The U.S. healthcare system could reduce costs by nearly $200 billion over the next 25 years by using remote monitoring technology in patients with of congestive heart failure, chronic obstructive pulmonary disease, and chronic wounds or skin ulcers, says a report from the Center for Technology and Aging.
This article appears in the April, 2014 issue of Medicine on the Net.
When providers began testing the concept of remote patient monitoring as a way to track patients outside a clinical setting, nobody was sure how well it would work. Now, the practice is booming, with some of the largest insurers and high-tech companies in the world participating in pilot programs.
Hospitals and technology companies are involved in multiple pilot programs that track patients from their homes after they are discharged from the hospital or monitor patients with chronic illnesses "passively" to track their everyday movements in an attempt to identify problems before they become serious. In both approaches, the goal is to keep patients healthier and generate savings by preventing expensive emergency department visits and hospitalizations.
A report from the Center for Technology and Aging (CTA) estimates that "the U.S. healthcare system could reduce costs by nearly $200 billion over the next 25 years if remote patient monitoring tools are used routinely in cases of congestive heart failure, chronic obstructive pulmonary disease [COPD], and chronic wounds or skin ulcers."
Reducing readmissions
Major players like Humana, AT&T, Healthsense, and Qualcomm are now taking part in pilot programs that deploy the concept of remote patient monitoring in a variety of ways. One project at Palomar Medical Center in Escondido, Calif., is using a small, wrist-worn device that monitors a patient's vital signs. The device, created by Sotera Wireless, measures the patient's heart rate, body temperature, and blood oxygen levels and sends the data to his or her physician's office several times a day.
"Having reliable data about a patient's condition is essential to responding to changes at the earliest possible time and preventing deterioration of their condition or even death," says Ben Kanter, chief medical information officer for Palomar Health, which operates three hospitals in San Diego County.
Another project conducted by Centura Health at Home and six hospitals in Denver involved 200 patients who were monitored at home following hospitalizations related to COPD, congestive heart failure, or diabetes. The pilot program includes daily teleconferences between physicians and patients at home.
Patients participating in the program had a 6.2% rate of 30-day readmission compared to an 18% rate among patients with similar conditions in the general patient population.
The remote monitoring pilots help patients by allowing them to go home instead of rehabbing at a nursing home or long-term care facility (a practice that also generates cost savings for insurers). And they help hospitals reduce readmissions, which can be costly in more ways than one now that the Centers for Medicare & Medicaid Services penalizes hospitals for excessive readmission of Medicare patients.
"The programs are good for patients because they help them stay in their homes and stay healthier," says David Lindeman, president of the Center for Technology and Aging. "And if they prevent hospitalizations or emergency department visits, they can be very cost-effective."
A longer view
Other projects are taking a longer view. Humana launched a pilot program in January that is testing passive patient monitoring among 100 Medicare Advantage patients in five states. The pilot uses a monitoring system developed by Healthsense to track the average daily activities of patients in their homes.
Patients selected for the program have one or more chronic illnesses such as congestive heart failure, diabetes, or COPD and have been admitted to the hospital at least twice in the past 12 months. The program uses an in-home monitoring system called eNeighbor to track the movements of participants using 11 sensors installed throughout patients' homes. They include motion sensors placed on walls, beds, and refrigerators, as well as sensors placed on toilets to track bathroom activity.
After a few days, the system establishes a pattern of behavior for each patient and alerts caregivers to changes that could raise a red flag, such as disrupted sleep or repeated visits to the bathroom. Humana said the information on each patient is processed through proprietary algorithms that trigger an alert when activity exceeds a "pre-established individualized threshold."
"We know that daily activities like eating, sleeping, and physical activity can tell you a lot about a person's health," says Gail Miller, vice president of telephonic care management services for Humana Cares/Senior Bridge. "With the information relayed to us through Healthsense in-home sensors, we're able to quickly act on the alerts we receive.
This is especially important in cases where you have a member with multiple chronic conditions living alone where a timely response can drastically change a health outcome."
The concept of passive monitoring involves tracking everyday activity instead of vital signs. Many of the tests currently being conducted have a dual goal of seeing how effective the program can be and whether it is cost-effective.
"The primary target audience for these programs is older people with problems like Alzheimer's or chronic illnesses like COPD," says Lindeman. "It's a different concept because instead of looking at things like vital signs, you're watching for changes in behavior that could signal a problem. So the idea is to manage by exception."
A new report suggests the programs can be cost-effective and easily pay for themselves, particularly ones that use low-cost technology. An economic analysis conducted for Healthsense Care Alliance found that the percentage of resident move-outs in senior living facilities with monitoring systems was 27% lower than facilities without remote monitoring.
The report also estimates that the systems reduce overhead by the equivalent of one full-time salaried employee per week in terms of time saved on room checks.
Connected aging
Though remote monitoring is still in its early stages, a CTA report predicts the practice will accelerate rapidly in the next few years. The report, titled The New Era of Connected Aging, suggests connected aging program adoption "is likely to go much more quickly" due to several factors. They include a downward trend in the cost of maintaining programs due to the "expanded use of technologies such as tablets, smartphone technologies, and other mobile devices."
Lindeman says connected aging is now so affordable that some companies are marketing products directly to consumers. "There's a product called Lively that's a simple system of motion sensors people can now buy in stores," he says. "And there's another simple monitoring system called Quiet Care that's being installed in a lot of senior living facilities and is also being marketed directly to consumers. So that's the direction we're going in now."