COMMENTARY — LIFEMASTERS PULLS THE PLUG ON OKLAHOMA MEDICARE HEALTH SUPPORT PROJECT

Christobel Selecky, Executive Chairman of Lifemasters, announced yesterday that Lifemasters was ending participation in its Oklahoma Medicare Health Support (MHS) project. The announcement was made to an audience at the Care Continuum Congress held in Washington, D.C.

THE NEXT BIG THING — HOSPITAL AT HOME

I hereby predict the Next Big Thing is hospital at home (HAH).

How do I know this? My primary source is my wife, Jill. Both of our children — now age 18 and 21 — were born by C-section during the golden era of indemnity insurance. I remember Jill practically begging her doctor to get the insurance company to authorize a few extra days in the hospital so that she could rest and recover.

I asked her how she would handle that today — would she want to spend the extra time in the hospital? “No way!” she said.

Today many people would prefer to receive medical treatment in their homes. Emergency room and inpatient hospital care is expensive, and patients are paying more out-of-pocket. People are fearful of medical errors and hospital acquired infections. They want the comfort of their own surroundings. Advancing technology will allow for safer care in the home.

The first generation of hospital at home has been around for 40 years, but the coming revolution in HAH will truly be able to build on the convergence of a wide range of new eHealth and consumer technologies.

Hospital at Home — First Generation

Hospital at home is a concept that dates back to the 1960s. Don’t feel bad if you’re not familiar with the term — it hasn’t received much airtime in the U.S.

While speaking at the recent Healthcare Unbound conference, I asked the audience of 300 people whether they were familiar with HAH. Only about 20% raised their hands.

However, HAH advancements have occurred in many other countries — including Australia, the UK, Canada, France, Israel, Greece and others. There is a significant research and literature base about HAH, but curiously, almost none of it is from the U.S.

There are many HAH models: early discharge of elderly medical patients, early discharge of patients following elective surgery, and inpatient hospital admission avoidance initiatives.

In its purest form, HAH is voluntary. Patients are given a choice — hospital or HAH? Equipment and people are brought to the patient’s home.

In 2005 a Cochrane review examining studies of first generation HAH was published. Drawing from an initial list of over 80 studies, the review focused on 22 randomized trials of hospital at home care compared with acute hospital inpatient care.

The findings of the Cochrane review of first generation HAH are inconclusive and mixed:

Patients admitted to hospital at home did not generally have significantly different outcomes than those treated in hospital. While there is some evidence that patient satisfaction may be higher at home, the burden on carers can also be greater and there is little evidence of cost savings to the health service.

The most significant HAH project in the U.S. is being conducted as a collaborative project among Johns Hopkins Medicine, Johns Hopkins Bloomberg School of Public Health, and The John A. Hartford Foundation. Initial results were published in a recent issue of the Annals of Internal Medicine:

The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.

Click here for more references on HAH.

Hospital at Home — Next Generation

While the original concept of HAH is not rooted in technology, the next generation of HAH will be dramatically enhanced by technology.

The ground work is being laid today with a wide range of independent eHealth and consumer technologies, including: electronic health records, personal health records, digital home networks, broadband, remote patient monitoring, secure electronic messaging between patients and physicians, mobile technologies, ePrescribing, medical call centers, interactive health portals, and others.

As these technologies converge, a next generation of HAH will become possible. Advanced technologies will allow a wider range of patient conditions to be treated safely at home. As an approach that builds on and synergizes multiple emerging eHealth technologies, HAH could be highly disruptive to traditional health care delivery.

Care Level Management is one early example of a company offering HAH services. Care Level Management focuses on the frail elderly.

There are significant concerns and barriers. There is a potential to over-burden caregivers at home. HAH could become viewed as a reincarnation of the negatives of managed care — “We won’t pay for you to be in the hospital; good luck recovering at home.” Physician workflow is not yet structured to accommodate HAH. The models to provide appropriate reimbursement for HAH are not yet developed, and the business models for HAH are not mature.

Pressures to reduce inpatient hospital costs are increasing. CMS actuaries writing in Health Affairs project that that hospital spending in the U.S. will exceed $1 Trillion (yes, with a “T”) in 2015.

If we can plan to spend $1 Trillion to care for people in buildings where there’s a high risk of medical errors and infection, where the cost of care is higher than anywhere else, where people would rather not be….

…how much should we be willing to spend to spend provide safe hospital at home care?

Now that’s an issue worth talking about.

Vince Kuraitis
Principal
Better Health Technologies, LLC

TECHNOLOGY & CARE MANAGEMENT

Home Telehealth Reference 2006/2007
Medicare Quality Improvement Community, Fall 2006

Health Plans Partner With Purchasers In Consumerism Drive
Online tools are evolving to better answer cost, quality questions
URAC Issue Brief, August 2006

Few Patients Use or Have Access to Online Services for Communicating with their Doctors, but Most Would Like To
64% of adults would like access to an electronic health record, yet just 2% of adults currently use EHRs
Harris Interactive/The Wall Street Journal Online; September 22, 2006

Pilots Versus Mainstreaming Checklist
Care Services Improvement Partnership Factsheet (UK); Version 1, September 1, 2006

National Survey on Telecare Implementation – early results now available
Care Services Improvement Partnership (UK); September 16, 2006

Diagnosis, Access And Outcomes: Update Of A Systematic Review Of Telemedicine Services
Journal of Telemedicine and Telecare, September 2006,

Wikis, Blogs And Podcasts: A New Generation Of Web-Based Tools For Virtual Collaborative Clinical Practice And Education
BioMed Central; August 15, 2006

Medical Device Makers Push for Coverage
Medical Device Companies Lobby Congress to Require Medicare Pay Doctors for New Technology
Yahoo Financial News; September 25, 2006

Physicians Slow to Adopt Patient E-mail
Center for Studying Health System Change, September 2006

Remote Control for Health Care
The New York Times; September 9, 2006

A Systematic Review Of The Literature On Home Monitoring For Patients With Heart Failure
Journal of Telemedicine and Telecare, July 2006

Why Are Health Care Interventions Delivered Over the Internet? A Systematic Review of the Published Literature
Journal of Medical Internet Research; June 23, 2006

Anticipation Grows For At-Home Tech
Healthcare IT News; August 1, 2006

WORTH REVIEWING!

Reducing Corporate Health Care Costs: Refocusing the Strategy
Employers Endorse Consumer-directed Plans, Care Management Programs
Deloitte Center for Health Solutions and Deloitte Consulting LLP, September 2006

How Common Are Electronic Health Records In The United States? A Summary Of The Evidence
Health Affairs; October 11, 2006
Almost 24% of physicians used an EHR but only 9% used systems with at least 4 key functionalities identified by the Institute of Medicine

The Future of the Internet II
A survey of technology thinkers and stakeholders shows they believe the internet will continue to spread in a “flattening”and improving world. There are many, though, who think major problems will accompany technology advances by 2020
Pew Internet & American Life Project; September 24, 2006

Thought Leadership Survey: Physician Alignment through IT
Harris Interactive (sponsored by McKesson); August 2006

The Rise In Spending Among Medicare Beneficiaries: The Role Of Chronic Disease Prevalence And Changes In Treatment Intensity
Health Affairs; August 22, 2006

Report to the Congress: Increasing the Value of Medicare
Chapter 2: Care coordination in fee-for-service Medicare
Medicare Payment Advisory Commission (MEDPAC), June 2006

Applicability of the Evidence Regarding Intensive Glycemic Control and Self-Monitored Blood Glucose to Medicare Patients with Type 2 Diabetes
AHRQ Technology Assessment (Draft); August 16, 2006

E-CareManagement News is a complimentary e-newsletter courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases and conditions, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding customers, and developing key partnerships.

Disclosure — no clients are mentioned in this issue.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2006, Better Health Technologies, LLC. All rights reserved

Comments? Write or call Vince Kuraitis at vincek@bhtinfo.com, (208) 395-1197

WILL PHYSICIANS COLLABORATE OR COMPETE WITH DM COMPANIES?

Doctors, before you get mad, let me acknowledge that the word “compete” isn’t in most physicians’ vocabularies. Doctors relate much more to a culture rooted in service and professionalism rather than business competition.

The medical home concept being advanced by primary care physicians could wind up competing with disease management (DM) companies. Ironically, this occurs at a time when most DM companies are picking up the pace of improving relationships and communications with doctors.

While the medical home model isn’t new, it has recently received formal endorsements from primary care physician groups. The American Academy of Family Physicians (AAFP) Board adopted a policy in May 2006 and the American College of Physicians (ACP) Board of Regents approved a position paper in January 2006. The AAFP represents 94,000 family medicine physicians and the ACP represents 119,000 internists.

Here’s how the ACP summed up its version of the medical home:

The advanced medical home is a physician practice that provides comprehensive, preventive and coordinated care centered on their patients’ needs, using health information technology and other process innovations to assure high quality, accessible and efficient care. Practices would be certified as advanced medical homes, and certified practices would be eligible for new models of reimbursement to provide financing commensurate with the value they offer. These practices would also be accountable for results based on quality, efficiency and patient satisfaction measures. The advanced medical home would be particularly beneficial to patients with multiple chronic diseases—a population of patients that is growing rapidly and that consumes a disproportionate share of health care resources.

There is a lot at stake here. No matter what the doctors intend, the effect of the medical home model could be competitive to disease management (DM) companies and others. The medical home could affect the flow of hundreds of billions of dollars – money that over time might flow either to physicians or to private companies.

Click here for more information about the medical home model.

