Connected health technology, including the use of mobile devices and apps, sensors, wearables and remote patient monitoring, has the potential to transform healthcare delivery, by enabling providers to track and care for patients outside the four walls of hospitals and physicians’ offices. The ability to tie mobility around care is especially promising when caring for patients with chronic illnesses. From wireless blood pressure cuffs to blood glucose monitors and wellness apps, these technologies enable providers to reach into patients’ homes and daily lives, and capture patient-generated health data.
The most successful mHealth initiatives to date have been implemented by health systems, hospitals and physician practices with a clear, strategic vision about the role that mHealth plays in the overall patient care strategy.
The University of Pittsburgh Medical Center (UPMC), a large integrated healthcare delivery system, has seen significant patient outcomes improvements as a result of its mHealth initiatives. Its remote patient monitoring program for congestive heart failure patients, for example, has helped reduce 30-day readmission rates for congestive heart failure (CHF) patients in the program to 12 percent, compared to the nationwide average readmission rate of 25 percent for CHF patients.
Ed McCallister, CIO at UPMC Health System, says the biggest lesson learned is to not approach mHealth as one-off projects or separate from the overarching strategy for patient care.
“If you drift off too far, says McCallister, you create technology outposts that are very hard to support. Secondly, they are very inefficient when it comes to seeing a complete picture and the security becomes more of an issue when you have those outposts. We start with the patient at the center, versus the shiny object, which many times is a deterrent to achieving great patient care.”
More broadly, UPMC’s mHealth strategy also is strongly aligned with the organization’s analytics initiatives.
“When you think about a single data source, such as the electronic medical record (EMR) or mHealth data or self-report data or data collected via device, we don’t envision that as one data source. Rather, it’s the layer that sits above those various data sources that is really going to be the win for the industry. It’s how you consume that data at the right point at the right time. It is a challenge, but here at UPMC, it ties into a larger data analytics/data governance initiative that we have underway with mHealth being a key component.”
He continues, “The data collection component of mHealth is very powerful and it’s really extended our ability to collect data for better patient care,” he says.
At the Boston-based integrated health system Partners Healthcare, the Center for Connected Health is leading the use of technology to deliver care outside of a hospital or doctor’s office. The Connected Health program has implemented a number of remote monitoring initiatives focused on heart failure patients, diabetes management, high blood pressure and activity and weight programs. The Partners Healthcare at Home congestive heart failure program has resulted in significant decreases in 90-day re-hospitalizations and improvements in mortality. And, Partners has seen significant success with the Blood Pressure Connect home monitoring program as well.
Joseph Kvedar, M.D., vice president of Connected Health, Partners Healthcare, says, “What makes these programs work well is the same that makes other programs work well—the use of the data feedback loop to educate patients about how their lifestyle affects their illness and, secondly, the ability to reach into their lives and make changes. Those two reproducible value propositions—self-care and just-in-time care—pervade through these programs.”
Through its Research and Innovation platform, Partners’ Connected Health also conducts a number of innovative research projects, including the development of a mobile app to help patients in palliative care better self-manage cancer pain.
Joseph Kvedar, M.D.
“It’s a combination of education and interactivity on the mobile app that allows patients to take charge of how they manage their pain medication. It’s quite topical given the attention to opioids across the country right now. And that program is going quite well as we’ve found that use of the app tends to reduce patients’ overall pain score,” he says.
Hurdles to mHealth Adoption
While leading-edge health systems and hospitals are moving forward to leverage connected health technologies, health IT leaders say there are still significant hurdles—around data integration and governance, data security, patient education, clinician workflow and reimbursement—that must be addressed to successfully implement and sustain mHealth programs. And, time and again, health IT leaders say the biggest challenge is more cultural than technical.
“We’ve hit a tipping point where the technology is there and I think we have the ability to do some great things. But now we have to work through the culture of what people are used to. I think it’s a good problem to have and it’s an easier problem to solve,” McCallister says.
Beyond behavioral changes and looking at the overall healthcare landscape right now, healthcare providers looking to shift to value-based reimbursement will have much greater momentum behind their mHealth strategy, Kvedar says.
“If you are still in a fee-for-service world, there is very little about this that makes sense. You’ve got the Medicare reimbursements, but that’s the only real driver. If you’re really considering that the world is going to value-based payments, then this is a great opportunity for you to get involved early and get some things figured out before they hold your feet to the fire,” he says.
Many health IT leaders say that healthcare providers need to clarify their thinking about the economics of mHealth to really reap the benefits.
Even the most forward-thinking organizations that are embracing value-based payment tend to ask, How do I pay for it? How does it get reimbursed? Rather, Kvedar says, healthcare leaders should think of mHealth programs as a business expense to improve practice efficiency, resulting in better patient management and better performance on risk-based contracts.
In January 2015, The Centers for Medicare & Medicaid Services (CMS) issued a rule allow for reimbursement of remote (non-face-to-face) chronic care management services for patients with multiple chronic conditions.
“That’s a perfect opportunity to bill for some telemonitoring work. It’s still early stage and not a lot of people are taking advantage, but it is a reimbursement opportunity,” Kvedar says.
Seeing first-hand how the use of mobile apps can improve chronic conditions, such as diabetes, through clinical trials, Kvedar envisions the day when mHealth becomes a routine part of healthcare delivery. “Imagine a future where your doctor might say, You need to take this medication and then please download this app because we know that if you use it, you’ll be more active and be generally healthier.”