Connected Health: Using patient-centric technologies to change behavior and improve outcomes Joseph C. Kvedar, MD Director Center for Connected Health Partners HealthCare

About the Center for Connected Health Division of Partners IS organization –Research and evaluation –Program development and rollout –Operational systems and support –Commercialization Our interest is in the use of technology to deliver care remotely: –Heart failure monitoring –Diabetic monitoring and coaching –Blood pressure self-management for large employer Benefits include: –Increased patient engagement –Improved health outcomes –Improved patient-provider communications

Four Cornerstones of Connected Health Harness accurate physiologic and behavioral data Engage patients to view and understand their health information Achieve care goals via data driven coaching Leverage providers when needed Connected Health is Patient Centered Care

Connected Cardiac Care Population: CHF Technology: Blood pressure, oximeter, weight, touch screen device Coaching: telemonitoring nurse Goal: decreased readmissions ROI: Better bed management Lower cost of care Heart Failure Monitoring

Total CHF Cases 1,600 Total Medicare CHF Cases 1,200 Total 30 Day Readmit CHF Cases 300 Impact to System: Risk to SystemWith no preventable readmissions Revenue = $0 Direct Cost = $2M Direct Margin = -$2M By avoiding admissions could save up to $2M Plus, backfill opportunity resulting from 300 avoided admissions ~$1.7M 30-Day Readmissions: CHF Monitoring Business Case

Provider Feedback “This program has tremendous promise for improving the care for patients and potentially for improving access to office visits for new or other existing patients. I have a patient who was enrolled in the program recently. She had been in my office or her cardiologist’s office just about weekly and now she is regularly monitored and managed from her home. As I result, I see her every six weeks and that has opened up appointment slots for other patients who need to get into see me.” - Elizabeth Mort, MD, MGH

As MDs gain experience with the telemonitoring program, they are more likely to enroll their patients. MD Refusal Rates

Connected Health Diabetes Population: Diabetics – requiring daily glucose readings Technology: glucometer, gateway, web interface Coaching: diabetes educator Goal: improved control Business justification: Meet P4P targets Decreased downstream complications

Shila Hill, diabetes educator at BWH Newton Corner: This program improves communication between the patient and provider. I would recommend this program for any diabetes patient on insulin, for those who need their medications adjusted often, and for the newly diagnosed.” Connected Health Diabetes

Diabetes Connect – Case studies Sample - successful patient charts (weekly readings) Over 80% of enrolled patients uploading data on a regular basis.

Connected Health Diabetes Journal of Diabetes Science and Technology (Volume 3, Issue 2, March 2009) Pilot Study conducted by the Center for Connected Health: Assessed patient & provider satisfaction, frequency of use and changes in glucose levels over a period of 3 months. Mean blood glucose range decreased in Month 3 vs Month 1 (141.1 and 146.5, respectively). Self-reported HbA1c fell from 6.8% at the start of the study to 5.8% at the end. Web application was well received by participants.

Evidence from other studies MyCareTeam study – McMahon et al Greater change in HbA1c over time in intervention group p <0.05

Cost of Diabetes/person/year Hospital Inpatient Nursing home Physician office Hospital Outpatient Emergency Ambulance services OP Meds Insulin and delivery supplies Oral agents Morbidity Home health516 Hospice Cost of days lost Productivity Cost of non-work days lost Sub-Total13, A1c>7.5A1c<7.5 Potential savings/ per person per year 531 1,052 $7,661 Source: American Diabetes Association Sub-Total Cost difference

Diabetes Monitoring ROI Est. Cost of Diabetes related morbidity and productivity per year $7,661,000 Est. Success Rate of Intervention 33% Est. Cost of Intervention $500,000 Est. Savings$2,528,024 For 1000 enrollees: Return in Year 1 $2,028,024 5:1 ROI Success Rate needed to cover cost of intervention: 7%

Remaining Challenges Cost reduction Patient identification Workforce optimization Program optimization

Conclusions Connected health is evolving as a new dimension in HIT. Patient behavior change is a critical goal. Monitoring increases engagement and improves coaching. Quality, access and efficiency are improved. Learn more: LinkedIn group – Connected Health Community