Key Aspects of the Medical Home: Care Coordination + Technology

While there are many aspects to the medical home, I’d like to focus on two in particular:

  1. Care coordination
  2. Information and communication technology to support care and care management

Pop quiz: Who wrote the following statement describing the term “care coordination”:

The literature has correctly indicated that the term “care coordination”, which is often used interchangeably with the term “care management,” refers to a variety of activities. These include managing the transition of care across settings, the use of patient registries to allow for population-based care protocols, the use of frequent follow-up with patients to promote treatment plan compliance and to obtain healthcare data, the use of clinical practice guidelines, including feedback to the physician regarding their degree of compliance with the guidelines, and the teaching of disease self-management skills to patients. …

Was this written by someone from a disease management company? a health plan? a home health agency?

It was written by…doctors! …and here’s the punch line:

These care coordination activities are at the core of what defines a primary care physician.

Reform of the Dysfunctional Healthcare Payment Delivery System, ACP Position Paper, April 2006, p.16

Hmmm….doesn’t this definition sound a lot like what DM companies (e.g., Healthways, Matria) and payers (e.g., health plans, employers, Medicare) have been working on for the past several years?

Is this surprising? Yes and no. I certainly want my doctor to be involved in care coordination activities, but very few doctors do this in a systematic way.

There’s more…physicians are also warming to the use of technology to care for patients both at doctors’ offices and in patients’ homes and communities. Another recent ACP position paper describes that key elements of a revised reimbursement system should include compensation for:

b) adoption and use of health information technology for quality improvement; c) provision of enhanced communication access such as secure e-mail and telephone consultation; d) remote monitoring of clinical data using technology; and e) pay-for-reporting or pay-for-performance. (p.8)

Doctors leading the charge for the use of technology?! That’s invigorating!

Will the Medical Home Compete with DM?

While genteel physicians would never be so crass and direct, one interpretation of the medical home model might be — “Don’t pay a private company to do care coordination, pay physicians instead.”

DM companies have been working hard to develop better relationships and communications with physicians. While the need for better relations has been evident for years, the recent Medicare Health Support (MHS) pilot projects underscore the urgency felt by DM companies to coordinate with doctors. These projects focus on frail, elderly patients who are particularly dependent on their relationship with their primary care physician. For an example of a physician focused approach, see Dr. Sandeep Wadwha’s innovative PowerPoint presentation describing McKesson’s MHS project in Mississippi.

The medical home model puts DM companies in an awkward position. On the one hand, DM companies have been working hard to improve their relationships and workflow integration with physicians; on the other hand, the medical home model could put doctors into direct competition with DM companies.

And while competition is a possibility, it’s also possible to envision a range of collaborative scenarios – companies holding DM contracts could subcontract with physicians for their services; physician groups who have signed up medical home patients could subcontract with DM companies.

As an aside, health plans that have built their own DM programs are much more likely to be unreservedly supportive of the medical home – they don’t view DM as a direct profit center.

Do physicians have the ability to compete? There are strong arguments suggesting “NO” and strong arguments suggesting “YES”. Let’s look at both sides.

“NO”. What’s the rationale suggesting that physicians cannot be effective competitors at providing care coordination and chronic disease management?

Physicians cannot be cost effective. The use of expensive physician time is not economical to provide care coordination; a mix of nurses, other professionals, lay persons, and technology will be much more cost effective.

Physicians lack training and experience at care coordination. DM companies and health plans have spent the past decade developing their care coordination capabilities.

The medical home model does not provide financial guarantees for purchasers. Many DM purchasers require guaranteed financial savings; these guarantees are typically backed by reinsurance and/or a very strong balance sheet. For example, the current MHS projects require contractors to guarantee 5% savings. Guaranteed savings for purchasers is not an integral part of the medical home model.

Physicians lack capital and management expertise. Most physicians work in small groups or solo.

“YES”. Here’s the rationale suggesting that primary care physicians can be effective competitors at providing care coordination and chronic disease management:

The medical home is a better clinical model. The medical home approach integrates the Chronic Care Model. It provides for better integration of local care providers and strengthens the doctor patient relationship; DM companies and health plans have been viewed as operating parallel to the doctor-patient relationship, or as getting in between doctors and their patients. Initiatives to develop and validate the Chronic Care Model have been supported by the Robert Wood Johnson Foundation, the Institute for Healthcare Improvement, RAND Corporation, and the World Health Organization.

Technology levels the playing field. Physicians can provide DM services efficiently. They can subcontract with DM companies or other specialized vendors to gain access to appropriate call center services, health coaching, and other technologically supported interventions. Doctors can compete in a flat world.

Physicians can leverage their grass roots connections. Primary care physicians live everywhere in America; physicians are often influential citizens in their local communities and will have broad access to all members of Congress. Working with their national organizations, they will be able to influence passage of legislation favorable to the medical home model.

Doctors have trusting relationships with patients. How do you think the doctor and the patient will respond at the moment of truth in the privacy of the exam room when the patient asks: “Doctor, should I sign up for this DM program being offered by my health plan, or should I sign up for your ‘medical home’ program?”

Of course, all this is very speculative. There are strong points supporting both sides.

Closing Thoughts

Many things are still unclear:

Do the national physician organizations speak for individual member physicians in advocating the medical home?

Can physicians gain political support for their medical home proposal?

Can physicians get payers, especially Medicare, interested in the medical home model?

Can physicians develop evidence to support clinical and cost effectiveness of the medical home model? (and you thought the ongoing debate about DM-ROI has been thorny)

Overall, physicians’ promotion of the medical home model is good news. It will provide patients with more and higher quality choices.

Physicians also read the analyst reports predicting that DM will grow to become a $10 to $30 billion dollar a year market. They are understandably asking, “Is some of that coming out of our pockets? How do we get our share and hang on to the bread and butter activities that define the physician of the future?”

Will physicians collaborate or compete with DM companies? I predict doctors will learn to expand their vocabularies to include words like “compete”.

Vince Kuraitis
Principal
Better Health Technologies, LLC

HEALTHCARE UNBOUND III CONFERENCE

In 2002, Forrester Research coined the term Healthcare Unbound — technology in, on, and around the body that frees patient care from formal institutions.

The Center for Business Innovation (TCBI) presents:

The Third Annual Healthcare Unbound
July 17-18, 2006
Hyatt Regency Cambridge, Cambridge, MA
Click here for full details including sponsorship/exhibition and registration.
Or contact TCBI:
Ph: 310-265-2570 Email: info@tcbi.org

Healthcare Unbound is a conference and exhibition on the convergence of consumer and healthcare technologies. This year’s Healthcare Unbound conference focuses specifically on innovative applications of remote monitoring, home telehealth and pervasive computing technologies for disease management and wellness promotion. The program takes an in-depth look at these technologies — and the impact their adoption will have on hospitals, integrated delivery networks, long-term care providers, home care agencies, health plans, insurance companies, disease management companies, pharmaceutical companies, medical device companies, IT vendors, as well as telecom/wireless companies, consumer electronics companies, and the financial community. The program will also explore the concept of the digital home, with an emphasis on healthcare applications.

View The Preliminary Agenda

Join hundreds of fellow senior-level executives in business development, operations, technology, marketing, IT, R&D, and medical management this July in Boston for an exciting, thought-provoking conference and exhibition.

Keynote Speakers Include:

Erik Olsen, President, AARP

Vince Kuraitis, JD, MBA, Principal, Better Health Technologies, LLC

Astro Teller, PhD, CEO, Bodymedia, Inc.

Michael J. Barrett, Managing Partner, Critical Mass Consulting

Elizabeth W. Boehm, Principal Analyst, Healthcare & Life Sciences, Forrester Research

Jeremy J. Nobel, MD, MPH, Faculty, Harvard Medical School & Harvard School of Public Health

Tom Precht, Executive Vice President & General Manager, Honeywell HomMed

Mariah Scott, General Manager, Personal Health Platforms, Intel Corporation

Craig Frazier, Vice President & General Manager, Extended Care Solutions, McKesson Corporation

Joseph C. Kvedar, MD, Director, Partners Telemedicine & Vice-Chair, Dermatology, Harvard Medical School

Jouko Karvinen, Chief Executive Officer, Philips Medical Systems

Donald Jones, Vice President Business Development, QUALCOMM

RESOURCES

MiHome Journal. This excellent e-newsletter focuses on product development and distribution strategies for the medically integrated home.

The Connected Health Initiative focuses on extending the care community beyond the traditional walls of healthcare institutions by bringing healthcare to the everyday surroundings of the health consumer and their families. The founders include Partners Telemedicine and a number of other prominent telehealth leaders in Massachusetts.

DM World e-Reports ™ is the weekly e-newsletter of the International Disease Management Association.

CSIP e-newsletter. The Care Services Improvement Partnership (CSIP) is responsible for providing general implementation support to organisations building their telecare programmes in the UK.

