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Program brings hypertensive patients within BP ranges

Automated telephone systems can serve as a barrier for senior citizen patients. However, a recent study focusing on hypertensive elderly patients showed that telephony backed by nurses didn’t affect health results and saved money.

Healthways of Nashville and Varolii Corporation of Seattle teamed up for “Use of Automated Telephony to Optimize Blood Pressure and Medication Management of Hypertensive Elderly Patients,” which they presented at DMAA: The Care Continuum Alliance’s Disease Management Leadership Forum in September 2007. The study explored whether elderly hypertensive patients were willing to self-report BP and medication adherence during weekly automated calls. The study authors sought to see if the system could improve medication management, quality of care, and live agent utilization.

An automated BP cuff and telephony system, backed by Healthways nurses, produced the following results:

54% of participating patients received a change to or an additional prescription for BP medication by nurses longitudinally tracking BP readings

87.5% of those in the program now have systolic BP readings within target

96.79% are in compliance with diastolic BP target ranges

When calculating costs spread across 50,000 or more beneficiaries, the study found a savings of 4% (taking into account the cost of BP reading using the traditional system of a Healthways nurse making the calls vs. Varolii automated calls). The actual savings will depend on the volume and specific contracts.

There were no differences between Varolii and nurse-treated cohorts in terms of the clinical endpoints (systolic and diastolic BPs).

Healthways and Varolii tackled hypertension because of the costs associated with the ailment and its prevalence in older Americans. Hypertension is evident in more than 70% of Americans older than 80, and high BP is the single most important risk factor for stroke. Michael F. Montijo, MD, MPH, FACP, Healthways’ senior vice president of government operations, provides this sobering number: The healthcare system spends about $50,000 in the first year alone on the average Medicare patient after a stroke. Costs associated with hypertension, which can lead to heart attacks and CHF, caused Healthways and Varolii to create a program that could control costs while not adversely affecting patient health.

Engaging the elderly population can be difficult, and Montijo says he was not overwhelmingly optimistic at the start.

“This is a tough environment, and I did not have high expectations going in that we would have marked improvement in blood pressure,” says Montijo.

The study included Healthways members from the Maryland/Washington, DC, area who had primary diagnosis of either CHF or diabetes and recently reported BP readings higher than the established target ranges for those diagnoses, which are as follows:

CHF patients: 140/90

Diabetic patients: 130/80

When the study began, 58% of the CHF patients and 30% of the diabetic patients were within the target ranges. Six hundred and twenty-two patients from the Medicare Health Support pilot population were asked whether they wanted to take part.

The patients were told the study was an outreach program that would measure their BP longitudinally, which would allow their doctors to better manage BP toward the goal of reducing the likelihood of heart attack or stroke. They were not initially told about the automated phone system. The treated and untreated cohorts broke down as follows:

318 patients consented to participate in the trial (291 were given automated BP cuffs; the rest already possessed BP recording devices)

304 patients who declined to take part received Healthways nursing program’s usual services

The program lasted from March 19 to May 24, 2007. Those in the treated cohort were called once a week by the automated system, which asked the patients to self-report their BP readings and medication adherence.

The automated system was fortified by a rules-based transfer that was predicated on their responses. For example, if patients reported BP numbers that were greater than the target range or that they were having trouble taking their BP or not managing medication properly, the phone system transferred the person to a Healthways nurse. The nurse, in turn, communicated with the patient’s doctor, who changed the medication regimen if needed.

At the beginning of the study, 40%–50% of patients in the treated cohort were transferred to a nurse. That number dropped to less than 20% by the end of the two months after BP was normalized, according to S. Michael Ross, MD, MHA, Varolii vice president of healthcare.

The study found that the automated system cost per BP reading was “significantly lower than using a live agent to retrieve the reading.” Ross says gaining trust is particularly important when dealing with the elderly. However, on the plus side, they are easier to contact because they are usually home and welcome phone calls.

Though the larger population views a telephone system as simple technology, elderly patients may still feel apprehensive taking part in such a program. Montijo says the up-front education informing the patients what to expect and the benefits of the program engaged the population. “They say, ‘It is pretty easy, pretty simple, they aren’t selling me anything, and it’s helping me. What’s in it for me? It’s helping me, I can see my blood pressure coming down, I can see my doc and bring these numbers with me,’ ” says Montijo.

Ross says the elderly are open to Varolii’s automated communications backed by high-tech protocols that forward callers with problems to live professionals. The findings reported no statistical difference between the phone system and nurses’ ability to get the information from patients.

“One of the Varolii secret sauces here is that every single communication is uniquely constructed to the patient and can be understood and accepted by the elderly patient,” says Ross.

Montijo says Healthways is exploring which other patient populations could benefit from a similar automated communications system. Ross says a comparable program could work with certain patient populations, such as those with diabetes.

Ross is optimistic about telephony as a way to reach patients, especially given many Americans’ preference to use automated systems. He cites the example of an ATM. During bank hours, customers could just as easily go to tellers, but prefer banking via ATM.

“I’m not sure how the elderly feel in this regard. A lot of people want to just get it over with, and a computer just works fine. ‘Give me the information. Give me those automated numbers, and I’ll just plug it in and be done,’ ” says Ross about the changing way Americans are dealing with companies.