Making house calls, digitally
Home scales trim costs, aid in preventing medical crises
newsobserver.com

Last April, Kathy Sedaris held her newborn daughter, Madelyn, and her heart melted. Five days later, it literally failed.

Sedaris, 33, had developed a rare type of congestive heart failure that sometimes affects otherwise healthy women after pregnancy. She has since recovered, but without careful monitoring, her condition can spiral out of control in a matter of days.

Every morning, Sedaris steps on a special digital scale beside the bed in her Raleigh home and answers a series of questions. Is she swollen or short of breath? Has she taken her medicines? The scale, provided by her health insurer, ships her weight and other data to a nurse's computer at Blue Cross and Blue Shield's disease management center in Winston-Salem.

Any suspicious results -- an overnight weight gain of just a pound or two is a signal that Sedaris is retaining fluid that may strain her heart -- and the nurse is on the phone. She'll talk with Sedaris and, if necessary, send her to get medical attention.Industry analysts expect such monitoring devices will eventually transform the delivery of health care. The equipment could make it possible for the elderly to avoid institutionalized care, improve rural patients' access to treatment and head off complications in the chronically ill. The technology to remotely monitor patients' pulse, weight, blood pressure, blood-oxygen levels, general mobility and other indicators is already widely available. The declining costs and increasing use of high-speed Internet service should only accelerate acceptance of monitoring devices.

However, such gadgets are now still in limited use, in large part because most health insurers won't pay for them.

That's the sticker," said Elizabeth Boehm, a senior analyst in the health care and life sciences division of Forrester Research, a Massachusetts company that tracks technology. "It's the reason this isn't already a huge market."

The device-making industry has high hopes that a demonstration project authorized by the Medicare reform bill passed in November will culminate in the government making the technology eligible for Medicare, which could speed acceptance. But a policy change is likely still years away.

"We definitely expect it to be a growing market," Boehm said. "But it's not going to be one that's going to explode. It's something where the business model is going to evolve over the next 10 or 15 year period."

Replaces house calls

Because of the uncertain reimbursement climate, health care organizations tend to use monitoring technology where it has the most potential to save money.

Home health agencies that normally would have to send a nurse to patients' homes daily to check vital signs and other disease-specific benchmarks can use monitoring in place of some visits.

In disease management programs, such as the one Sedaris participates in with Blue Cross, insurers use devices to gather almost current health information on at-risk members, including heart patients.

Keeping those patients stable and quickly getting them care when it's needed can reduce hospitalizations and cut the insurer's medical costs. And since the savings come from improving the patient's health and quality of life, programs such as Blue Cross' "Your Heart Matters" are generally popular with participants.

I think it's great," said Sedaris, who was enrolled in the Blue Cross program within weeks of being diagnosed with peripartum cardiomyopathy.

Her heart now functions normally, But she must take medication, restrict physical activity and adhere to a strict low-sodium diet to manage her condition. She and her husband, Paul, don't even keep salt in the house. Knowing that her nurse, Deanna, is looking over her shoulder gives Sedaris that much more resolve. "It feels like we're not alone in this," she said.

Since last April, when Blue Cross started using the Cardiocom Telescale, the insurer has put about 160 congestive heart failure patients on the device, out of about 1,500 members diagnosed with the disease.

The cost of providing members with scales was less than $100,000. The plan hopes to see a 50 percent reduction in hospitalizations, which would more than pay for the devices.

"We look at where the costs are and where there are opportunities to intervene and make a difference," said Dr. Doug Knoop, senior medical director for population health management with Chapel Hill-based Blue Cross, the state's largest health insurer.

Lung patients' Q&A

A Blue Cross subsidiary, Partners National Health Plan of Winston-Salem, uses another transmitting tool with about 300 members of Medicare health maintenance organizations who have the lung condition chronic obstructive pulmonary disease.

The device, which is similar to a handheld computer with its display screen and push-button keys, leads patients through a series of disease-specific questions about their health that day. Case managers determine which patients need attention that day, based on patients' answers, which are transmitted to nurses.

The device from Partners doesn't measure biometric data, such as patients' blood-oxygen levels, but it could easily add features.

But insurers likely will need evidence that such tools meaningfully improve disease management programs that emphasize self-monitoring by the patient, backed up by regular phone calls or visits with a case manager.

For some conditions, low-tech solutions get the job done.

For example, many insurers provide asthma patients with simple nonelectronic plastic devices to measure their peak airflow at home. Patients know to get help when they fall below a certain range. Diabetics use at-home blood sugar monitors in much the same way. There is ample evidence that such approaches can dramatically cut hospitalizations and emergency room visits.