To really bend the health cost curve downward, we must engage patients directly and shift from the current model of  late diagnosis and treatment (“sick care”) to a more cost-effective system that focuses on healthy lifestyle promotion, disease prevention and highly-coordinated care from the most appropriate providers. This is particularly true for low-income patients, a growing number of whom suffer from chronic diseases.  As health costs rise, more of these patients are being moved into capitated health plans. The rest usually have limited coverage or no health insurance at all, and have great difficulty accessing health promotion programs or medical care.

How can we provide care to these patients with increasingly limited resources? Fortunately, a host of new “connected health” technologies can now support patient education, treatment compliance, shared-decision making, motivation for life-style changes, patient triage, medical record access, health professional training and other activities that could dramatically improve patient outcomes while lowering costs.  Used in conjunction with service innovations, such as group medical appointments, health coaches, remote monitoring and telemedicine, such technologies can lead to better coordinated care, lower costs and higher quality.

Presently, health costs are consuming a growing portion of family, business, local and federal government resources.  According to the actuarial firm Milliman, the average cost to insure a family of four in the US has grown from $8,414 in 2001 to $20,728 in 2012, or more than 100% of family income at the official poverty level and over $5,000 per person per year.  Simultaneously, key health indicators including obesity, blood pressure and chronic diseases such as diabetes are also increasing, leading to clearly unsustainable costs.

This trend comes with tragic human costs as well.  If we continue on this path, one child in three in the US will develop type II diabetes.  For minority children, one in two will become diabetic.  These children are innocent bystanders in a growing epidemic of chronic disease. We must provide them and their parents the health programs that will allow them to avoid this fate. The tools to implement effective health programs for this vulnerable population are available now.  An optimal platform will both empower patients through health promotion and help them obtain the best quality care from the most appropriate provider, when needed.

The US health system is difficult to navigate and more expensive than that of any other comparable country. The poor have particular difficulty accessing and affording quality health care.  As a result, diagnosis and treatment are often delayed and usually takes place in the emergency room, worsening health outcomes and raising costs.    

It’s been well documented that US health care services are fragmented, plagued by waste and hampered by distorted financial incentives that reward per procedure rather than for optimal patient outcomes. Moreover, doctors and other health professionals are usually not trained or incentivized to promote life-style management such as nutrition, and find it difficult to change patient behavior.   Such behavioral counseling is also poorly reimbursed, which has led many medical students to choose specialties over primary care, leading to a shortage of family physicians.

However, the explosion of information technologies, particularly mobile phones, provides an unprecedented opportunity to improve health promotion and care for the underserved. Today, most of the poorest people have access to a mobile phone.  Healthcare providers, meanwhile, are using smartphones and tablets for a growing number of medical applications, including diagnostic instruments, for telemedicine consultations and to access a wealth of new resources such as health information databases and decision support tools.  Over the last few years, there have also been multiple innovations in preventive care, wellness, diagnostics and treatment that have demonstrated high-impact on patient health, and can be used more effectively through a health care platform designed to more easily “connect” various services and stakeholders required to provide quality care to patients.

The future of health care is “connected health”: Care that is cost-effective, accessible, highly-integrated and easily personalizable.

• Cost-effective health care starts with disease prevention, continuous monitoring of health indicators, early detection and lifestyle management
• Accessible health care leverages modern communication technologies
• Integrated health care requires continuous aggregation of data from all stakeholders throughout the health care continuum

Connected health is an optimal care delivery model where patient data is continuously aggregated from multiple stakeholders. This data is used to “connect” the patient to the optimal tool or provider that can address needs immediately and in the most appropriate cost-effective manner. Patients needing routine screenings could see a specially trained nurse practitioner, those with minor symptoms can quickly determine if they need a medical appointment at all using self-assessment tools. Access to the right specialist can be quickly arranged, at the earliest signs of potentially serious disease.

Expected outcomes of connected health:

• Improved health from regularly tracking key health indicators such as weight and blood pressure, especially if with the patient is working with a coach or a peer group
• Increased access to affordable health care
• Increased ability to self-manage through tracking and improving basic health indicators like weight and regular exercise
• Increased use of preventive care services, such as screenings and vaccinations
• Decreased emergency room visits
• Decreased rates of unnecessary hospitalization
• Greater use of “right-skilled” providers, e.g. lower-cost resources such as nurses for common ailments with known treatments, lifestyle management for chronic diseases, etc.
• Overall cost reduction for patients, payors, and even providers, particularly under capitated systems

What methods of care will Connected Health empower:

• Health promotion
• Early detection and prevention through better access to  family history and medical information
• Expedited diagnosis through faster connections of patients to doctors who are experienced with treating the suspected disease
• More effective treatment through better collaboration among doctors and specialists, decreasing time to diagnosis while reducing costs
• Increasing shared-decision making between doctors and patients, thereby improving health outcomes
• Effective disease management through continuous monitoring of health conditions, just-in-time patient education to facilitate self-management, aggregated health data overtime for better overall outcomes and risk detection
• Proven and tested methods for continuously improving self-management

Achieving “Connected Health” vision

Grameen Research and ClickMedix are designing novel health promotion and delivery systems that leverage ClickMedix’s mobile-phone enabled connected health platform, allowing each step within the health care continuum to be implemented cost-effectively.  We are also reaching out to other innovators who can contribute to this unique and forward-looking new care delivery system.  The first program will be implemented within Grameen communities of ultra-poor women entrepreneurs and their children in New York City.  The goal is to improve their access to health care while building a sustainable health service revenue model.

