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New Models of Disease Management: Improving Quality and Access through Remote Health Monitoring Technology

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New Models of Disease Management: Improving Quality and Access through Remote Health Monitoring Technology. Plenary Presentation at the DMAA - Disease Management Association of America annual …

New Models of Disease Management: Improving Quality and Access through Remote Health Monitoring Technology. Plenary Presentation at the DMAA - Disease Management Association of America annual conference in San Antonio Texas, October 26 2002.

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  • 1. New Models of Disease Management: Improving Quality and Access through Remote Health Monitoring Technology Presented by: Steve Brown President and CEO Health Hero Network Inc. Saturday, October 26, 2002 DMAA Annual Meeting, San Antonio TX
  • 2. Technology Advances… “In the old days we would do nothing and he had a 50-50 chance. With all this high tech equipment the odds are even.” From OKBridge HMO DMAA Keynote - Health Hero Network 2
  • 3. The Promise • A better model of care is possible • Crisis care  Coordinated care • Higher quality with lower cost DMAA Keynote - Health Hero Network 3
  • 4. Role of Technology •  Move the point of service closer to the user -  Convenience -  Timeliness -  Access •  Increase productivity of service providers -  Timely, relevant, actionable information -  Process improvement -  Quality assurance •  Change behavior -  Better self-care -  Better treatment compliance -  More appropriate utilization DMAA Keynote - Health Hero Network 4
  • 5. Changing Behavior… DMAA Keynote - Health Hero Network 5
  • 6. Health Hero Network Example: Internet- Based Services for Disease Managers Secure Data Center DMAA Keynote - Health Hero Network 6
  • 7. Health Hero Network Example: Daily Dialogues with the Patient DMAA Keynote - Health Hero Network 7
  • 8. Health Hero Network Example: Patient Stratification and Management Tools DMAA Keynote - Health Hero Network 8
  • 9. AMAC Example: Disease Management with Personal Emergency Response *Licensee of Health Hero Network DMAA Keynote - Health Hero Network 9
  • 10. Philips Example: Comprehensive CHF Solution with Peripheral Devices * *Licensee of Health Hero Network DMAA Keynote - Health Hero Network 10
  • 11. TheraSense Example: FreeStyle Tracker Diabetes Management System *Licensee of Health Hero Network DMAA Keynote - Health Hero Network 11
  • 12. Some Results DMAA Keynote - Health Hero Network 12
  • 13. Oakland Asthma Study •  Oakland Children’s Hospital, Oakland, California •  Asthma self-management program using telemedicine technology for high-risk population with asthma •  Randomized controlled trial compared to traditional patient education for 90 day intervention •  66 patients in intervention group, 68 in control group, ages 8-16 DMAA Keynote - Health Hero Network 13
  • 14. Oakland Asthma Results •  Significant reduction in Activity Limitation (p = .03) •  Significant reduction in reported high peak flow readings (p = .01) •  Significant reduction in urgent calls to hospital (p = .05) •  Improved self-care behaviors •  Published in: Arch Pediatr Adolesc Med. 2002; 156:114-120 DMAA Keynote - Health Hero Network 14
  • 15. Veterans Demonstration •  Veterans Health Administration Community Care Coordination Service, Florida •  Telemedicine-based care coordination demonstration project •  791 veterans enrolled for 1 year, compared to comparison group data •  Elderly, high-risk, high-cost veterans with hypertension, heart failure, COPD, and diabetes DMAA Keynote - Health Hero Network 15
  • 16. Veterans Results •  40% reduction in Emergency Room visits •  63% reduction in Hospital Admissions •  60% reduction in hospital bed days of care •  64% reduction in nursing home admissions •  88% reduction in nursing home bed days of care •  Significant improvement in Quality of Life SF36V •  Published in: Disease Management, Volume 5, Number 2, 2002 DMAA Keynote - Health Hero Network 16
  • 17. Mercy Diabetes Study •  Mercy Health System in Laredo, Texas •  Home-based telemedicine program for uninsured, high- risk, underserved population with diabetes •  One year study period using comparative cohort data from previous calendar year •  Total of 169 patients - 130 females and 39 males with average age of 53 years in both genders DMAA Keynote - Health Hero Network 17
  • 18. Mercy Diabetes Results •  Inpatient Admissions reduced 32% (p < 0.07) •  Emergency Room Encounters reduced 34% (p < 0.06) •  Outpatient visits reduced 49% (p < 0.001) •  In press: Diabetes Technology & Therapeutics Journal, December 2002 DMAA Keynote - Health Hero Network 18
  • 19. Mercy Results: Patient Satisfaction DMAA Keynote - Health Hero Network 19
  • 20. Mercy Results: Patient Compliance DMAA Keynote - Health Hero Network 20
  • 21. Traditional Process •  Scheduled calls based on diagnosis and initial assessment: “hit or miss” •  Technology used for scheduling, documentation, reporting •  More time spent on assessment than on intervention: -  Care manager with 100 patients -  Scheduled call once per week to assess patient status and needs -  20 successful calls per day -  20 – 30 minutes per call, including set-up, rapport building, etc. -  7 – 10 hours per day, no time for lunch DMAA Keynote - Health Hero Network 21
  • 22. Technology-enabled Process •  Communicate with patients daily, especially those with complex conditions and the frail elderly •  Encourage, teach, reinforce, and remind patients to improve self-care and change behavior •  Stratify patients by risk and need in order to and target calls and interventions on those most in need: -  Care manager with 400 patients -  Monitor once per day and risk stratify results -  20 - 40 calls per day to check in with patients who report elevated risk -  3 - 6 minutes per call because most patients have already taken action -  2 – 4 hour job to coordinate care DMAA Keynote - Health Hero Network 22
  • 23. Criteria for Success Simplicity and Focus [Remember who needs care the most] Personal, Relevant, Actionable Information [What matters most to care providers] Support Self-Care and Behavior Change [What makes the biggest difference to quality of life and overall outcomes] DMAA Keynote - Health Hero Network 23
  • 24. DM and Technology: Empower Patients and the People Who Care for Them DMAA Keynote - Health Hero Network 24