• January 2009 FEATURE ARTICLES •
Health Plans and Technology
Disease Management Mobilized
Mobile collaborative care solutions are utilizing cell phones for
just-in-time interventions, improving outcomes for the chronically ill and containing costs.
By Jeffrey Wolf
With the growth of medical costs exceeding the
nation’s overall inflation rate, healthcare providers, employers
and insurers are stepping up their efforts to contain costs by
maximizing the effectiveness of disease management and
prevention programs targeting those with, or at risk for
developing, chronic conditions. For organizations across the
healthcare spectrum, the answer lies with the development of
consumer-facing wireless and mobile technologies. Delivering
real-time intervention, interactive communications and targeted
clinical decision support is possible via the cell phones and
other mobile devices ubiquitous among U.S. consumers.
The California HealthCare Foundation reports
that if left unchecked, U.S. health spending will reach nearly
$2.4 trillion in 2008 and will represent 19.5 percent of the
nation’s gross domestic product by 2017. A major contributing
factor is a dramatic change in the profile of diseases
contributing most heavily to death, illness and disability among
Americans. According to the Centers for Disease Control and
Prevention, conditions including cardiovascular disease, chronic
respiratory disease and diabetes account for more than 75
percent of the country’s medical care costs. As such, they are
among the more prevalent, costly and preventable of the nation’s
health problems.
Wireless Convergence
Given that costs associated with chronic
conditions consume the majority of healthcare expenditures, it
makes sense that finding ways to control and manage them has
been the focal point of many cost-containment strategies. An
estimated 90 percent of private health plans and 88 percent of
large employers offer disease management programs. Yet, these
programs have been only moderately successful. By 2030, the
number of Americans with at least one chronic condition will
increase from 125 million to 171 million.
Non-compliance with prescribed therapies is a
key factor in this increase — one traditional disease management
programs have failed to adequately address. Just 50 percent of
those currently suffering from chronic conditions adhere to the
treatment and medications prescribed by their physician. This
lack of compliance costs the
U.S. healthcare system more than $100 billion in direct costs.
The key to containing rising healthcare costs and reducing the
incidence of chronic disease is to transition from
"just-in-case" to "just-in-time" healthcare by leveraging
wireless technologies and point-of-care clinical decision
support to drive real change in patient behaviors.
Driving this transition is the convergence of
existing clinical wireless solutions with cellular/mobile
technologies that make use of medical devices and user-generated
data to collect and analyze information about an individual’s
chronic condition or activities relating to overall health and
wellness. Mobile collaborative care solutions can be accessed
when and where they are needed and deliver to the patient
clinically relevant instructions and recommended actions in
real-time. This bidirectional communication and tailored
intervention closes the gaps in traditional disease management
programs. Existing programs are limited in their ability to
provide real-time interventions and support based on immediate
needs. They rely on patients to self-monitor their health and
determine if and when to seek care. As a result, many wait until
their conditions require emergency intervention.
To overcome this patient inertia, mobile
collaborative care capitalizes on the immense popularity of cell
phones, which are owned by 72 percent of Americans. Further,
advanced cellular features enable greater connectivity and a
broader range of applications that can be delivered across
mobile networks. This allows cell phones to wirelessly connect
with medical devices to collect real-time biometric data,
communicate it back to remote monitoring services for analysis
and deliver actionable information back to patients and
providers. It enables focused patient management and wide-scale
population health management in which cell phones, referred to
by the authors of a TripleTree industry analysis on telemedicine
2.0 as the "perfect CRM tool," are used both to collect data and
deliver just-in-time interventions.
"Like steam, water, electricity and the
Internet, the cell phone is fast becoming a technology that
resides in the background of our lives and enables the
ubiquitous connectivity of always-on computing," wrote the
TripleTree authors. "This trend will facilitate the adoption of
wireless products and services that are able to monitor,
diagnose and report on our health and wellness, all in the
background, all without our direct involvement. It will be
analogous to turning on the lights without having to know how to
run a power grid."