TECHNOLOGY & CARE MANAGEMENT

Leading Health and Technology Companies Form Alliance to Improve Personal Health Through Connected Devices

Continua Health Alliance Press Release; June 6, 2006

Consumers in Health Care: Creating Decision-Support Tools That Work

California Health Care Foundation, June 2006

A Roadmap for National Action on Clinical Decision Support

American Medical Informatics Association; June 13, 2006

“…developing CDS starter sets – rapid consensus on core knowledge and interventions for specific high-visibility targets, such as chronic disease management for a specific condition, could provide clarity and unity for vendors and clinicians, and could lead to short-term achievements that can bootstrap further CDS activities.” (p. 50)

The Plan: Drive Consumers Online

Big I.T. changes are in store for payers and providers as consumer-driven health revs up

Health Data Management, June 2006

Growing Availability of Clinical Information Technology in Physician Practices

Center for Studying Health System Change, June 2006

Telecare – at the Tipping Point

Telecare Services Association (UK), May 2006

Health Industry Insights Consumer Survey (on Personal Health Records)

Health Industry Insights, an IDC Company; May 2006

The Next Generation of Health Information Tools for Consumers
Testimony to the Joint Economic Committee, U.S. Congress; May 10, 2006

AHIC Makes Recommendations on IT Adoption Projects
Healthcare IT News; May 16, 2006

Finding Answers Online in Sickness and in Health
Pew Internet Project; May 2, 2006

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care
Annals of Internal Medicine; May 16, 2006

Pervasive Medical Devices: Less Invasive, More Productive
IEEE Pervasive Computing, April – June, 2006

Telemedicine: Saving Time, Saving Money, Saving Lives
Key Research Findings and Presentation Highlights
10th Annual Meeting of the American Telemedicine Association
April 17 – 20, 2005 · Denver, Colorado

Issue Focus: Telehomecare
Telemedicine and e-Health Journal; April, 2006

A Systematic Review of Interactive Computer-assisted Technology in Diabetes Care
Journal of General Internal Medicine; February 2006

Imagine – the Future of Aging
Center for Aging Services Technology (CAST) ; December 2005
Commentary: for those of us who have a hard time explaining to Mom and others what we do for a living, this video does a tremendous job of painting a vision of how technology can help older people continue to live independently in their homes.

Telemedicine for the Medicare Population: Update
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, February 2006

New Report Demonstrates the Need for Systematic Use of Mobile Technology in Healthcare
Vodafone Group; March 24, 2006

WORTH REVIEWING!

Protecting Consumers in an Evolving Health Insurance Market.

National Committee for Quality Assurance (NCQA), June 2006

New Study Shows Need for a Major Overhaul of How United States Manages Chronic Illness
Center for the Evaluative Clinical Sciences (CECS) at Dartmouth Medical School; May 2006

Realizing the Promise of Disease Management
The Boston Consulting Group; April 19, 2006

Meta-Analysis: Chronic Disease Self-Management Programs for Older Adults
Annals of Internal Medicine; September 20, 2005 (.pdf available free to the public as of April 20, 2006)

Is DM Worth It?
Managed Care Magazine, April 2006

Care Coordination Programs Adapt to Real-World Challenges
Managed Healthcare Executive; May 1, 2006

E-CareManagement News is a complimentary e-newsletter courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding customers, and developing key partnerships.

Disclosure — BHT has consulted with Intel Corporation to assist in the formation of Continua Health Alliance.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2006, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197

RESOURCES AND COMMENTARIES — MEDICARE’S CHRONIC CARE IMPROVEMENT RFP

It’s the event of the year — if not the decade — for U.S. organizations involved in disease management or chronic care. On April 23 the Center for Medicare and Medicaid Services (CMS) released a request for proposal (RFP) inviting organizations to bid on Chronic Care Improvement pilot projects under Section 721 of the Medicare Modernization Act.

While the RFP has generally been viewed very positively, there are many potential pitfalls, particularly for organizations that do not have significant experience at chronic care programs.

Are you interested in more information about the RFP? There have been several excellent analyses and commentaries specifically on the RFP and more generally about the CMS Chronic Care Improvement program:

Medicare’s Chronic Care Improvement Pilot Program: What Is Its Potential?
National Health Policy Forum; May 10, 2004
This article is an excellent recap and analysis of the pros and cons of the CMS RFP.

Population-Based Disease Management Under Fee-For-Service Medicare
Health Affairs; July 30, 2003
At the May 13 CMS bidder’s conference, Sandra Foote, the author of this article, was announced as the new director of the CMS Chronic Care Improvement project. She previously directed the Health Insurance Reform Project at the George Washington University in Washington, D.C.

Update on the New Medicare Chronic Care Improvement Program
Audioconference PowerPoint presentations are available from:
Christobel Selecky, CEO of Lifemasters and President Elect of the Disease Management Association of America
Vince Kuraitis, Principal, Better Health Technologies

Chronic Care Improvement: How Medicare Transformation Can Save Lives, Save Money, and Stimulate an Emerging Technology Industry
Information Technology Association of America, May 2004
This report focuses on the role of technology in transforming chronic care.

Perspective: Integrating Disease Management Into The Outpatient Delivery System During And After Managed Care
Health Affairs; May 19, 2004
This article by Victor Villagra, President of Health and Technology Vector and Past-President of DMAA, provides perspectives on better integrating physicians into disease management.

Additional Resources:

MMA Creates Framework for Transforming Chronic Care. DMAA Testifies before Ways & Means on Merits & Challenges of CCIP
Disease Management Association of America Press Release; May 11, 2004

Congresswoman Nancy L. Johnson (R-CT) Calls Hearing on Medicare Chronic Care Improvement Program
Disease Management Association of America Press Release; May 11, 2004

Medicare Exploring Changes In Pay For Chronic Care
ACP Observer, May 2004

Bush Administration Approach to Chronic Care Leaves out Doctors
PPI Health Policy Wire; May 20, 2004

CMS Bidder’s Conference Materials

McClellan Says Medicare Chronic Care Pilot Program Would Reduce Costs, Improve Treatment
Kaisernetwork.org; May 12, 2004

The Promise and Pitfalls of Disease Management in Medicaid and Medicare
American Enterprise Institute Event; March 22, 2004

U.S. Subcommittee on Health: Hearing on Medicare Chronic Care Improvement Program
May 11, 2004

HEALTHCARE UNBOUND
A Conference & Exhibition on the Convergence of Consumer and Healthcare Technologies
Special Focus on Telehomecare & Remote Patient Monitoring
July 8 – 9, 2004, Cambridge, MA

The Healthcare Unbound conference brochure is now available.

Forrester Research recently coined the term “Healthcare Unbound” to encompass the technology-enabled shift toward self-care, mobile care, and home care. Healthcare Unbound technologies will transform health care and empower healthcare consumers to promote wellness and manage diseases.

Conference faculty includes:

William Novelli, Executive Director & CEO, AARP

Joseph Kvedar, MD, Partners Telemedicine; President-Elect, American Telemedicine Association

Vince Kuraitis, JD, Better Health Technologies

Eric Dishman, Intel Proactive Health Research

Elizabeth Boehm, Forrester Research

Alice Pentland, MD, Center for Future Health, U. of Rochester

Steven Intille, MIT Home of the Future

Robin Felder, Medical Automation Research Center, U. of Virginia

Victor Villagra, MD, President, Health & Technology Vector, Inc.

Ron Poropatich, MD, Past-President, American Telemedicine Association

Carol Rozwell, Gartner

….and many others

Supporting organizations include the Disease Management Association of America (DMAA) and America’s Health Insurance Plans (AHIP).

Disease Management Conferences

E-CAREMANAGEMENT NEWS SUBSCRIBER DISCOUNT AVAILABLE FOR DISEASE MANAGEMENT COLLOQUIUM AT JEFFERSON

E-CareManagement News has arranged for a special discount to the excellent Disease Management Colloquium, June 27 – 30, 2004, at Jefferson Medical School In Philadelphia, PA

HOW TO TAKE ADVANTAGE OF THE SPECIAL DISCOUNT OFFER:
E-CareManagement News subscribers qualify for the special discounted registration rate of $1595 for the Disease Management Colloquium. This constitutes a discount of $300 off of the full registration rate. The $1595 rate applies prospectively only. This special rate covers the Colloquium only, and not the preconference symposia on Sunday, June 27, 2004.

The E-CareManagement News discount code is BHT. It can be entered on the online registration page at “Optional Registration Code” and will cause the discounted rate to be charged. Alternatively, you may print the down loadable registration form on the website and enter the discount code BHT and the amount. The completed form can be faxed to (215) 545-8107or send to: Disease Management Colloquium, .1211 Locust St., Philadelphia, PA 19107. For more information about this special discount offer call (800) 546-3750 or email registration@rmpinc.com.

WORTH REVIEWING!

DMAA Invites Comment on New Paper: Principles for Assessing Disease Management Outcomes
Disease Management Association of America; May 2004

Table of Contents — Special Theme Issue on eHealth and IT
British Medical Journal; May 15, 2004

Chronic Disease Registries: A Product Review
California HealthCare Foundation; May 20, 2004

eHealth Striving For Critical Mass
eHealth Institute, May 2004

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

Disclosure — No clients were mentioned in this issue.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2004, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com at (208) 395-1197.

AUDIOCONFERENCE AN UPDATE ON MEDICARE’S CHRONIC CARE IMPROVEMENT PROGRAM

Please participate in Tuesday’s audioconference on the new Medicare Chronic Care Improvement Program! fyi, you can review my PowerPoint presentation Strategies for Winning a Contract: The CMS Chronic Care Improvement Phase I RFP.

Best of health,

Vince Kuraitis
Principal
Better Health Technologies, LLC

PRESS RELEASE:
CMS Provides Update on the New Medicare Chronic Care Improvement Program in National Disease Management Audioconference

Tuesday, May 25, 2004
1:00 pm – 2:30 pm (Eastern)
12:00 pm – 1:30 pm (Central)
11:00 am – 12:30 pm (Mountain)
10:00 am – 11:30 am (Pacific)
www.DMAudioconferences.com

PRESS RELEASE
Contact: Paul Tunnecliff
800-684-4549 phone
registration@hcconferences.com

WASHINGTON DC USA — HEALTHCARE UPDATE NEWS SERVICE(TM) — MAY 18, 2004: Disease Management Aduioconferences, www.DMAudioconferences.com, announced today the scheduling of a National Disease Management Audioconference on an Update on the New Medicare Chronic Care Improvement Program on next Tuesday, May 25, 2004 from 1:00 pm to 2:30 pm eastern.

