Usefulness of home monitoring devices studied

Insurers traditionally have shied away from home monitoring reimbursement, but pilot programs are allowing payers to test the benefits.

By Pamela Lewis Dolan — Posted Dec. 22, 2008

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Proponents of home monitoring devices long have believed that widespread use of those systems can help solve some of the problems plaguing health care today. Now, some technology companies, medical centers, insurers and patients will be testing that theory.

Intel and the Cleveland Clinic announced in recent weeks that they are focusing less on the technology itself than on the ease of its use by the elderly, its role in the continuum of care, and the potential cost savings.

Technology developer Intel announced four separate pilot programs, in partnership with Aetna, SCAN Health Plans in Arizona, Erickson Retirement Communities and Advanced Warning Systems. The Cleveland Clinic is conducting a pilot with Microsoft HealthVault.

Home monitoring provides a way for patients to use electronic devices to collect their own health data, such as vitals or glucose levels. The devices can then be linked with a computer, allowing data to be transmitted to the health care team or to an accessible data repository.

Ray Askew, spokesman for Intel, said each of its pilot sites will focus on a specific chronic condition. Each partner will choose its own participants, with the pool likely to be made up mostly of elderly patients.

One of the biggest questions with home monitoring devices is whether the elderly, the population from which the most benefits could potentially be gained, will actually use the technology.

Askew said ease of use has been one of the key consumer research areas for Intel. Several modifications, such as limited functionality and large buttons, were made to make the systems easier to use.

C. Martin Harris, MD, chief information officer at the Cleveland Clinic, said its pilot, and home monitoring programs in general, are not limited to the elderly, but that demographic does present the most opportunity. "But the biggest question is will they use it. How do you plan to engage the elderly?"

Cleveland Clinic's pilot is being conducted with Microsoft HealthVault, which interfaces with the hospital's personal health record system, eClinic MyChart.

Approximately 500 pilot participants will be given a home monitoring device from which information can be gathered and uploaded to individual HealthVault accounts, and then personal health records systems.

An online log of the data will be evaluated by the care team, which will triage the patients based on the data.

Dr. Harris anticipates many patients will find the devices are not easy to use. "I think we will have difficult compliance with everyone. Part of the pilot is how can we make it easy to use. We are looking at everything [participants] do, including their home set-up and how to make it work with that set-up."

The other big hurdle has been lack of insurance reimbursement. Medicare does not have a formal policy for reimbursing for home monitoring. One of Intel's pilot partners is SCAN, a Medicare Advantage HMO in Arizona.

Alan Little, business development executive for SCAN, said the health plan will be using the pilot to gauge member satisfaction and whether the technology can become a part of a comprehensive care plan.

Little said the growing shortage of primary care physicians and geriatricians, combined with the aging baby boomer population, means that "technology has to be part of the equation. As a health plan ... we know we have to assume some responsibility in this."

Gregg Malkary, founder and managing director of Menlo Park, Calif.-based Spyglass Consulting Group, said early adopters of home monitoring technology were home health care agencies, which typically took on the costs themselves, knowing money could be saved through remote monitoring.

"Now we are seeing low-hanging fruit because the benefits are coming to providers and payers," Malkary said. Both are starting to figure out that every dollar saved goes right back to the bottom line, he said.

Harry Wang, director of health and mobile product research for Parks Associates, a Dallas-based market research group, said it's going to take some serious efforts on the part of the technology vendors to make insurers see the potential benefits of covering the devices. "Although they are aware of the cost benefits and the empirical evidence, they are still skeptical of the return on these types of devices. There is no clear evidence that the return is there that meets their threshold."

Wang said he is encouraged that private insurers, such as Aetna, are getting involved with the pilot programs. But, he said. it will be important for the pilots to involve third parties to verify the results. SCAN is partnering with an academic institution that will produce a white paper on the study, Little said.

"It's too early to draw conclusions on whether the pilots will be successful enough for reimbursement policies to relax, but it gives us the hope that the growth will be faster than the current conditions in the market," Wang said.

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