BRINGING TECHNOLOGY HOME Mary Ann Rayrat, MSN St. John Home Care Michigan Home Health Association

Why? Increase in aging population Increase in ‘working’ retired Accessibility to health care Early hospital discharges Increase in managed care Consumer more ‘techie’ See that in nursing workforce More ‘retired’ are actually working part time to supplement income Rural access, closure of facilities, mergers, becoming specialized LOS pushed to 4 days; hospital reimbursement per DRG; costs of technology in acute Availability to do more testing, etc in outpatient venue Managed care mandating best practice, outcomes, LOS Working on P4P with physicians, hospitals, home health---what are expected outcomes and when will they occur; how often pt being hospitalized; what meds are being used; what tests are being done. Consumers raised in technology age; activities are done remote; gadgets are the way to go; blackberry, cellphone, pager, home theaters

Care of the Chronically Ill CHF Diabetes COPD Lack of caregivers Health care costs More than 100 million in US with chronic disease Preventive care needs rising but sometimes unavailable What will insurance pay for; what will consumer take advantage of What works into my schedule No longer family available to care for pt; don’t want LTC; what other options are there Adult day care; minus medical focus, more social Actual dollars lost, work days lost,

Caregivers Nearly 79% of people who need long-term care live at home or in community settings In 1997, about 22 million U.S. households care for someone age 50 or older By 2007, will rise to 39 million households 59% of the adult U.S. population either is or expects to be a family caregiver No longer have family member support to care for aged Dual income families; working longer to meet finances Number of children per family decreased so additional support not available

Businesses lose between $11 and $29 billion Older caregivers with chronic disease and stress of care giving=earlier death

CMS Demonstration Projects Disease management 70% of medical costs Continuum of care Fragmentation of medical care Rise in Medicare managed care Medicare dollars to chronic disease Need to increase education and prevention Co-morbidities and progression of disease unwarranted Dr Smith unaware of what Dr Brown prescribing and for what I’m the heart/lung guy that doesn’t worry about the diabetes; that’s the endocrinologist’s focus Consumer not educated to share medical knowledge with each MD Costs to the consumer now evident with changes to MCR managed care Insurances touting what services will be available; unfortunately consumer not aware of prices attached to care; information very confusing

Health Care Costs ER visits Inpatient costs Co-morbidities Disease progression/system failure Quality of Life/productivity Patients don’t even bother with doctors office---straight to ER Once in ER, most likely will be admitted Difficult for covering physicians without pt history to know

The number of people working to support Medicare dollars falling from around 9 down to 2 people Seniors retiring and remain working to supplement pension/social security Mandatory retirements---people finding other jobs

Example 2004 estimate for heart failure $25.8 billion 2006 estimate $29.6 billion Health dollars and lost work days 2003 stroke cost estimated $51 billion in lost productivity and health care costs, including $12 billion in nursing home costs. Dollars and work days lost for both patient and family who needs be at hospital or home once discharged

Age 40---risk of CHF 1 in 5 If elevated BP-----risk doubles Women with diabetes----strongest risk factor

CHF 5 million people in US 550 new cases each year 266 thousand die each year More than 40% of patients readmitted within 90 days of hospital discharge 62% of CHF patients visit ER’s Hospitalizations from 1979-2001

Diabetes As of 2002, 18.2 million people—6.3 percent of the population 1.3 million new cases diagnosed each year Age 60 years or older: 8.6 million; 18.3% of all people in this age group Sixth leading cause of death ----2000

IDEATel—Informatics for Diabetes Education and Telemedicine project CMS project 2000 IDEATel—Informatics for Diabetes Education and Telemedicine project Initially 1600 patients enrolled 1st phase completed 2004 Over 18.2 million have 2002 figures---$92 billion per year to the economy $40 billion indirect costs for disability Early intervention save $247 million; up to $457 million if telehealth used Self-management Physicians treat ‘a’ illness; don’t look for other problems Fragmented diagnosing/treatment IDEATel---funded another 4 years so thru 2007 Computer monitoring---BS, pics of skin/feet, BP Internet service Care guideline to analyze data and educate pt

COPD 4TH leading cause of death Increased incidence for women 2003—10.7 million in US 2004----costs of $37.2 billion

Limitations ADL functions Work productivity Sleeping Social/family activities

Lung Health Study II, Ancillary Study: an aim of evaluating the DOSER's ability to improve compliance. The Lung Health Study is funded by the Heart, Lung and Blood Institute of the U.S. National Institutes of Health Study Aim: the study is aimed at evaluating the effectiveness of various therapeutic approaches to treating smokers and people in the early stages of COPD.

Deterrents Adherence Compliance Literacy Accountability Unable to correlate cause and effect Lack of preventive services/access

Telehealth: the use of electronic communication networks to transmit data or information that focuses on health promotion, disease prevention, diagnosis, consultation, education, and/or therapy

Funding Opportunities Office for the Advancement of Telehealth National Library of Medicine USDA National Institute of Health CDC

Range of Telehealth Internet access 1:1 contact Self-reporting Modules that monitor automatically Patient input of information

Benefits Real-time reinforcement Support of self-management Decrease in medical emergencies 1:1 program coordinator contact Physician satisfaction Evidence based guidelines for care

Barriers to Telehealth Costs Lack of reimbursement Physician buy-in Patient buy-in Payer buy-in

St. John Home Care Program Telehealth for CHF—Cardiocom monitor Implemented 2001 Over 1100 patients 90 referrals per month 45 patients enrolled in program

Criteria Primary diagnosis of CHF Working phone line Comorbidity of DM, COPD Working phone line Patient able to stand on scale Cognitive ability Physician order

Options Weights Patient/symptom specific questions Glucometer Pulse oximeter BP cuff

Program Nurse program coordinator 7 days per week Timed call ins for patients Contact if no call-in or alarms Real time education and consequences Reports faxed to physicians Immediate interventions

Outcomes Decreased readmission rate Improved quality of life Improved self-management Minimal incident of return on service

Surveys Extremely helpful in managing mom’s CHF I like the telescale/at least I watch my weight Never realized sodium was a salt While I had use of it in my home, it got me in some good habits that I continue to use.

Types Video monitoring/virtual visit Body sensors Data transmission Electronic medical records Physician access Wireless connectivity

                              

Questions? Thank You!!