NATIONAL DISEASE MANAGEMENT AUDIOCONFERENCE: UPDATE ON THE NEW MEDICARE CHRONIC CARE IMPROVEMENT PROGRAM:

Tuesday, May 25, 2004
1:00 pm – 2:30 pm (Eastern)
12:00 pm – 1:30 pm (Central)
11:00 am – 12:30 pm (Mountain)
10:00 am – 11:30 am (Pacific)
www.DMAudioconferences.com

FEATURED FACULTY:

Stuart Guterman
Director, Office of Research, Development and Information
Centers for Medicare and Medicaid Services
Baltimore, MD

Vince Kuraitis, JD, MBA
Principal, Better Health Technologies, LLC
Boise, ID

Christobel E. Selecky
Chief Executive Officer
LifeMasters Supported SelfCare, Inc.
President-Elect
Disease Management Association of America
Irvine, CA

Richard P. Vance
President and Chief Executive Officer
CorSolutions, Inc.
Rosemont, IL

John K. Iglehart
Founding Editor, Health Affairs
National Correspondent, New England Journal of Medicine
Washington, DC
(Moderator)

AUDIOCONFERENCE REGISTRATION:

The Audioconference Registration Fee is $345 per Site. No limit to number of attendees per site.

You can register online at: www.DMAudioconferences.com

Alternatively, you can download and print the Audioconference Registration Form from the website:
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The completed form can be faxed to 760-418-8084 or sent to:

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If this issue of E-CareManagement News was forwarded to you from a colleague, you can subscribe at http://www.bhtinfo.com/newsletter.htm. It’s free and it’s easy!

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC.

THE VIEW DOWN THE ROAD — BABY BOOMERS WILL BENEFIT FROM “HEALTHCARE UNBOUND” TECHNOLOGIES

Forrester Research recently coined the term “Healthcare Unbound” to encompass the technology-enabled shift toward self-care, mobile care, and home care. The Center for Aging Services Technologies recently facilitated a demo day for members of Congress and showed examples of “Healthcare Unbound” technologies beginning to enter the marketplace.

Skeptics might point out that “If you look in the rearview mirror at the road we’ve traveled over in the past few years, consumer technologies haven’t had much on impact on health care.”

….and they would be right.

HOWEVER, the view down the road for consumer health care technologies is very promising.

So what’s different looking down the road instead of in the rearview mirror? Four things:

1) Baby Boomers Will Have Far Greater Expectations for Health Care Technologies
2) Prices Will Fall Dramatically
3) Technology Will Become Part of the Background of Life
4) Technologies Will Integrate and Work Together

Let’s take a look at these one at a time.

1) Baby Boomers Will Have Far Greater Expectations of Health Care Technologies. The Pew Internet Project report Older Americans and the Internet reveals statistics showing a startling generational digital divide. The percentage of Americans with Internet access varies dramatically by age:

62% of Americans age 50-58 years-old

46% of Americans age 59-68

17% of Americans age 69 and older

I have often remarked that the Internet will have arrived for seniors when my Mom (who just turned 80) actually orders a pizza over the Internet. I’m still waiting….and my Mom is blissfully happy remaining unwired.

Baby boomers are a different story, however. As the Pew Internet Project points out, “there is a burgeoning group of Americans who are slightly younger but vastly more attached to the online world”.

2) Prices Will Fall Dramatically. Some of the early devices used to measure vital signs in patient’s homes were built by companies with a medical mindset. These companies are used to charging a couple of million dollars for a CT Scanner or MRI machine, so what’s the big deal with selling a bathroom scale for heart failure patients with a price tag of 6 or 7 thousand dollars?

Other remote monitoring companies have approached this opportunity with a very different mindset. “Let’s see…we’ll need to get a digital scale from the local medical supply store, we’ll need to connect it through a POTS (plain old telephone service) line….” The price tag so far — a couple hundred bucks.

Which approach do you think will win in a consumer health care market?

Buzz Peddicord, President of the remote monitoring company HomMed, started his company’s success by selling to home health agencies. However, he anticipates that HomMed’s technology will soon be sold at stores like BestBuy or Sharper Image. He believes the consumer market for remote monitoring technologies eventually will be “larger than all other markets combined.”

3) Technology Will Become Part of the Background of Life. Today’s technology mostly requires that users must DO something to interact with the technology. Many of tomorrow’s computing technologies will NOT require user interaction; the technology will just be there, running in the background, doing what it needs to do to assist us in monitoring health for ourselves and our loved ones.

For example, many companies are developing sensors for people’s homes to provide real-time information to answer the question “Are my elderly parents OK?” Another example is the FitSense Technology BodyLAN™ Wireless Intelligent Sensor Network that collects data on the human body and transports it virtually anytime, anywhere and to anyone.

My work over the past year and a half with several divisions of Samsung Electronics has educated me on the value of “ubiquitous” technologies. The Samsung Advanced Institute of Technology is conducting R&D on five technology platforms, including digital, nano, opto, energy, and bio. All these contribute to Samsung’s competency of making technologies ubiquitous.

4) Technologies Will Integrate and Work Together. Yesterday, most self care and consumer health technologies were a collection of pieces-parts. A blood pressure cuff here…a heart monitor there…blood sugar readings that diabetics scribble down on the back of a napkin (if they remember). Few of these devices work together or share information. However, all this is changing.

On the health care front, integration is now a major theme. Health care payors and providers are recognizing that they must share information. The new Administrator of the Centers for Medicare and Medicaid Services, Dr. Mark McClellan, is making the electronic health record a top priority.

On the consumer electronics front, companies like the Samsung Digital Solution Center are developing home networks — connecting your appliances, computing and entertainment technologies. Take a look at Samsung’s vision for an eHealth solution and you can begin to envision the day that you will be able to have a virtual visit with your doctor, supported by technology at home.

“What about privacy?” you ask. First, successful “Healthcare Unbound” technologies will have a big “OFF” button controlled by the user. …and we will want other safeguards, but that’s for another newsletter….

Vince Kuraitis, Principal
Better Health Technologies

Additional Resources:

Older People – Independence And Well-Being: The Challenge For Public Services
Audit Commission (UK), 2004
Assistive Technology Report
Other Supporting Reports also available.

Technology and Aging — AAHSA and CAST Meetings
Sandy and Dave’s Report on The Broadband Home; March 24, 2004

The State of 50+ America
AARP, January 2004

Tech firms want to help elderly — and cash in
USA Today; February 10, 2004

Fact Sheet: Assistive Technology
U.S. Department of Health and Human Services, Administration on Aging; January 2004

Picture of Health
A Robot for the Elderly
Washington Post; March 23, 2004

HEALTHCARE UNBOUND
A Conference & Exhibition on the Convergence of Consumer and Healthcare Technologies
Special Focus on Telehomecare & Remote Patient Monitoring
July 8 – 9, 2004, Cambridge, MA

Healthcare Unbound technologies will transform health care and empower healthcare consumers to promote wellness and manage diseases.

Conference faculty includes:

William Novelli, Executive Director & CEO, AARP

Joseph Kvedar, MD, Partners Telemedicine; President-Elect, American Telemedicine Association

Vince Kuraitis, JD, Better Health Technologies

Eric Dishman, Intel Proactive Health Research

Elizabeth Boehm, Forrester Research

Alice Pentland, MD, Center for Future Health, U. of Rochester

Steven Intille, MIT Home of the Future

Robin Felder, Medical Automation Research Center, U. of Virginia

Victor Villagra, MD, President, Health & Technology Vector, Inc.

Ron Poropatich, MD, Past-President, American Telemedicine Association

Carol Rozwell, Gartner

….and many others

Supporting organizations include the Disease Management Association of America (DMAA) and America’s Health Insurance Plans (AHIP).

For additional information and registration information, click here.

FAMILY DOCS THINK AHEAD

The Future of Family Medicine: A Collaborative Project of the Family Medicine Community
Annals of Family Medicine; Supplement, March/April 2004

The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance.

State-of-the-art chronic disease management will be an important part of the services provided by New Model practices. The care of patients with chronic diseases will utilize a community population-based approach, including the use of disease registries and community-oriented primary care methods. The practice will adhere to evidence-based clinical practice guidelines, which will be embedded into the electronic health record, and will participate in continuous quality improvement and practice-based research. The management of patients with chronic diseases will involve the full multidisciplinary team and will include some care of patients in their homes. The use of telemedicine and other new technologies will be explored as ways of enhancing the management of these patients (page S17).

Commentary: Perhaps what’s most refreshing about the report is how the theme focuses on “How WE (family physicians) need to change to adapt to the future.” In contrast, last year the American College of Physicians conducted a similar study entitled “Revitalizing Internal Medicine: Recommendations for Resolving Payment and Practice Hassle Issues”. That report can be summed up as focusing on “How everybody else needs to change.”

DMAA’s 1st Annual Integrated Healthcare Leadership
Summit: Co-Morbid Depression and Chronic Illness
June 7-8, 2004
JW Marriott, Washington, DC

The 1st Annual Integrated Healthcare Leadership Summit: Co-Morbid Depression and Chronic Illness features the most renowned Keynote Speakers in behavioral and chronic care. The Summit was created to bring together stakeholders in the chronic and behavioral care community to address fragmentation in our current delivery system that hinders the optimization of care for patients with chronic conditions. A full listing of the Summit Faculty, Program Details, and the Conference Advisory Committee can be found on the Summit Website.