Just-In-Time Intervention
Leading the emergence of mobile collaborative
care are a handful of technology companies focused on
introducing applications that deliver real-time intervention,
24/7 clinical support and health information to consumers via
their mobile phones, and facilitate direct communication with
physicians or other caregivers. These integrated mobile
solutions for collaborative care address the key issues
preventing traditional disease management and prevention
programs from achieving maximum results, both in terms of cost
containment and improved health outcomes.
Specifically, they provide the tools
necessary to enable physicians and caregivers to detect critical
signals before a crisis begins, encourage compliance and
adherence to prescribed therapies, facilitate continuous,
on-going collaboration between physicians, caregivers and
patients, as well as reduce input errors, thereby increasing the
quality of the data that is collected, and also, empower
patients to maintain active control over their health and
wellness. Most are designed as either stand-alone solutions, or
can be integrated with existing disease management programs to
drive improved results. They are based on advanced protocols and
scripts that tie into evidence-based best practices for a range
of chronic conditions and can be customized according to the
specific health needs of the targeted patient population.
Patients receive medical reminders via their
cell phones to take medications, test blood glucose levels and
to check their blood pressure, in addition to many other kinds
of medical alerts. In the case of medication reminders, an image
of the medication can also be delivered to help ensure the
appropriate drug and dosage is being taken at the time
specified. This is important for medication compliance, as 50
percent of patients who leave their physician’s office with a
prescription are unclear as to the directions, dosage and other
important information. Depending upon the targeted disease
state, patients may be prompted to respond to a series of
questions designed to evaluate their current health status.
For example, an asthma patient may be asked
if they are feeling short of breath or suffering from any chest
tightness, or if they’ve used their emergency inhaler in the
past 24 hours. A patient with congestive heart failure may be
queried about their sleep quality, number of pillows used,
presence of edema and so on. The patient responds using their
phone’s keypad or, if they prefer, through an interactive voice
response system. Data can also be wirelessly collected from
medical devices, such as Bluetooth-enabled scales, blood
pressure cuffs and glucometers, and automatically transmitted
back to the solution vendor’s remote monitoring database.
The information is automatically analyzed
according to the specified protocols and actionable information
is delivered back to the patient when necessary. For example, in
the case of a diabetic whose glucose levels are high, the system
would alert the patient to eat certain food types to bring
levels down or prompt them to take other appropriate actions,
including seeking emergency treatment in severe cases. Pre-set
triggers can also be established that determine if and when the
patient’s physician or other authorized caregiver is altered.
This allows for immediate intervention, such as changes to care
routines or prescription medications, to avert a health crisis.
Patients are also able to alert their provider to specific
symptoms such as chest pains or blurred vision and receive
immediate information on the most medically appropriate course
of action.
Because making the right decisions regarding
diet, exercise and other lifestyle activities is critical to
managing chronic conditions, mobile health solutions also
provide patients with just-in-time health and dietary education
information. This equips them with the tools they need to modify
their behaviors and make smart choices to ensure their
conditions are controlled.
The Solution is Everywhere
Ultimately, it is not that disease management
programs are ineffective. Rather, they are limited in their
ability to fully address such key issues as non-compliance with
prescribed therapies for controlling chronic conditions. Until
health plans, employers and providers deploy the consumer-facing
tools necessary for just-in-time interventions and support,
their efforts will fall short of their goal of facilitating the
behavioral changes necessary to effectively control and even
prevent chronic conditions.
The good news is that the advanced wireless
technologies and clinical decision support required for disease
management programs to achieve maximum results already exist;
they need only be integrated into collaborative care efforts and
delivered across the nation’s most ubiquitous communication
device — the cell phone.
Jeffrey Wolf is CEO of
GenerationOne Inc. Contact him
at jwolf@generationone.com .
