Telemonitoring of heart failure patients produces gains

A Geisinger Health Plan (GHP) telemonitoring program significantly reduced hospital readmissions and cost of care for members diagnosed with heart failure (HF), according to a recent study published in Population Health Management.

The telemonitoring program, which incorporated Bluetooth scales with an Interactive Voice Response (IVR) solution from Advanced Monitored Caregiving (AMC Health), also improved the efficiency of care managers and delivered a 3.3 return on GHP’s investment-in other words, for every $1 spent to implement this program, GHP saved about $3.30. The savings amounted to approximately $216 or 11% per patient per month (PPPM) between 2008 and 2012.

The study, led by Daniel D. Maeng, PhD, research investigator at GHP, Center for Health Research, compared inpatient admissions and total cost of care incurred by HF patients during the time when they were enrolled in the AMC Health telemonitoring program against those incurred when they were not enrolled in the program, adjusting for patient characteristics and other potential confounders.

A total of 541 members were included in the final evaluation. These patients were all GHP Medicare Advantage plan members, who were at least aged 65 years with confirmed HF, and who maintained their plan membership for the 70-month study period. They had a high prevalence of comorbid conditions (most commonly hypertension PPPM cost of about $1,600). The implementation of the telemonitoring program delivered an 11% cost savings during the study period, which is in addition to cost savings attributable to complex care management alone.

NEXT: Process was threaded into existing best practices

“The remote monitoring approach was simple,” according to Jonathan Shankman, senior vice president, clinical innovation, AMC Health, a telehealth solutions provider. Daily weights were collected from Bluetooth scales that automatically transmit weight patterns to the cloud and solicit symptom information through regular automated IVR telephone calls. Both processes can issue real-time alerts to remote care managers, helping them prioritize which members need their attention first, dramatically extending the reach and productive capacity of the constrained team.”

The members in the sample group experienced significant reductions in their probability of hospital admissions, as well as 30-day and 90-day readmissions in a given month. The study showed that the odds of a patient being admitted to the hospital in any given month were 23% lower during the months when they were enrolled in the telemonitoring program; their odds of 30-day and 90-day readmissions were reduced 44% and 38% respectively.

“When remote monitoring processes are threaded into existing complex heart failure best practices, members with congestive heart failure [CHF] can expect to see significantly lower utilization and cost than with case management alone,” according to Shankman.

Specifically, according to Shankman, the odds of any member being hospitalized for any reason while on remote monitoring were 23% lower relative to when they received case management alone.

“CHF is one of the costliest and most difficult to manage disease states in just about every Medicare manage care population,” Shankman says.

NEXT: Labor-intensive process  

He points out that it is a factor in at least one-fifth of all hospitalizations for people over aged 65. Heart failure costs the nation an estimated $32 billion each year. This total includes the cost of healthcare services, medications to treat heart failure, and missed days of work.

“Geisinger had a very sophisticated and elegant pathway for complex Heart Failure management before these technologies were introduced, but this labor-intensive process was very difficult to scale,” Shankman says. “The intention of the study was to see the additive value of remote monitoring, and to quantify that value both in terms of clinical effectiveness and cost.

“These flexible remote monitoring technologies can be readily threaded into exiting clinical best practices. In doing so, they can dramatically reduce utilization by detecting pre-acute scenarios in a far more timely manner, while simultaneously extending the reach of a care management team otherwise overwhelmed by unscalable manual processes,” Shankman adds.