DMAA is offering readers of E-CareManagement News a 20% discount on registration fees: enter promotion code “promo c” and referred by “BHT”

OBESITY AND WEIGHT MANAGEMENT FLASHES ON THE RADAR SCREEN FOR EMPLOYERS AND HEALTH PLANS

HEALTH PLANS
Support Systems
Health Leaders, March 2004

Plans Encouraged By Activities That Lift Obesity’s Heavy Burden
Managed Healthcare Executive, March 2004

Obesity and Telecare or “Tele-Obesity”: A Workable Solution
Information for Tomorrow, February 2004

Obesity and Disability: The Shape of Things to Come
Rand Research Highlights, March 2004

Cost Of Treatment For Obesity-Related Medical Problems Growing Dramatically
Rand Corporation; March 9, 2004

New Data Available That Show Relationship Between Diabetes, Obesity, and Chronic Disease
Agency for Healthcare Research and Quality; January 21, 2004

Obesity Management: Prevention, Treatment and Coverage Strategies for Health Plans and Employers
May 19 – 20 2004; Hotel Derek, Houston

USAGE PATTERNS ARE STABILIZING FOR ONLINE HEALTH USERS

No Significant Change in the Number of “Cyberchondriacs” – Those Who Go Online for Health Care Information
Harris Interactive; April 12, 2004

For the second year in a row, Harris Interactive finds no significant change in the numbers of adults who have ever been online to look for health information. In our latest survey on this topic, we find that 74% of all those online have looked online for health information at some time.

The main reason that the growth of cyberchondriacs slowed was that Internet penetration slowed.

HEALTH PLANS GEARING UP FOR GREATER CONSUMER INVOLVEMENT

Managed Care Redux: Health Plans Shift Responsibilities to Consumers
Center for Studying Health System Change, March 2004

[Health] plans…expressed little interest in returning to blanket pre-authorization requirements. Instead, plans are focusing on services that are high-cost or at high risk for inappropriate use.

Plans also continue to move away from primary care physician gatekeeping, giving consumers more liberal access to a wider range of services and providers.

Rather than focusing on traditional managed care practices that affect many members, such as prior-authorization requirements for a broad range of services, plans are instead ramping up care management for the small percentage of members that use a disproportionate share of resources. Disease management is one approach plans are actively using across product platforms ranging from more restrictive HMO products to more loosely managed preferred provider organization (PPO) products.

DM AND TELEHEALTH TECHNOLOGY UPDATES

Your Daily Digital Doctor
Advanced analysis of home medical data can offer continuous care for patients with diabetes and other life-threatening chronic diseases.
MIT Technology Review; February 20, 2004

e-Health Comes Calling
On the trip to disease management, quality made the plans but cost does the driving
Healthcare Informatics, March 2004

Innovation, Demand, and Investment in Telehealth
Office of Technology Competitiveness, US Department of Commerce, February 2004
Press Release; February 19, 2004

How Health Plans are Using the Internet to Reach Customers: A Survey of Payor Web Sites
Cap Gemini Ernst & Young; February 19, 2004

Using Computerized Registries in Chronic Disease Care
California HealthCare Foundation, February 2004

Electronic Monitoring Can Improve Diabetes Care
Center for the Advancement of Health; February 16, 2004

IPTS Report – Special issue: Aspects of eHealth
European Science and Technology Observatory, Institute for Prospective Technological Studies, 2004

Consumers Unwilling To Pay For Online Chats With Doctors
TechWeb News; March 10, 2004

Setting the Public Agenda For Online Health Search (report)
Press Release
URAC and Consumer Webwatch; February 2004

Geared Up For Health
Time; February 16, 2004

Smart Sensors That Detect and Delivery Therapies Will Transform the Future of Medical Care
Press Release, The Health Technology Center; April 5, 2004

WORTH REVIEWING!

More Care, Less Cost
Workforce Management, March 2004

DM Standards Off and Crawling
Managed Care Magazine, February 2004

Finding The ROI: Searching To Measure Returns On Disease Management Is Tough But Doable
Employee Benefit News; April 1, 2004

Disease Management For Diabetes
National Pharmaceutical Council, February 2004

Disease Management Programs: Improving health while reducing costs?
Center on an Aging Society, Georgetown University; January 2004

Large Employers Now Use DM To Cut Their Costs
Managed Care Magazine, January 2004

Desktop Resource Chart: Disease management strategies of managed care companies
Managed Healthcare Executive, January 2004

Delivering interventions for depression by using the internet: randomised controlled trial
British Medical Journal; January 31, 2004

Depression Link To Chronic Disease Goes Both Ways
Untreated depression’s debilitating nature could trigger chronic disease, new research suggests.
American Medical News; March 15, 2004

COPD: Consequences of an Underrecognized Disease
Business and Health; February 13, 2004

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

Disclosure — Samsung Electronics and FitSense Technology are clients of Better Health Technologies

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2004, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197 or Harry Leider MD, MBA at harryl@bhtinfo.com, (410) 252-7361.

E-CareManagement News

Disease Management News Reprint

Expect Greater Use of eHealth in DM in 2004

7 Key Trends Focus on Integration of Technologies,

Convergence of Devices

1) Cost Management Will Continue to Be the Primary Driver of DM Technology Adoption
2) Predictive Modeling Technologies Will Focus on “Impactability”
3) Information and Communication Technologies Will Enable DM Assembling as a Viable Business Strategy
4) Consumer Electronics Giants Will Bring DM into the Living Room
5) Remote Patient Monitoring and Wireless Technologies Will Enable “Healthcare Unbound”
6) Personalization Technologies Will Allow Patients to “Have It Your Way”
7) The Electronic Health Record Will Break From the Pack

EVIDENCE-BASED MEDICINE IS PIVOTAL IN ADVANCING CARE MANAGEMENT

Evidence-based Medicine and Managed Care: Applications, Challenges, Opportunities
Results of a National Program to Assess Emerging Applications of Evidence-based Medicine to Medical Management Strategies in Managed Care
Vanderbilt Center for Evidence-based Medicine, December 2003

Health plans touch all facets of healthcare and therefore have a unique opportunity to stimulate adherence to evidence-based practices….The purpose of this program was to explore how managed care is applying principles and concepts of evidence-based medicine to its delicate balancing of cost and quality management.

Some of the key findings include:

1) The role, scope and functions of medical management in managed care organizations are expanding dramatically. There are five key impact areas: a) Disease and case management, b) provider profiling & reports cards, c) pay for performance, d) consumer-directed care, and e) coverage & denial management.
2) Current resources/budgets for medical management programs do not correlate with enrollments or other measures of plan size.
3) Reducing health costs is a primary consideration in most medical management programs.
4) Medical directors in managed care believe the application of evidence-based medicine is central to enhancements in each of the key impact areas.

PEW INTERNET PROJECT UPDATES WEB USAGE PROFILES

America’s Online Pursuits: The Changing Picture Of Who’s Online And What They Do
Pew Internet & American Life Project; December 22, 2003

A broad analysis of over three years’ worth of Pew Internet Project data illustrates shifting trends in Internet use by Americans:

Online activity has consistently grown

Despite this growth in activity, the growth of the online population itself has slowed.

Different people use the Internet in different ways.

Experience and the quality of online connections matter.

Online Americans’ experience with the commercial side of the Internet has expanded dramatically in spite of the economic slump.

Email continues to be the “killer app” of the Internet.

Big news stories drive lasting changes in the news -seeking audience online.

There has been a surge in use of the Internet for health or medical information.

66% of Internet users have said “yes” when we asked the simple question: Do you ever use the Internet to get health or medical information? However, when we asked about 16 specific kinds of health searches (seeking diet and fitness information, material about health insurance, mental health information, etc.), the percentage of Internet users who had done health searches came to 80%….

The number of those who have done health searches online grew at least 59%, from a figure of 46 million in March 2000 to 73 million in December 2002.

Online women are much more likely than online men to have done health searches using the Internet.

The Internet has increasingly become an important source of health-care and medical information for the majority of online American adults. Those health seekers who turn to the Internet as a reference for health information grew substantially from 54% in March 2000, to 66% of the online population in December 2002.

RETURN ON INVESTMENT FOR DM? — THE DEBATE CONTINUES

The Cost Savings of Disease Management Programs: Report on a Study of Health Plans
American Association of Health Plans, November 2003
J Yes!
Consistent with the single-plan studies reported in the peer-reviewed literature, the eight evaluations that AAHP/HIAA surveyed found that enrollees in DM programs had fewer hospital admissions and fewer emergency room (ER) visits, and lower overall costs. Thus, these evaluations are supportive of the hypothesis that DM programs contribute to reductions in health care costs….The eight evaluations presented here break new ground in overcoming the limitations of previous research on disease management. Unlike some earlier studies, these evaluations are valid because they address important methodological issues, such as the statistical phenomenon known as regression to the mean. And these evaluations are generalizable because they cover multiple health plans, different areas of the country, and a diverse range of people of various ages from different socioeconomic backgrounds.

Disease Management: A Leap of Faith to Lower-Cost, Higher-Quality Health Care
Center for Studying Health System Change, October 2003
L No proof!
Despite high expectations, evidence of both disease management and case management programs’ success in controlling costs and improving quality remains limited.

Evaluating ROI in State Disease Management Programs
Academy Health Issue Brief, November 2003
K Be careful out there!
Measuring the financial return associated with DM is difficult because changes in health care costs over time cannot be assumed to be solely due to the DM intervention in the population that received DM services…. Given the uncertainty associated with DM analyses, it is probably not possible to “prove” that DM positively affects ROI by the legal standard of “beyond a reasonable doubt.” A more reasonable goal is to aim for a “preponderance of evidence.” That means that ROI assessments should not be based on a single study. Rather, evidence should be refreshed constantly with new data. This will assure those who pay the health care bills that the investments they made months or years earlier were intelligent ones.

Why We Can’t Wait to Implement Disease Management
Business and Health; October 15, 2003
ü Just do it anyway.
True, we don’t yet know if the promise of cost reduction will materialize fully, but the target is enormous and the early indications are encouraging. We can hold back until every single skeptic is satisfied, or we can get to work on the roots of health expenditure with a potent new tactic.

