Here’s an article from the Wall Street Journal about the future of medicine as it applies to chronic and debilitating disease–in this case, congestive heart failure. Although I am sure the issue here was supposed to be the cost savings for the insurance companies, what stood out to me was the importance of the role of the nurse in this scenario. Without a nurse to review and monitor the data collected remotely, there would be no cost savings. Hmmm…..
Read this article and then tell me what your thoughts are on this topic. I do believe that remote monitoring is going to become normal practice in the future, I just hope that nursing gets credit for being the linchpin on which the success lies.
Insurer-Endorsed Remote-Monitoring Technology Leads Heart Patients to Take Their Readings at Home
Technology that aims to keep congestive heart failure patients out of the hospital is gaining traction.
The idea is for heart patients to take readings like their weight, blood pressure and other key metrics using wireless and other technologies; the data are then transmitted to a case manager or medical care giver. That way health care givers can catch, and address, warning signs before the patient lands in the ER with shortness of breath or a heart attack. In the past, patients have found such technology difficult to use. But a number of managed-care companies are experimenting with electronic devices meant to make the process easier.
A big benefit is that it allows patients to stay in their homes, but the systems can’t catch everything, and patients shouldn’t be lulled into a false sense of security by the technology.
WellPoint Inc.’s Anthem unit in California is piloting a wireless scale and blood-pressure cuff that communicates in real time with nurses on alert for fluctuations that can signal heart failure, or when the heart can no longer pump enough blood to the body’s organs. Humana Inc. in January will launch a program to track heart patients’ vital signs wirelessly and link them up via video to chat with nurses if appropriate.
It is more important than ever for health plans and patients to combat medical costs, growing at a clip of between 6% and 9% a year, according to various estimates. Heart failure—which can be triggered by simple mistakes such as consuming too much salt—is a leading cause of hospital readmissions, with about 25% of patients returning to the hospital within 30 days. It’s also one of the biggest single claims expenses at insurance companies. Aetna estimates that 40% of readmissions are avoidable.
For patients, the extra surveillance could cut down on trips to the hospital and provide peace of mind. That’s what Carolyn Brown, a 63-year-old retired teacher’s aide from Bronx, N.Y., found when she started using a new monitoring system covered by her insurer, MetroPlus Health Plan Inc., after she suffered two heart attacks.
“I was constantly going to the doctor. Now they can tell right away if I am in trouble,” she said.
The program puts a scale, blood-pressure cuff and glucose monitor into patients’ homes and then collects the data daily via wireless or landline. Nurse case managers follow up with the patients if any of the vital signs seem worrisome.
The plan, which specializes in Medicaid and Medicare and is owned by the New York City Health and Hospitals Corp., says it pays about $6,300 for a Medicaid heart patient’s typical hospital stay. The plan foots the bill for the remote monitoring system, which is rented and worth approximately $626.
Such remote monitoring programs have limitations. Doctors can get over-alerted when patients put the cuffs on wrong, or step onto the scale with their shoes on. The technology requires ill patients to remember to use it, and can be troublesome if it acts up. For instance, Ms. Brown’s data at first weren’t uploading through the modem correctly, a problem that was solved within 24 hours when the machinery was converted to a wireless hookup.
Ms. Brown’s blood-pressure reading and transmission devices.
Both Humana and WellPoint are incorporating video-chat into their approaches to connect members more closely with nurses. UnitedHealth’s wireless scale asks a series of questions in the morning and evening that are followed up by nurses and doctors if appropriate. “The relationship between the consumer and doctor is primary,” said Sam Meckey, chief operating officer for disease solutions at UnitedHealth’s OptumHealth unit.
Ray Freeland, a 54-year-old heart patient who is part of Anthem’s pilot program, said the system he uses to monitor his weight and blood pressure has “eliminated those trips to the doctor to find out everything is still the same.” But in March, the system picked up through Mr. Freeland’s pulse measurements that he might be experiencing abnormal heart rhythm. Mr. Freeland, who lives in Glendale, Calif., was sent to his doctor to shock his heart back into a normal rhythm. His medical center, Cedars-Sinai, estimates that about $30,000 was saved on Mr. Freeland’s care between March and July.
New approaches aim to find problems earlier. A study of 1,450 patients out Tuesday in Circulation, a journal of the American Heart Association, showed that implantable defibrillators that wirelessly transmit data on the patient’s heart function reduced in-hospital evaluations by 45%. Suspected cardiac events were evaluated in less than two days compared with 36 days.
Another approach being tested by devicemaker CardioMEMS Inc. uses an implantable sensor device to measure pulmonary artery pressure and wirelessly transmit readings to a secure Web site for doctors and nurses. The idea is to detect changes and intervene before the patient has to be hospitalized. The wireless transmitter resulted in a 30% reduction in hospitalization for heart-failure patients, the study of 550 patients released last month showed.
Write to Avery Johnson at avery.johnson@WSJ.com
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