For further information, please contact:                

Vidar Jorgensen

Founder and President Grameen America and Grameen Research

Advisor, Grameen Trust and Grameen Health Trust

Email: vidar@wchnet.com

www.grameenamerica.com

www.grameenresearch.org www.grameenhealth.com

Ting Shih

CEO & Founder | ClickMedix

Email: ting@clickmedix.com

http://clickmedix.com

Gaylord National Resort & Convention Center on the Potomac, Maryland, USA

The 10th Annual World Health Care Congress (WHCC) is committed to improving global health care by bringing together business, political, and academic leaders to actively share information and collaborate to improve the overall quality and cost of health delivery in the US and throughout the world.

WHCC is where decisions are made, deals are drawn up, strategies are planned and ideas become reality. Having a seat at the table has never been more important, and the WHCC provides the most influential, interactive, and transactional table in health care.

Tuesday, April 9, 2013

11:40 am - 2:00 pm

Using Mobile and Connected Health Care to Transform Through Innovation Understanding the opportunities that mHealth and telehealth present Assessing the scale of the savings available to health systems through the coordinated implementation of remote monitoring for chronic disease Leveraging the power of connected technologies to join up clinical professionals, enable care integration and innovation and deliver cost savings across health systems Understanding global health reimbursement landscapes and their evolving approaches to connected health Reviewing a range of global connected health implementations – what is the evidence to date? Zakiuddin Ahmed, MD President, Healthcare Paradigm; Medical Director, PharmEvo; CEO, eHealth Services ; COO, Smart Health Care; President, OPEN Karachi; Convenor, Health Chapter, QPSP Naomi Fried, PhD Chief Innovation Officer Boston Children’s Hospital Ting Shih CEO ClickMedix

Mar 6-8, 2013

In most countries women are under-represented in engineering and technology professions. The Marathon–a free, virtual event–engages women (and their supporters) from any discipline, experience level, age, interest, culture, industry or employer. It encourages any and every woman in engineering and technology to create opportunities for connecting through discussions locally and globally.

REGISTER for FREE

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ATA CEO, Jon Linkous: Paying for Telemedicine in the United States

Of the $2.8 trillion that constitutes healthcare market in the U.S., there are five primary sources that support almost all telemedicine.  All are rapidly expanding.

1. Hospital and healthcare systems – Support comes from two areas.  First, managed care, health home and Accountable Care plans allow providers the flexibility to pay for and use telemedicine wherever it is warranted.  Almost 100 million Americans are now covered under these plans and the number is growing rapidly.  Second, a growing number of hospitals and health systems use core funds to support telemedicine between facilities to lower costs by sharing specialty services and increase revenue from expanded referrals.
2. Private, public and employer insurers – Every large health insurer in the U.S. is expanding coverage of telemedicine.  Sixteen states currently mandate private insurance coverage and so far in 2013 thirteen more states have pending legislation (see http://www.americantelemed.org/docs/default-source/policy/state-telemedicine-legislation-matrix.pdf?sfvrsn=10)
3. Federal Medicare – Medicare reimbursement is unlimited for remote imaging services.  Live consults are reimbursed for patients in rural areas.  In 2013 Congress is taking up several proposals to significantly expand this support.  (For details of current Medicare policies for telemedicine see http://www.americantelemed.org/docs/default-source/policy/medicare-payment-of-telemedicine-and-telehealth-services.pdf?sfvrsn=14)
4. State Medicaid Some Medicaid coverage is available in 44 states and so far this year three states are considering full support.  (For a breakdown of current telehealth payment policies for each State’s Medicaid program seehttp://www.cchpca.org/sites/default/files/State%20Telehealth%20Laws%20and%20Reimbursement%20Policies.pdf)
5. Health services provided to beneficiaries directly by federal and state agencies – Governmental agencies such as the U.S. Veterans Administration, Department of Defense, Indian Health Service, federal and state and local corrections departments are active providers of remote health care.  This is rapidly expanding and increasingly relies on partnerships with non-governmental health providers.

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Andrew Broderick

ABSTRACT: Partners HealthCare’s programs in home telehealth have been driven by its Center for Connected Health, which has pilot-tested and implemented telemedicine and remote monitoring solutions. The center focuses on practical innovations that can change patient behaviors to realize better clinical outcomes. The center’s Connected Cardiac Care Program has enrolled more than 1,200 patients since its introduction in 2006 and has experienced an approximate 50 percent reduction in heart failure hospital readmission rates overall for enrolled patients. The center estimates the program has generated total cost savings of more than $10 million since 2006. Human factors and social processes have been important in successfully introducing telehealth technology solutions into workflow and patient care. Technology has also had a positive impact on patient activation and engagement in self-care, helping to demonstrate to providers that this new program supports behavior changes that lead to improved care and quality outcomes.

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