One of the focal points of health reform is improving transitions in care settings, particularly to the home. Alternative reimbursement and care delivery models such as accountable care organizations will require more patient self-management tools and remote monitoring devices.

In a Nov. 30 webinar, Lynne Dunbrack, program director for research firm IDC Health Insights Framingham, Mass., described how the legislative impact of the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Patient Protection and Affordable Care Act (PPACA) is combining with other market drivers such as the increase in the incidence of chronic disease and provider staffing shortages to create new opportunities for efforts at home monitoring, e-visits and telemedicine.

“There is a greater focus on early interventions to help avoid hospital readmissions and redundant care,” Dunbrack said. “Providers are going to be given incentives to keep patients out of the hospital.”

She went on to describe some “connected health” pilot projects that suggest such early interventions can improve outcomes, but she added that more studies need to be done and that several issues still inhibit use of remote monitoring and telemedicine.

For instance, some clinicians question the veracity of data collected through remote patient monitoring devices, she said, and others believe it undermines clinician-patient relationships. There are also questions about payer reimbursement for monitoring patients in their homes, licensure issues about practicing across state lines, as well as liability issues.

Although they are very price-sensitive, consumers do seem willing to pay limited amounts for remote monitoring and e-visits, and payers are starting pilot projects to look for savings.

In one example of provider-payer cooperation, UnitedHealthcare and Centura Health launched Connected Care in June 2010 to provide rural Colorado communities access to physicians and specialists via telehealth technology. They expect to provide 4,800 annual patient visits.

In another example, Dunbrack described Hawaii Medical Service Association’s (HMSA’s) deployment of America Well's Online Care statewide to 1.3 million Hawaii residents, including members of other health plans and the uninsured. HMSA members pay a $10 co-payment, and non-HMSA patients pay the entire $45 fee for a 10-minute visit via webcam, voice and chat. “In a state where specialist visits often mean expensive travel between islands, the continuity of care these e-visits provide may be significant to consumers,” she said. (Since its launch in early 2009, nearly 10,000 consumers have enrolled, according to HMSA’s web site.)

Although these examples are promising, Dunbrack noted that payers and providers must plan carefully to develop a sustainable business model for any new venture involving remote monitoring or e-visits. “It’s always tempting to fall for the shiny new toy,” she said, “but you really have to focus on what problem you are trying to solve and align incentives to get there.”