Client Spotlight – Cardiobeat Poised to Revolutionize Hemodynamic Monitoring

Cardiobeat is an early stage company with a revolutionary impedance cardiography system for non-invasive measurement of hemodynamic (blood flow) parameters. Impedance cardiography holds great promise for disease management of patients with congestive heart failure, hypertension (high blood pressure), and other conditions.

The Clinical Opportunity

There is a need for better tools to diagnose and manage heart disease. In the US alone, there are 5 million patients with CHF and over 50 million patients with hypertension.

Modern medications are complex and highly effective for treating CHF and hypertension. These medications alter key hemodynamic parameters:

• Cardiac output (blood pumped in a beat of the heart)
• Vascular resistance (effort required by the heart to move blood through the vessels)
• Fluid content (volume of fluids in the body)

Until recently, clinicians have been “flying blind” on their patients’ status for these key hemodynamic parameters. For example, when prescribing ACE inhibitors or beta-blockers, physicians rely on ECG and blood pressure, neither of which provides insight into the hemodynamics impacted by these medications.

Prior to development of impedance cardiography, there has been no practical way to measure changes in these hemodynamic parameters. The sickest of patients often undergo right heart catheterization (RHC) — an insertion of a catheter into the heart. However, RHC is invasive, risky, and expensive.

Over 50 clinical studies have demonstrated the effectiveness of impedance cardiography to monitor and manage heart disease. Medicare and most other insurers now reimburse providers for performing impedance cardiography tests.

The Business Opportunity

The US market opportunity is huge and is primed for rapid growth. Gruntal & Co., an investment research company, estimated the potential US market for hemodynamic heart monitoring at $5 billion per year.

CardioDynamics (CDIC) is the only publicly traded company manufacturing an impedance cardiography device. CardioDynamics has a market capitalization of $150 million and is publicly traded at approximately 9 time’s sales. Yet, the company has achieved less than 1.0% penetration of the US market, suggesting tremendous untapped potential.

What’s new, different, and better about Cardiobeat’s system and business model?

• “One Glance Hemodynamics” — an easy-to-use, simplified reporting format
• Focus on family physicians and internists — making the technology affordable, understandable, and available
• Safe monitoring at low cost
• Remote capabilities
• Lifetime hemodynamic history for long term disease management

Cardiobeat Seeks Investors and Partners

Cardiobeat is seeking $3 million investor funding to:

• Complete FDA approval
• Finalize product enhancements for broader market deployment
• Achieve initial market penetration in specific US market segments
• Expand and further the intellectual property portfolio

Cardiobeat is developing partnerships with a wide range of organizations, including pharmaceutical, medical monitoring, medical device, and disease management companies.

For more information about investment or partnership opportunities with Cardiobeat, call or write George McBride, President, at (480) 419-3957.

Conference – Disease Management Contracting & Partnerships

A Must-Attend Networking Event!

Disease Management Contracting & Partnerships
May 23-24, 2002 — Omni Parker House — Boston, Massachusetts

A two-day event focusing on optimizing disease management clinical and economic outcomes through strategic partnerships and alliances. The Original Symposium that unites health plans, employers, providers, unions and state Medicaid programs.

Featuring, hands-on case studies of best practice industry achievements.
Register now for 25% discount! Contact Maria Cianflone Phone: 312.780.0700 ext.175.

Information Therapy

“If Doctors Prescribe Information, Will Patients Pay or Surf Web?”
Wall Street Journal; April 25, 2002

Healthwise is making a strong case for reimbursement of information therapy for patients.

New Study Estimates Eight Million American Families Experienced a Serious Medical or Drug Error

“Room for Improvement: Patients Report On the Quality of Their Health Care”
The Commonwealth Fund, April 2002

Some of the headlines:

• Medical errors may be more widespread than previously reported
• Preventive and chronic care are lacking
• Many physicians are not meeting patient expectations

What Went Wrong with the First Generation of E-Health Companies?

“The Rise and Fall of E-Health: Lessons From the First Generation of Internet Healthcare”
Medscape TechMed eJournal[TM], April 2002
(Medscape registration required to view article)

This article summarizes the stories of eight publicly traded e-health companies: Drugstore.com, PlanetRx.com, DrKoop.com, HealthGrades.com, Mediconsult, MDConsultCybear, Neoforma, and WebMD. The authors isolate four fundamental factors that can serve as a checklist for gauging potential success of future e-health ventures:

1. A compelling value
2. An unambiguous revenue model
3. Competitive barriers to entry
4. Organizational structure for cost control

Three New NCCC Reports Target Regulatory Reform on Chronic Illness Care

1. “A Guide to Regulatory Reform for People with Chronic Conditions”
2. “An Issue Brief on Regulatory Reform for People with Chronic Conditions: Patient Assessment and Care Planning for the Chronically Ill”
3. “An Issue Brief on Regulatory Reform for People with Chronic Conditions: Physician Reimbursement Issues”

Prepared by Health Policy Alternatives, Inc. in collaboration with The National Chronic Care Consortium (NCCC), March 2002

Recommendations for a Medicare Coordinated Care Benefit

“One Third At Risk: Creating A Blueprint For A Coordinated Care Benefit And Services In The Traditional Medicare Program”
Center for Medicare Advocacy; March 22, 2002

The Center for Medicare Advocacy, Inc., supported by the Commonwealth Fund, recently convened a group of experts for a conference in Washington DC. Attendees developed a list of 28 recommendations for a Medicare coordinated care benefit.

