Controlling Chronic Illness
Home scales trim costs, aid in preventing medical crises
Beacon Journal

Marianna Brown gets checked out by a nurse at Akron General Medical Center each morning without leaving the comfort of home.

The 53-year-old Uniontown woman is one of 150 congestive heart failure patients who received a free, computerized scale from Akron General. The scale is connected via the telephone to the hospital's computer system.

The scale readouts are monitored by a nurse. When the scale indicates a problem, the nurse calls.

``It's kind of like a support group in a way,'' Brown said. ``It makes you more aware. It encourages you to watch what you're doing.''

In recent years, many hospitals, managed-care insurers and pharmaceutical companies have developed programs, like scale monitoring, to identify and prevent medical crises among patients with the most common -- and most costly -- chronic diseases.

These programs, known as disease management, typically involve providing patients with support, educational material about warning signs and tips on how to stay healthy. Physicians get updates about the patients, as well as copies of nationally accepted treatment standards.

The services are provided free.
While skeptics question whether disease management is just another term for ``cookbook medicine,'' in which all patients with the same disease are treated exactly the same, supporters say there's growing evidence that everyone wins.

Patients are healthier, medical costs are lower and employers are happier because workers miss fewer days.

``People need that constant, positive reinforcement,'' said Dr. Thomas Stover, Akron General's medical director of care management. ``It's very difficult to admit you have a chronic illness and it will never go away.''

In many cases, costs with disease management programs initially increase as patients start taking more medication and getting preventive care, said Nancy Markle, vice president of health services management for SummaCare Health Plan.

A computerized scale connected by a phone line to Akron General's computer system helps detect problems for heart patient Marianna Brown of Uniontown. A nurse monitors the scale readouts and calls if the scale indicates a problem.

The Akron-based managed-care insurer has disease management plans for asthma, congestive heart failure, maternal care and diabetes.

``Sometimes, the cost savings come years down the road,'' Markle said. ``If you're managing a disease well, you may see an increase in costs for medications and treatments. But you avoid ER visits and inpatient hospitalizations.'' Akron General rolled out its disease management program for heart failure patients, known as Vigilance Monitoring, on a trial basis in 2000.``Sometimes, the cost savings come years down the road,'' Markle said. ``If you're managing a disease well, you may see an increase in costs for medications and treatments. But you avoid ER visits and inpatient hospitalizations.''

In congestive heart failure, the heart can't pump enough blood to meet the oxygen and nutrient needs of the body's other organs.

As a self-correcting measure, the body retains water.

Initially, the additional water increases the volume of blood in circulation and improves the heart's performance. But as the heart deteriorates, the excess fluid escapes and accumulates in various parts of the body, causing swelling and sudden weight gain.

Medical experts agree it's important for people with congestive heart failure to closely monitor their weight so their medication can be adjusted when they begin retaining water.

In addition to recording the patients' weight, the scale provided by Akron General features a computer voice that asks questions that raise red flags for heart problems -- things such as, ``Are you feeling more short of breath?'' or ``Are your ankles and feet more swollen?''

Denise Ertle, a registered nurse and care manager at Akron General who runs the Vigilance Monitoring program, reads the results and contacts the patients and their doctors if she sees any problems.

``You build up a relationship with these patients,'' Ertle said.

Since starting the program, the hospital has seen some dramatic results.

Of 91 patients studied, the hospital's cost for their care dropped from $1.3 million during the 12 months before they got a scale to $723,000 during the 12 months afterward.

Likewise, hospital admissions dropped from 182 in the year before they got the scale to 107 the following year.

Consider the case of Brown. She used to be in and out of the hospital with one medical crisis after another. But since getting the high-tech scale, she has managed to stay out of the emergency room for six months. ``People can be really sick and ignore what they need to do,'' said Dr. George Litman, Akron General's chief of cardiology. ``I think it's a source of denial. It's a sort of psychological protection. ``We hope that this program reminds them. I think that's why it's so successful.''

The financial incentives for disease management, especially for insurers, are obvious. Industry experts estimate that patients with chronic illnesses account for about 70 percent of all health-care expenses. If these patients can be kept out of expensive hospital beds and emergency rooms, the long-term savings add up. Since starting its congestive heart failure program four years ago, HomeTown Health Network in Massillon has seen a 31 percent reduction in emergency room visits and a 72 percent drop in the number of days in the hospital among participants. That equates to savings of $200,000 to $300,000 per quarter for the managed-care insurer, said Terri Bishop, manager of disease state management.

``All this relates to a savings for the members as well, because they don't have to pay the co-pays for the emergency room visits or hospital stays that they would pay,'' she said.

HomeTown also has a disease management program for diabetes, as well as one for people with complex chronic illnesses. Betty Sdono, 76, of Akron, gets weekly home visits from a nurse to help her manage her illnesses, including emphysema.

A HomeTown social worker also helped her find community resources and drug company discount programs so she could afford her medicines. ``They have really been good for me,'' she said. ``I had an awful time. Either I had to make up my mind to get my medicine or... eat. If it wasn't for HomeTown, I don't think I'd have my medicine.'' But why would a hospital want to keep patients -- its bread and butter -- from coming back? One answer -- again -- is money.

Medicare, the federal insurance program for the disabled and those 65 and older, pays a set amount for each hospital stay based on the diagnosis.

The amount paid by Medicare to Akron General for the typical congestive heart failure patient is about $1,000 less than the cost of the person's care, hospital officials said.

But money aside, programs that keep people healthy and out of the hospital are good for patients, Stover said.

``It's the right thing to do,'' he said.