PREDICTIONS FOR HEALTHCARE IN 2004

Healthcare’s Top Business Issues and Responses for 2004
Cap Gemini Ernst & Young; December 16, 2003

The Top 10 Issues:

1) A new level of business rigor in technology investments.
2) Transformation of clinical care through technology.
3) Detailed redesign of core business processes.
4) Outsourcing of non-core functions.
5) Protracted efforts to comply with HIPAA requirements.
6) Collaboration between payers and providers at an operational level.
7) Proliferation of “new” benefits models.
8) Redirection of medical management efforts.

With efforts to reduce administrative costs largely exhausted and medical costs continuing to rise, healthcare organizations are taking a new view of medical management. They are looking at advanced care management, or population health management approaches. This involves the use of predictive modeling techniques to identify “at risk” patients who are about to incur large claims. Technology enables prioritized outreach to these people to prevent complications. Employers (typically) offer support programs to modify patients’ behavior and thus avoid costly hospitalizations or procedures down the road….

9) Emphasis on organizational ethics and institutional governance.
10) Community approaches to new biological threats

Six Prescriptions To Ease Rationing In U.S. Health Care
Summary by KaiserNetwork.org; December 22, 2003
Original Wall Street Journal article (paid subscription required)

1) Wiring the health system
2) Evidence-based medicine
3) Fixing reimbursement
4) Disease management

Many experts agree the best opportunity to improve care and stave off costly complications is disease management — the strategy of monitoring people with chronic conditions such as diabetes, congestive heart failure and coronary artery disease. Those diseases are expected to cost $510 billion this year and soar to $1.07 trillion by the 2020. But many of those costs are related to preventable hospitalizations and emergency-room visits….

5) Redesigning the intensive care unit
6) Getting patients involved

Forrester’s Top 10 Healthcare Predictions For 2004
Forrester Research, December 15, 2003

Predicts 2004: Healthcare
Market challenges and increasing volatility have resulted in a floundering and troubled U.S. healthcare industry. However, there are glimmers of hope for 2004.
Gartner Research; December 16, 2003

DIABETES INFO ON THE INTERNET — PATIENT BEWARE

Design and Testing of a Tool for Evaluating the Quality of Diabetes Consumer-Information Web Sites
Journal of Medical Internet Research, Oct-Dec 2003

There is wide variation in the accuracy and comprehensiveness of online diabetes information and no existing mechanism for consumers to get detailed, objective information about true Web site quality. Furthermore, this research also demonstrates the limited utility of using proxies such as sponsorship characteristics to help guide consumers in searching for health Internet information.

This research also highlights the alarming amount of inaccurate and incomplete Internet information on diabetes. Given the increase in consumer use of the Web to make health care decisions, the potential threats to patient care are substantial. If diabetes information is incomplete, a consumer may not be aware of all the various complications of diabetes and thus not know to get tested for certain conditions. If a consumer finds inaccurate information on the Web, he or she may not be aware, for example, of the symptoms that indicate the onset of an acute diabetic event.

ADVERTISEMENTS

Home Health Care Technology Report — A New Publication!
Editor: Nancy A. Brown, Associate Editor: Robert Roberts
Discover the best new technology, applications, and practices for delivering quality health care in the home….and the legal, regulatory and reimbursement fundamentals you need to understand to succeed.

Home Healthcare: Wired and Ready for Telehealth — Just Published, the New and Revised Nurses and Nursing Students Edition
Available in hard copy and electronic formats. Call Audrey Kinsella at (301) 581-0090 or email audreyk@erols.com.
A primer and practical planning guide.

Future Care 2004 Healthcare Web Summit
Presentations by 30 faculty on key trends shaping the business of health care
“Disease Management: State-of-the-Industry 2004 and Beyond”
Vince Kuraitis, Principal, Better Health Technologies
Live teleconference on Tuesday, January 20, 2004 at 12:00 PM Eastern Time
Sponsored by Managed Care Online (MCOL)

Emerging Technologies in Disease Management: Improving Quality, Controlling Costs
Frank Martin, Chairman and CEO, I-trax
Vince Kuraitis, Principal, Better Health Technologies
Live teleconference on January 28, 2004 at 1:30 PM Eastern Time
Sponsored by Healthcare Intelligence Network,

RECENT RESEARCH ON PATIENTS WITH COMORBID CONDITIONS

Multiple Chronic Conditions: A Challenge to the 21st Century
Center on an Aging Society, Georgetown University, November 2003

Adults with multiple conditions, however, are substantially more likely than adults with one chronic condition to report accomplishing less, spending more time in bed sick, missing work, not working, living with less income, and having poor mental health.

Trends in Chronic Condition Comorbidities in a Group Health Plan
Partnership for Solutions, October 2003

This analysis looks at some basic trends among the privately insured who have chronic conditions by analyzing claims data from 1999 through 2001…. among enrollees with a chronic condition, the proportion with multiple chronic conditions increased slightly and there was a commensurate decrease in the proportion of enrollees with no chronic conditions.

Managing Multiple Conditions: A Challenge For Medicare
A Medicaid project in North Carolina has cut costs and improved care for patients with chronic diseases. Can Medicare do the same?
American Medical News; December 1, 2003

TELEMONITORING FOR HEART FAILURE

A Systematic Review of Telemonitoring for the Management of Heart Failure
European Journal of Heart Failure, October 2003

Eighteen observational studies and six randomised controlled trials involving telemonitoring and heart failure were identified.

Conclusion: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention.

DM AND TELEHEALTH TECHNOLOGY UPDATES

Emerging Technologies
Semantic Web • Smart Bandages • Contamination Information • RFID • Intelligent Agents • 3-D Computer Imaging • Artificial Intelligence • Personal Monitoring Networks • Email Protocol • Radiosurgery • Smart Cards • Data Storage
Healthcare Informatics, January 2004

Gadgets help baby boomers navigate old age
USA Today; November 17, 2003

E-Mail A Day May Keep Doctor Away
Some patients go online to renew prescriptions, or describe symptoms
The Detroit News; January 4, 2004

Assessing Technology Needs for the Elderly: Finding the Perfect Match for Home
Telehealth Opportunities for Home Care Patients
The Cardiac Connection Program: Home Care That Doesn’t Miss a Beat
Home Care Technology and Telehealth-The Future Is HERE!
Home Healthcare Nurse, October 2003

Computer-Based Technology And Caregiving For Older Adults Conference
Setting Priorities for Retirement Years (SPRY) Foundation; October 9, 2003

Big Sites Enter Into Diabetes Monitoring Market
Companies offer millions of patients the means to manage chronic conditions over the Internet.
American Medical News; September 22/29, 2003

Home-based Health Services: Telefónica’s Pilot
Sandy and Dave’s Report on the Broadband Home; September 23, 2003

Heart Patients May Benefit From Sensors In Clothes
Forbes; October 8, 2003

Technology That Makes You Healthy
CNN.com, October 16, 2003

Telemonitors Can Provide ‘Virtual Assisted Living’
Minneapolis-St.Paul Star Tribune; December 1, 2003

WORTH REVIEWING!

DMAA Applauds Medicare Prescription Drug And Modernization Act Of 2003
Disease Management Association of America, December 2003

The Hidden Epidemic: Finding a Cure for Unfilled Prescriptions and Missed Doses
Boston Consulting Group; December 15, 2003

How Broadening DM’s Focus Helped Shrink One Plan’s Cost
Managed Care, November 2003

Promoting Prevention Through Information Technology
Association of Health Center Affiliated Health Plans, October 2003

Reducing The Growth Of Medicare Spending: Geographic Versus Patient-Based Strategies
Health Affairs; December 10, 2003

Predictive Models Make Smart Purchasers
Business and Health; January 10, 2004

Obesity Is on the Rise and Costing Employers Billions
A Towers Perrin Point of View, 2003

Diabetes cases could double in developing countries in next 30 years
World Health Organization; November 14, 2003

Disease Management — Attracting and Retaining Participants: A Checklist
Healthplan, November/December 2003

A Report on the Evaluation of Criteria Sets for Assessing Health Web Sites
Consumer WebWatch; September 30, 2003

Chronic Conditions and Disabilities: Trends and Issues for Private Drug Plans
Commonwealth Fund, October 2003

Examining Chronic Care in California’s Safety Net
California Healthcare Foundation, October 2003

How Different Is California? A Comparison Of U.S. Physician Organizations
Medical groups and IPAs provide better chronic illness care and report being no worse off financially.
Health Affairs; October 15, 2003

Payers See Savings in Eliminating Risk Clauses in Disease Management Contracts
Managed Care Week; November 3, 2003

The Decade Preceding Medicare Coverage
Center on an Aging Society, Georgetown University, October 2003

Disease Management for Chronic Obstructive Pulmonary Disease
National Pharmaceutical Council, September 2003

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

Disclosure — No clients were mentioned in this issue.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2004, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197 or Harry Leider MD, MBA at harryl@bhtinfo.com, (410) 252-7361.

TODAY’ S GREAT IDEA — THE CONTINUITY OF CARE RECORD

While attending the Mobile Healthcare Alliance meeting earlier this month in Minneapolis, I was introduced to a brilliant, yet simple concept — the Continuity of Care Record (CCR).

The usefulness of the CCR struck me like a BFO — a blinding flash of the obvious. Two speakers — Peter Waegemann, CEO of the Medical Records Institute, and Claudia Tessier, Executive Director of the Mobile Healthcare Alliance — eloquently described and advocated for the CCR.

The CCR is a concept quietly being developed by ASTM International, the Massachusetts Medical Society (MMS), the Health Information Management and Systems Society (HIMSS), and the American Academy of Family Physicians (AAFP). The CCR holds great promise to improve disease management (DM).

