The annual cost of heart failure in the U.S. is $26.7 billion, with about $2.7 billion being hospital costs deemed preventable by adherence to medication and needed lifestyle changes.
Disease-management programs are known to be clinically effective for heart-failure patients, but today only 10% of such patients are enrolled in some form of a disease-management program, according to a study by the New England Healthcare Institute, a Cambridge, Mass.-based quality improvement consortium. Founded in 2002 to improve healthcare quality and reduce costs, the institute is made up of providers, educational institutions, consultants, payers, drugmakers and technology companies.
One technique that shows promise is remote physiological monitoring, or RPM, the institute said. Implementing very basic strategies, such as daily weight monitoring of patients with advanced heart failure, can reduce rehospitalizations by 32% and healthcare costs per patient by 25%, while "quality-adjusted life years" can increase by 2%, the institute's report said. A 25% participation rate among eligible heart-failure patients would save $500 million annually.
RPM involves using an electronic device in the patient's home to collect physiological data on the patient, such as weight and blood pressure, and a transmission system to send the data to a nurse or other caregiver for analysis.
Typically, patients use the systems once a day. The nurse or care manager looks for early signs of a worsening condition and provides information in hopes of reducing hospitalizations.
The report cites broader programs that also have had significant success. The Veterans Affairs Department health system established an Office of Care Coordination in 2003, which uses a Web-based system to support 3,150 patients at high risk of hospitalization because of chronic diseases. The VA reports a 40% drop in emergency room visits, a 63% decrease in hospital admissions and a 60% decline in bed days for patients monitored under the program. The agency plans to expand the program to 25,000 patients by 2006.
Congress, meanwhile, through the Medicare Modernization Act of 2003 is pushing to enroll 150,000 to 300,000 fee-for-service Medicare beneficiaries in chronic-care management programs. About 10 pilot projects will divide up to $100 million in funding over three years for programs that use monitoring technologies.
Lack of reimbursement for monitoring programs is the top barrier to broader adoption, followed by a lack of randomized clinical trials to prove such programs' effectiveness, disruptions to workflow and practice patterns, fear of liability, limited capabilities for data analysis and loss of control over patient care, the report said. To move forward, the report recommends: working with public and private payers to address coverage and reimbursement, encouraging collaboration among providers to share knowledge and experience, and educating patients about the benefits of monitoring.