactive patient-physician relationship before, during and between care visits is important to address
patients on an individual level, identify actionable steps and ensure adherence to treatment plans. During the days of paper patient records and snail-mail appointment reminders, this might have been diffi cult to achieve. However, hospitals and physician practices today have begun to realize the true po- tential of technology in changing the way both physicians and patients approach disease management. T ey have started to use patient education tools, care coordination technology and secure online/mobile messaging to better engage and monitor patients throughout their entire care process. Reducing chronic disease and associated healthcare costs is also about preventive care – educating patients to create positive change in health behaviors and managing health risks to avert compounding problems or adding to current ones. T is has become essential as the industry moves toward qual- ity initiatives and value-based care, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). From preventive screenings and patient education to appointment reminders and treatment adherence programs, the common thread to eff ective disease management and population health improvement is engaging patients in their own care from beginning to end.
Richard Bedrosian, Ph.D., director of behavioral health and solutions development, Wellness & Prevention, a Johnson & Johnson company
Cognitive-behavior therapy helps manage insomnia Insomnia is estimated to aff ect almost a third of all adults and is attributable to costs of more than $100 billion a year in the United States. T e growing role of the Internet in patient self-management
provides a unique opportunity to address insomnia through Web-based cognitive-behavior therapy (CBT) interventions, which can be effi ciently and inexpensively deployed to mil- lions of people. CBT for insomnia translates well into an interactive format,
where patients can track their sleep patterns and behaviors on- line; the program can off er suggestions based on data entered. Digital health-coaching programs based on CBT protocols for insomnia are designed to help users learn more eff ective sleep habits and relaxation techniques, change negative sleep thoughts, create a stable sleep pattern, make lifestyle changes to improve sleep and reduce daytime stress. Users have reported an average of 30 minut es more sleep per night, improvements in overall sleep quality, greater confi dence in ability to manage insomnia, less diffi culty falling asleep, increased ability to stay asleep and reduced anxiety and fatigue. Web-based interventions can eff ectively be deployed in conjunction with an online health-risk assessment (HRA), which can be used as a basis for recruiting employees into specifi c self-management programs, such as those for insomnia. T e proven eff ectiveness and aff ordability of Web-based
programs can help address a gap in services to reduce insomnia’s impact on health and productivity, providing a substantial return on investment to health plans and employers. HMT
HEALTH MANAGEMENT TECHNOLOGY March 2013 7