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.

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
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3. The Promise
• A better model of care is possible
• Crisis care  Coordinated care
• Higher quality with lower cost
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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
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5. Changing Behavior…
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6. Health Hero Network Example: Internet-
Based Services for Disease Managers
Secure
Data
Center
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7. Health Hero Network Example:
Daily Dialogues with the Patient
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8. Health Hero Network Example: Patient
Stratification and Management Tools
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9. AMAC Example: Disease Management with
Personal Emergency Response
*Licensee of Health Hero Network
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10. Philips Example: Comprehensive CHF
Solution with Peripheral Devices
*
*Licensee of Health Hero Network
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11. TheraSense Example: FreeStyle Tracker
Diabetes Management System
*Licensee of Health Hero Network
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12. Some Results
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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
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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
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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
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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
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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
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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
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19. Mercy Results:
Patient Satisfaction
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20. Mercy Results:
Patient Compliance
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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
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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
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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]
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24. DM and Technology: Empower Patients
and the People Who Care for Them
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