AdvancePCS Medical Director Candidly Describes New Strategy

“He Wants AdvancePCS to Manage More Than Drugs. The CMO of the nation’s largest pharmacy benefits manager says that the company’s mission has broadened. One new area of focus: worker productivity.”
Managed Care, March 2002

This revealing interview is with Alan T. Wright, MD, MPH, Senior Vice President of AdvancePCS. He highlights several of AdvancePCS’ strategies:

• Redefining itself as a health improvement company….less a question of keeping people out of hospitals than keeping them at their desks.
• Starting Centers for Health Improvement, covering work and health; health and aging; women’s health; school and health, and others.
• Initiating the American Productivity Audit.
• Paying increasing attention to physician networks.

BMJ Asks and Answers: “What’s Not a Disease”

“In search of ‘non-disease'”
British Medical Journal; April 13, 2002

Richard Smith, editor of the British Medical Journal, describes a vote on bmj.com to identify the “top 10 non-diseases”. He notes that while some critics thought it was an absurd exercise, the primary aim was to illustrate the slipperiness of the notion of disease. The BMJ’s list of non-diseases eventually totaled over 200!

Having a condition labeled as a disease may bring benefits, including sympathy, exemption from commitments, sick pay, free prescriptions, insurance payments, and access to facilities.

The diagnosis of a disease may also create many problems — you may be denied insurance, a mortgage, employment.

Top 20 non-diseases (voted on bmj.com by readers)

1. Ageing
2. Work
3. Boredom
4. Bags under eyes
5. Ignorance
6. Baldness
7. Freckles
8. Big ears
9. Grey or white hair
10. Ugliness
11. Childbirth
12. Allergy to the 21st Century
13. Jet lag
14. Unhappiness
15. Cellulite
16. Hangover
17. Anxiety about penis size/penis envy
18. Pregnancy
19. Road rage
20. Loneliness

What do Doctors Think About Patients Using the Internet?

“Survey of Doctors’ Experience of Patients Using the Internet”
Journal of Medical Internet Research, April 2002

Conclusions: These doctors reported patient benefits from Internet use much more often than harms, but there were more problems than benefits for the doctors themselves. Reported estimates of patient Internet usage rates were low. Overall, this survey suggests that patients are deriving considerable benefits from using the Internet and that some of the claimed risks seem to have been exaggerated.

MCOs Improve Care for High-Risk Seniors

“Constrained Innovation in Managing Care for High-Risk Seniors in Medicare+Choice Risk Plans”
Mathematica Policy Research, available April 2002

This case study of four well-regarded managed care organizations found that they made numerous innovations to improve care delivery for elderly Medicare beneficiaries with chronic illnesses and disabilities:

1. Screening to identify high-risk seniors
2. Care management and disease management
3. Network credentialing
4. Occasional provision of off-policy benefits
5. Better coordination in the delivery of inpatient, subacute, and home health services.

Advances in the Art and Science of Herding Cats

“Provider Incentive Models for Improving the Quality of Care”
Bailit Health Purchasing, LLC for the National Health Care Purchasing Institute, March 2002

This monograph examines 11 models of physician incentives, both financial and non financial.

1. Quality Bonuses
2. Compensation at Risk
3. Performance Fee Schedules
4. Quality Grants
5. Reimbursement for Care Planning
6. Variable Cost Sharing for Patients
7. Performance Profiling
8. Publicizing Performance
9. Technical Assistance for Quality Improvement
10. Practice Sanctions
11. Reducing Administrative Requirements

Many Patients Willing to Pay for Online Communications with Their Physicians

“Patient/Physician Online Communication: Many patients want it, would pay for it, and it would influence their choice of doctors and health plans”
Harris Interactive; April 10, 2002

Worth Reviewing

“Disease Management Could Cut Medicare Cost — Experts”
Reuters.com; April 17, 2002

“A Diabetes Report Card for the United States: Quality of Care in the 1990s”
Annals of Internal Medicine; April 16, 2002

“The Factors Fueling Rising Healthcare Costs”
PriceWaterhouseCoopers for the American Association of Health Plans, April 2002

“Renewed Emphasis On Consumer Cost Sharing In Health Insurance Benefit Design”
Health Affairs web exclusive; March 20, 2002

“Web-based plan not as popular as Highmark hoped”
Pittsburgh Business Times; April 5, 2002

Disclosure — Cardiobeat is a client of Better Health Technologies, LLC.

E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”. This e-newsletter is brought to you by Better Health Technologies, LLC. BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

You may copy, reprint or forward 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 © 2002, Better Health Technologies, LLC. All rights reserved.