Steve Brown thinks he knows how to improve the quality of life for chronically ill people and save millions of dollars in the process. Now the CMS is giving him a chance to prove it.
Brown is the president and chief executive officer of the Health Hero Network, a Mountain View, Calif.-based company that is partnering with the American Medical Group Association and others on the ACCENT Project to provide coaching and monitoring of patients with congestive heart failure, chronic obstructive pulmonary disease and/or diabetes.
The ACCENT (Advancing Chronic Care through E*Health Networks and Technologies) Project was one of six demonstration projects the CMS chose to test different ways of providing clinical support in nontraditional settings to improve the lives of Medicare beneficiaries with high medical costs.
"The goal is to show that higher-quality care is less expensive," Brown said. "If this works, it's a big step forward for Medicare."
Starting Jan. 1, Health Hero will work with Bend (Ore.) Memorial Clinic and the Wenatchee (Wash.) Valley Medical Center to manage the health of about 2,000 patients who "are at risk of going to the hospital every day," Brown said.
Using Health Hero's Health Buddy appliance, which plugs into a telephone outlet and is "easier to operate than a coffee pot," according to Brown, patients will report their conditions, symptoms or vital signs every day. Patients who are at risk of needing hospitalization are contacted and, if needed, a visit to the doctor's office -- instead of the emergency room -- is arranged.
"Lower hospital admissions represents improving the quality of life of chronically ill people by allowing them to live independently at home longer," Brown said. "We believe that doing that actually lowers the costs of care."
He said the project is not a trial to prove the effectiveness of a technology system, but a test for a new model of care that may literally turn the management of chronic illness upside down.
"It's inverting the typical model by being proactive instead of reactive," Brown said.
CMS spokesman Don McLeod said that funding for the ACCENT Project and five other nontraditional care trials will come from regular fee-for-service Medicare benefits. American Medical Group Association spokeswoman Julie Sanderson-Austin said that provider groups will also receive a negotiated per-patient per-month care management fee that's over and above customary charges for medical services they may be providing to the beneficiaries already.
As a condition of participating in the CMS trial, however, the parties involved have guaranteed that the new methods will result in cost savings of at least 5%.
Brown did not offer any figures for the ACCENT Project, except to say that "millions of dollars" would be involved, but he added that the potential for savings is huge. According to estimates from the U.S. Agency for Healthcare Research and Quality, 2004 Medicare inpatient costs for heart failure, chronic obstructive pulmonary disease and diabetes totaled about $15.2 billion, $6.2 billion, and $3.8 billion, respectively.
Brown cited how a similar remote physiological monitoring program at the Veterans Integrated Services Network in Florida resulted in a 40% reduction in ER visits and a 63% decrease in hospital admissions.
According to a July 2004 report by the New England Healthcare Institute, remote monitoring programs could lower heart failure patients' hospitalization readmission days by 32% and healthcare costs by 25% -- or by 132 days and $186,000 per 100 patients.
The NEHI study, however, also cited two barriers to widespread implementation of remote monitoring programs: reluctance by hospitals and clinics to invest in such projects because of a lack of Medicare reimbursement for capital and operating expenses, and reluctance by physicians to provide monitoring services because they will not be reimbursed for their time.
Brown said physician groups already monitor some patients, but that this is considered "overhead" and does not qualify for Medicare reimbursement.
Brown said Health Hero currently charges $50 a month for the Health Buddy system, and he hopes the trial will prove that reimbursing a physician group between $100 to $200 a month (which would include the $50 fee for using Health Buddy) for coaching and monitoring a chronically ill patient is both justifiable and cost effective.
"We say it should be defined as a 'service' and ought to be part of the recognized care for chronic illness," he said. "We're not selling technology to Medicare, we're advocating payment for chronic-care improvement."