Population Health and Wearables out of a Sci-Fi Film
This past Thursday kicked off the 11th annual Partners Connected Health Symposium in Boston. Baby boomers are now at the age where they need more healthcare and this need is only going to intensify. In 2050 there will be 2 billion people over the age of 60; the elderly will outnumber the youth and middle age groups, creating a worker shortage. Exacerbating this issue is a 4.3 million shortage of doctors and nurses and rising healthcare costs. Population health management can help alleviate stress on the healthcare system by lowering costs and increasing the health of patients. The important elements that will make population health successful and increase the quality of care are evidence based analytics, telehealth, coordination of care and wearables.
Predictive analytics can allow providers to pick a customized solution for each patient. Care customization is no longer synonymous with genomics, personalized medicine can now include individual goals for each patient into analytics. This will play a key role in cancer treatment in the future, currently only 62% of care plans are evidence based and almost none of them include the individual goals for the patient. Some patients would like to treat the cancer as aggressively as possible with radiation, chemotherapy and surgery until the end, while other patients are more concerned with quality of care for their remaining days. Presently, analytics are used most frequently in tracking and lowering readmission rates. Readmission rate algorithms focus on the patients who are most at risk to return to the hospital showing symptoms of the same illness they were recently admitted for. These patients are the high cost patients that have multiple chronic conditions such as Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Coronary Disease, Diabetes and Depression.
The goal is to keep high risk patients at home as long as possible, but still be able to monitor these patients’ vitals. There are many telehealth techniques that can be utilized to communicate with the patient in their home such as virtual visits, email, video conference, phone calls, text message and electronic curbside. However, there are currently barriers for reimbursement for telemedicine and there are no economic incentives to do telemedicine instead of office visits. Reimbursement for telemedicine is very fragmented and varies significantly by CMS, private insurances and carriers. Nevertheless, there is patient demand for virtual visits. In a recent iTriage survey 26% of the patients thought that it was important that they could do virtual visits.
Wearables will be key to implementing and tracking population health initiatives. The health symposium had an extensive assortment wearables from devices that track the amount of sunlight you receive in a day to devices that can determine your mood based on your brain waves. Dr. Rajani LaRocca, a primary care physician at MGH has already begun to experiment with wearables for a small pilot group of patients with metabolic syndrome. The patients were from all walks of life and were provided Fitbits by MGH to improve their health. The group also had a group meeting were they were able to receive support from other members of the community who are going through the same issues. The pilot was a success, patients were engaged and improved their health as a result of utilizing the wearables. Companies that produce wearables can encounter regulatory issues depending on whether they market their device as health information or as diagnostic/treatment advice. The current trend for most wearables is to market themselves as purely health information that does not provide treatment advice, so that they do not have to be regulated by the FDA.
Wearables can also be used for remote monitoring for patients with cardiac ailments such as congestive heart failure. Patients can step on a scale in their home and have their weight sent to the provider. If their weight has increased drastically over a short period of time it could mean that the patient is in need of emergency care and needs to be readmitted. There are also wearables that can monitor the patient’s heart rate and oxygen levels which could predict a-fib or hypoxia due to an asthma attack. Wearables are not on just valuable for acute events such as an asthma attack or CHF, but they are also valuable for tracking long term illness, such as Parkinson’s disease. At present, the patient can only report back to their provider their perception on how their medication is helping their tremors. However, with the use of wearables the provider could use quantitative data to determine how well a medication is working.
Another piece of the puzzle to improving patient health is coordination of care. Some states have already implemented HIEs, but many hospitals and doctor’s offices cannot even communicate within their own organization let alone send data to an outside organization. The current HIEs are very rudimentary and usually operate sending CCD’s which contain basic patient information like allergies, medications, family history, encounters and diagnoses. Sharing data that a patient gets from their wearable is not yet possible in many settings.
The Partners Health Symposium was an exciting innovative event that brought together several professionals with the goal of improving healthcare. In the coming years the healthcare system will have to change drastically to be able to handle the larger group of elderly and have to learn how to cut costs to be a sustainable industry.
Originally published at healthitmhealth.com on October 28, 2014.
