If the U.S. healthcare system was to select a single ailment to illustrate both the need for chronic disease management and the promise of technology to keep down healthcare costs, it might choose congestive heart failure.
The most common diagnosis of hospital patients age 65 and older, CHF is the scourge of an aging population. And while most patients don't live long—half die within five years of diagnosis—the associated costs of this disease are high, a fact attributable primarily to hospital admissions. CHF is the primary reason for 875,000 hospitalizations annually, with one of every four admitted patients readmitted within 30 days.
Some of those hospital admissions may be preventable. The Agency for Healthcare Research and Quality estimates that in persons 65 and older, as many as 60% of all hospital admissions are avoidable, "with the delivery of high-quality outpatient treatment and disease management," according to a report published in November 2010.
To reduce costs associated with CHF, some insurers and employers are turning to disease management programs that monitor patients' symptoms and intervene when medically necessary to keep patients out of the hospital.
"Seventy-eight percent of [CHF] costs is inpatient admissions," says Sam Meckey, COO for disease solutions at Optum Health, UnitedHealth Group's healthcare management company. Optum Health has designed a disease management program for CHF patients that uses biometric home monitoring devices (Internet-connected body weight scales) and a reporting system to gauge patients' symptoms.
Twice a day, a patient will step on a scale provided by Optum and respond to six questions about other symptoms. The data is transmitted via an Internet connection to an Optum facility staffed by nurses. Software algorithms process the data on an exception basis, sending alerts to nurses whose patients need attention.