CONTINUITY OF CARE CHALLENGES IN DISEASE MANAGEMENT

Today’s reality: DM is done primarily using stand-alone information technology software. Patients with chronic conditions usually have multiple care providers, most of whom have minimal current information about what the others are doing to provide care for the patient.

Tomorrow’s vision: DM will be one of many applications that will revolve around standardized electronic medical records (EMRs). Disease managers will be able to draw patient information from EMRs, and in turn will feed information back into EMRs.

The path from today’s reality to tomorrow’s vision is not an easy one:

Diverse, incompatible information technology (IT) systems are currently used by physicians, hospitals, disease management companies and others
Standards to exchange information among these IT systems are just beginning to emerge
Any DM organization that would like to integrate information today among its partner physicians and other local caregivers is faced with an overwhelming and bewildering IT interface challenge.
The primary information sharing tools among health care providers today are still paper, phone, and fax.

THE CONTINUITY OF CARE RECORD (CCR)

The CCR offers tremendous great opportunities to improve disease management processes for patients and disease management organizations. You can read all about it:

Continuity of Care Record (CCR) Concept Paper

The goal is to create a CCR that will enable the next provider to easily access information at the beginning of a first encounter and easily update the information when the patient goes on to another provider, in order to support the safety, quality, and continuity of patient care.

The CCR is intended to be technology neutral and vendor neutral in order to maximize its applicability. It is being developed on an XML platform in order to offer multiple options for its presentation, modification, and transmittal, e.g., in a browser version, as an HL7 message, in a secure email, as a Word document (electronic or paper).

The CCR could have a great impact on the quality of care, on the reduction of medical errors, and on the containment of costs. The potential benefits include:

The next healthcare provider will not have to search for or guess about a patient’s allergies, medications, or current and recent past diagnoses and other pertinent information.
The next healthcare provider will be informed about the patient’s most recent healthcare assessment and services.
The next healthcare provider will be informed about recommendations of the caregiver who last treated the patient.
As patient demographics will be provided, time and effort will be saved by not having to repeatedly ask a patient for demographic information in detail. Rather, this information can be more quickly and easily verified.
A patient’s insurance status will more easily be established. Over time, this can be expanded within the system.
Costs associated with the patient’s care will be reduced, for example through avoiding repetitive tests and basic information gathering.
The effort required to update the patient’s most essential and relevant information, will be minimized

If you would like to discuss the CCR concept and/or express your support, you can contact Claudia Tessier, Executive Director of the Mobile Healthcare Alliance and co-chair of the CCR Workgroup — (202) 452-0889, ctessier@mohca.org.

ASTM, MMS, HIMSS, and AAFP are hosting a series of consensus-building and content development meetings on the CCR, in order to involve government agencies, medical societies, other professional societies, state departments of public health, and others who may be interested in contributing to its development and adoption.

The CCR promises dramatic improvements for disease management — quality improvements for the patients we serve, and efficiency improvements for disease managers. Please support the development and implementation of the CCR!

By Vince Kuraitis
Principal, Better Health Technologies, LLC

TODAY’S SHOPPING LIST FOR RADIO SHACK….

ü Batteries

ü Tape recorder

ü Heart monitor

Heart monitor? Yes.

Check out http://www.lifewiseonline.com/, then read the press release.

GROWING INTEREST IN TELEHEALTH TECHNOLOGIES

Progress and Possibilities: State of Technology and Aging Services 2003
Center for Aging Services Technologies, 2003

Caregiver Tech Slowly Evolves
Wired; September 14, 2003

Keeping Patients at Home
Telemonitoring technologies help chronic disease patients receive care at home
Health Data Management, July 2003

Home monitoring gives health care by modem
Telemedicine: Heart patients are checked using devices that transmit over phone lines.
Baltimore Sun; September 22, 2003

Computer-Based Technology and Caregiving of Older Adults: Exploring the Range of Possibilities and Beyond
SPRY Foundation, 2002

Monitoring Mom
As population matures, so do assisted-living technologies
MIT Technology Review, July/August 2003

Repurposing Broadband: Home Health Technologies for the Worldwide Age Wave
Sandy and Dave’s Report on The Broadband Home; July 15, 2003

Telecommunications technology makes its mark on healthcare delivery
Managed Healthcare Executive, August 2003

Study Shows Patients Decrease Hospital Visits with Home Monitoring Equipment
ATSP Online; August 29, 2003

The Doctor Is In
Predicting and treating disease will get a whole lot easier when monitors are implanted
Forbes; September 1, 2003

DEPRESSION DM MOVES FRONT AND CENTER

Depression is a clinical condition that affects millions of people. From a clinical perspective, it is highly amenable to disease management approaches. The challenge has been creating the right business models for depression DM programs to take root. As innovative companies continue to explore depression DM approaches, the business case for depression DM is growing stronger:

Total productivity losses resulting from mental health disorders, of which depression is the most common, accounts for an average total work time lost of around 13 hours per week.
70 percent of all healthcare visits are driven by a behavioral factor.
66 percent of patients with depression never receive treatment.

New Program Illustrates Growing Interest in Depression Management
Disease Management News; August 25, 2003

Disease Management for Depression
The National Pharmaceutical Council, June 2003

EMPLOYER PERSPECTIVES

2003 Employer Health Benefits Survey
Kaiser Family Foundation & Health Education & Research Trust; September 9, 2003

Private health insurance premiums increased 13.9% in 2003, a larger increase than last year and the third consecutive year of double-digit increases. This annual survey tracks trends in employer health insurance coverage, the cost of coverage, and other topical health insurance issues.

Few respondents view current cost containment strategies as highly effective for reducing premium increases. When asked which cost containment strategies they thought were very effective, 22% of firms cited disease management; 14% said consumer-driven health plans (e.g., high-deductible plans with a health savings account); 10% listed ‘higher employee cost sharing;’ and 6% said ‘tighter managed care networks.’ Each of these strategies, however, was viewed as somewhat effective by about half of the respondents. (p. 141)

Other perspectives….

Californians Respond to Changing Health Benefits
Ready or Not: Consumers Face New Health Insurance Choices
California Healthcare Foundation/Harris Interactive; July 10, 2003

Employers push to change health behaviors
Employee Benefit News, August 2003

Employers come to terms with disease management contracting
Opinions vary about whether to call on vendors directly for DM services or to go through health plans
Managed Healthcare Executive, August 2003

STUDIES DESCRIBE IMPACT OF THE WEB ON PHYSICIAN-PATIENT RELATIONSHIPS

The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1,050 U.S. Physicians
Journal of Medical Internet Research, September 2003

Results: Eighty-five percent of (physician) respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician’s feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship, in the quality of health care, or health outcomes. Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate, or the physician felt challenged.

The Impact of Health Information on the Internet on the Physician-Patient Relationship
Archives of Internal Medicine; July 28, 2003

Results Of the 3,209 (patient) respondents, 31% had looked for health information on the Internet in the past 12 months, 16% had found health information relevant to themselves and 8% had taken information from the Internet to their physician. Looking for information on the Internet showed a strong digital divide; however, once information had been looked for, socioeconomic factors did not predict other outcomes. Most (71%) people who took information to the physician wanted the physician’s opinion, rather than a specific intervention. The effect of taking information to the physician on the physician-patient relationship was likely to be positive as long as the physician had adequate communication skills, and did not appear challenged by the patient bringing in information.

UPDATES TO THE CHRONIC CARE MODEL

The Chronic Care Model is the most widely referenced framework for implementing chronic care management in local delivery systems. Improving Chronic Illness Care, a national program of the Robert Wood Johnson Foundation, recently updated the model.

You can view the changes at the Improving Chronic Illness Care website. Minor changes and updates were made in the following areas:

Patient Safety
Cultural competency
Care coordination
Community policies
Case management

WORTH REVIEWING!

The State of Health Care Quality 2003
National Committee for Quality Assurance; September 18, 2003

Weight Management and Obesity Symposium
The Permanente Journal, Summer 2003

Clinical Transformation:
Cross-Industry Lessons for Health Care
Deloitte Research, July 2003

Population-Based Disease Management Under Fee-For-Service Medicare
Health Affairs; July 30, 2003

Creating Better Systems of Care for People with Chronic Conditions: A Building Block Approach
California Center for Long Term Care Integration, July 2003

Declaring War on Chronic Illness
Health care providers need tools, technology, and the right incentives to provide patients state-of-the-art care.
Progressive Policy Institute BluePrint; June 30, 2003

Health searches and email have become more commonplace, but there is room for improvement in searches and overall Internet access
Pew Internet Project; July 16, 2003

Theme Issue — Chronic Illness
Medical Journal of Australia; September 1, 2003

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

Disclosure — No clients were mentioned in this issue.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2003, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197 or Harry Leider MD, MBA at harryl@bhtinfo.com, (410) 252-7361.

HEALTHCARE UNBOUND: CONVERGENCE OF CONSUMER AND HEALTHCARE TECHNOLOGIES

HEALTHCARE UNBOUND: CONVERGENCE OF CONSUMER AND HEALTHCARE TECHNOLOGIES

THE OPPORTUNITY

Consumer healthcare technologies are driving opportunities to serve patients in new ways and in new settings. Forrester Research recently coined the term “Healthcare Unbound” to encompass the trends toward self care, mobile care, and home care. More specifically, Forrester Research describes Healthcare Unbound as “technology in, on and around the body that frees care from formal institutions.”

In addition to dramatically changing traditional healthcare delivery, Healthcare Unbound attracts a range of companies that previously have not been deeply involved in healthcare — consumer electronics, telecom, and information technology companies to name a few.

Better Health Technologies’ recent consulting work with Samsung Electronics highlights some of the dramatic benefits flowing from the convergence of consumer and healthcare technologies:

1) Improving patient adherence to clinical guidelines
2) Gathering vital sign data from patients remotely
3) Providing information to patients — anywhere, anytime
4) Automating information flow among patients, healthcare providers, and payors — reducing costs AND improving quality.
5) Keeping people in their own homes (rather than in hospitals or nursing homes)

Are consumers interested? In the enlightening report, “Consumer Healthcare Electronics: Consumer are Ready, Willing and Able”, Accenture found that consumers are eager to play an active role in managing their health and embracing emerging home healthcare technologies.

What are examples of converging consumer and healthcare technologies?

CONSUMER TECHNOLOGIES: smart houses, personal communications devices (PDAs, cell phones, smart phones, etc.), broadband (cable, DSL, satellite), digital cameras & video, wireless, etc.

HEALTHCARE TECHNOLOGIES: remote patient monitoring, personal health records, electronic medical records, e-prescribing, e-disease management, e-clinical trials, telehealth/telemedicine, sensors, traditional medical devices (becoming smaller, internet enabled, implantable), call centers, customer relationship management technologies and Internet/web technologies (interactive web sites, doctor/patient email, virtual physician visits, etc.)

SEIZING THE OPPORTUNITY

With assistance from Drapin & Co. and BHT, The Center for Business Innovation (TCBI) is organizing a conference:

Healthcare Unbound:
A Conference & Exhibition on the Convergence of Consumer and Healthcare Technologies

You can view a preliminary agenda for the conference. Are you interested in speaking? Exhibiting? Sponsoring? Attending? Call or write Satish Kavirajan, Managing Director, TCBI, (310) 265-2570, sk@tcbi.org.

Are you interested in discussing how your company can benefit from Healthcare Unbound? Call or write Vince Kuraitis, Principal, Better Health Technologies at (208) 395-1197, vincek@bhtinfo.com.

We will be bringing you more details over the coming months….stay tuned.

YOU HAVE A 55% CHANCE OF GETTING THE RIGHT MEDICAL CARE

The Quality of Health Care Delivered to Adults in the United States
New England Journal of Medicine; June 26, 2003
Abstract
Rand Organization Fact Sheet with link to full NEJM article

Results: Participants received 54.9 percent…of recommended care. We found little difference among the proportion of recommended preventive care provided (54.9 percent), the proportion of recommended acute care provided (53.5 percent), and the proportion of recommended care provided for chronic conditions (56.1 percent).

Conclusions: The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits in care are warranted.

SURVEY SAYS “TELEMEDICINE REIMBURSEMENT PROGRESSING BETTER THAN EXPECTED”

Private Payer Reimbursement Information Directory
American Telemedicine Association (ATA) and AMD Telemedicine, May 2003

Telemedicine Private Payer Reimbursement Insurance Survey
Mark Vanderwerf, President, AMD Telemedicine, Inc.
Presented at the ATA 8th Annual Meeting; April 30, 2003

There appears to be a critical mass for private payer reimbursement for telemedicine!

38 programs in 25 states currently receive reimbursements from private payers

3 programs receive reimbursement for store and forward

7 Programs receive reimbursement for facility fees

Private payers appear to follow leadership of Blue Cross more than Medicare or Medicaid

CYE&Y DESCRIBES MEDICAL MANAGEMENT BENCHMARKS

Managed Care Measures: Results of the 2002 Managed Care Benchmarking Study
Cap Gemini Ernst & Young (CGE&Y), May 2003

Here are a few relevant findings relating to medical management benchmarks:

PMPM (per member per month) spending on Medical Management was up 34% over 1999 benchmarks, but reductions were noted in certain areas and plans were spending in a narrow range. In particular, utilization management (UM) staffing dropped by 50% and FTEs performing hospital precertification and referral authorization were less than one-third of 1999 levels.

Nonetheless, investment in focused medical management programs continue to demonstrate returns. Higher spending on medical management is strongly associated with lower medical loss ratios….

Overall utilization of disease management (DM) programs has remained steady, with the ratio of members in DM programs relatively unchanged between the 1999 to 2002 Benchmarking Studies. However, the programmatic focus changed…. Diabetes programs remained strong, but membership shifted out of high-risk obstetrics and into asthma and coronary artery disease (CAD) programs.

A HOME TELEHEALTHCARE REPORT FOR YOUR REFERENCE SHELF

“Home Telehealthcare: Process, Policy, and Procedures” is a new, 150- page, practical report for home care planners and providers embarking on the new frontier of home telehealth.

Chronic disease management services and new and affordable tools are key areas of focus. Sample in-house policies and forms for patient and home assessments, equipment maintenance routines, and other management concerns are provided to help achieve the consistency needed for effective telehealthcare program planning and delivery.

More information is available at www.InformationForTomorrow.com or from the author, Audrey Kinsella, at 800-506-6587/301-581-0090.

DOCTOR/PATIENT EMAIL — WELL SUITED FOR PATIENTS WITH CHRONIC CONDITIONS

Doctors Who Are Using E-mail With Their Patients: a Qualitative Exploration
Journal of Medical Internet Research, April-June 2003

The authors surveyed physicians currently using e-mail with their patients. They found that chronic disease management is one area of consistent agreement for respondents. These physicians felt that e-mail is a very effective way of managing patients whom they know well. Many cited examples of using e-mail to manage conditions such as diabetes, hypertension, psoriasis, and even congestive heart failure

E-PRESCRIBING: 5 OBSTACLES, 5 POTENTIAL SOLUTIONS

5 Obstacles To E-Prescribing: 5 Approaches To Overcoming Them
American Medical News; May 12, 2003

Obstacle 1: Physicians can’t afford the technology.
Potential solution: Someone else must pay for or subsidize the up-front cost.

Obstacle 2: There is no direct benefit to doctors.
Potential solution: Those who do benefit could offer financial incentives to physicians.

Obstacle 3: The technology is poorly designed and more inefficient than the paper-based system it’s supposed to replace.
Potential solution: Companies should design technology that reflects how doctors work and offers them many benefits in a seamless package.

Obstacle 4: There is a lack of interoperability.
Potential solution: Companies should seek a wider adoption of clinical data standards so different information systems will work with each other.

Obstacle 5: There are regulations that ban or can be interpreted to ban e-prescribing.
Potential solution: The federal government needs to develop laws facilitating both e-prescribing and a clearer understanding of the applicability of the Health Insurance Portability and Accountability Act.

THE BUSINESS CASE FOR DIABETES MANAGEMENT IS CHALLENGED TO SHOW SHORT-TERM PAYOFFS

The Business Case For Diabetes Disease Management At Two Managed Care Organizations: A Case Study
The Commonwealth Fund, April 2003

Diabetes care is often poorly managed, and the disease exacts a high toll on society in terms of health costs and lost productivity. Analysis of two health plans with established diabetes programs shows that the business case for diabetes disease management is weak. The initial costs for such programs are substantial, and plans may not be able to reap the potential savings until 10 years after a health plan member is enrolled in the program.

To make diabetes management more attractive to health plans, a financing system that pays plans and providers on the basis of quality of services would need to be put into place. For example, fee-for-service payments could add reimbursement for group visits and electronic communications. Moreover, the institutions that benefit from improved diabetes care, including Medicare, Medicaid, and employers, could contribute to the financing of diabetes disease management.

U.S. IS AMONG LEAST VULNERABLE COUNTRIES TO CHALLENGES OF AGING

The 2003 Aging Vulnerability Index: An Assessment of the Capacity of Twelve Developed Countries to Meet the Aging Challenge
Watson-Wyatt Worldwide, March 2003

The rapid aging of developed countries will pose a major challenge for global prosperity and stability during the first half of the twenty-first century. Watson-Wyatt analyzed characteristics of 12 developed countries and grouped them into low/medium/high vulnerability:

Low Vulnerability
1. Australia
2. United Kingdom
3. United States

Medium Vulnerability
4. Canada
5. Sweden
6. Japan
7. Germany
8. Netherlands
9. Belgium

High Vulnerability
10. France
11. Italy
12. Spain

The Index was compiled from indicators in four basic categories, each dealing with a crucial dimension of the aging challenge: 1) Public-burden indicators, 2) Fiscal-room indicators, 3) Benefit-dependence indicators, and 4) Elder-affluence indicators.

WORTH REVIEWING!

Connecting Healthcare in the Information Age
Markle Foundation; June 5, 2003

Health Plans: The Next Wave
HealthLeaders: June 10, 2003

Today’s system treats health crises, but it fails at chronic disease care
The Hill; June 18, 2003

National Medical Spending Attributable To Overweight And Obesity:
How Much, And Who’s Paying?
Health Affairs; May 14, 2003

New model gauges health risks
Employee Benefit News, May 2003

How Does Quality Enter into Healthcare Purchasing Decisions?
The Commonwealth Fund, May 2003

Disease Management: The Programs and the Promise
Milliman USA May 2003

Ageism: How Healthcare Fails the Elderly
Alliance for Aging Research May 2003

Value-Based Purchasing: A Review of the Literature
The Commonwealth Fund, May 2003

Broadband Adoption at Home: A Pew Internet Project Data Memo
Pew Internet Project; May 18, 2003

Investment in Population Health in Five OECD Countries
Organisation for Economic Co-operation and Development; April 22, 2003

Use of the Internet and E-mail for Health Care Information
Results From a National Survey
Journal of the American Medical Association; May 14, 2003

European Union citizens and sources of information about health
The European Opinion Research Group, March 2003

Success Stories in Telemedicine: Some Empirical Evidence
Telemedicine Journal and e-Health, Spring 2003

If Cars Can Have Microprocessors, Why Can’t People?
Health IT World; May 27, 2003

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC .

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

Disclosure — Samsung Electronics, South Korea, is a client of Better Health Technologies.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2003, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197 or Harry Leider MD, MBA at harryl@bhtinfo.com, (410) 252-7361.