New Ideas About Human Behavior in Economics and Medicine, Peter Orszag, Director of the CBO, October 16, 2008

The current economic crisis emerged because as a nation we have been consuming more than we have been producing, and borrowing the difference. Poorly thought through banking regulations made credit too easy, and millions of Americans borrowed against their homes to finance consumption. Because economic growth depended on the “American Consumer”, policymakers rationalized, denied, and delayed addressing the problem. Home prices rose, borrowing rose, people used rising home prices to service debt and to consume. The resulting credit bubble burst, as every credit bubble does, deflating the assets of millions and costing millions more their jobs, their homes, and their security.

Beyond the housing credit bubble, a bigger fiscal challenge looms: Productivity in our economy is fundamentally shifting due to the demographics of an aging population. As baby boomers retire, our economy shifts further in the direction of producing less while consuming more, especially in health care. It is possible that technology will improve productivity, and people may postpone retirement. On the other hand, health care costs may rise faster than projected because of the epidemic of obesity and resulting chronic illness. In any case, there is little doubt that current spending trend is not sustainable.

When the next economic crisis hits, we will look back and see that despite clear warning and plenty of hard data, policymakers had delayed, denied, rationalized and obfuscated any meaningful reform to our currently ill-thought out health policies that already fuel over $2 trillion a year in health care spending.

At an institutional level, incentives must be changed to encourage more efficient models of chronic care. Half of health spending is the result of chronic illness. Complications can be prevented through better monitoring, management and prevention, yet we are painfully slow to implement policy changes that could accelerate innovation and adoption. At an individual level, baby boomers need accelerated innovation in technologies, products, and services that help them keep physically and mentally fit in order to stay productive longer in a highly competitive global information-based economy.

It is a law of nature that anything unsustainable must and will change. The only question is whether or not we will make the changes proactively and thoughtfully, or the changes will be imposed on us painfully and in a crisis. Recent CBO reports contain a glimmer of hope: Because a substantial part of health care spending is driven by human behavior, these are not fixed costs. How doctors practice medicine, or how patents communicate with doctors, and how we live our lives are all major factors in the future trend of health spending.

Many of the same factors that can reduce health care spending, like healthy lifestyle choices and continuous learning that promotes brain fitness, also enable us to be more productive in the global economy. The next financial tsunami is not inevitable but perhaps we can do something about it.

If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of our democracy, tonight is your answer.

It’s the answer told by lines that stretched around schools and churches in numbers this nation has never seen, by people who waited three hours and four hours, many for the first time in their lives, because they believed that this time must be different, that their voices could be that difference.

It’s the answer spoken by young and old, rich and poor, Democrat and Republican, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled. Americans who sent a message to the world that we have never been just a collection of individuals or a collection of red states and blue states.

We are, and always will be, the United States of America.

It’s the answer that led those who’ve been told for so long by so many to be cynical and fearful and doubtful about what we can achieve to put their hands on the arc of history and bend it once more toward the hope of a better day.

It’s been a long time coming, but tonight, because of what we did on this date in this election at this defining moment change has come to America.

I typed the word “economy” into the search engine Google today, and saw that BarackObama.com is the third search result on the list out of 254,000,000 sites in the Google index. This is an amazing feat of Search Engine Optimization.

There are three fundamental ways to get attention on the Internet: pay for it, word of mouth, or through organic search results.

Paying for traffic by purchasing keywords from Google is expensive. It is so expensive to buy traffic that Google brought in a record $5.5 billion revenues for the three months ending September 30, 2008.

Word of mouth is the power of social networks like Facebook and Myspace. Information that we post travels through our newsfeed with lightning speed to our friends, even faster than we can email a YouTube video.

Organic search is perhaps the most important way of obtaining traffic. When we are seeking something, most of us start with a Google search. Traffic that comes in from a search result tends to be the most relevant. Rarely do we make it past the first page or two of Google results, however, before clicking on a search result or trying a new search term.

How does a website end up “above the fold” on the first Google result page out of 254,000,000 results? The exact Google algorithm is a well kept secret that Google keeps adjusting and updating, but the basic PageRank concept that Google patented 7 years ago still provides the underlying model. Google is looking for the center of attention, and their computers rank pages based on quantity and rank of the pages that are pointing to it.

Google PageRank Patent

Because lots of other sites copy content and use artificial means to get other sites to link to them, the algorithm needs to be updated constantly to do a better job of identifying original rather than copied content and to identify and discount and paid or artificial links. The way to be at the top of the list is to have quality original content useful enough to inspire lots of other quality sites to reference, plus Search Engine Optimization or SEO.

Winning SEO combines high quality, high utility content that is highly relevant to a keyword, together with coding that ensures the Google robots are able to find and prioritize the keyword you are optimizing, and intentional strategies to get high quality sites to link to your site with the intended keyword. This usually does not happen by accident. The appearance of BarackObama.com near the top the first page for a generic keyword like Economy can only be the result of very thoughtful and diligent SEO practice.

Fascinated by the ability of the Barack Obama campaign to land near the top of the list for the number one campaign issue, while JohnMcCain.com is nowhere to be found, I looked at other election issues, starting with the CNN issue list below and then adding some variations.

CNN Election Issues 2008

Here are the results. I marked each CNN issue with a plus sign in the left column. The number of searches is for the month of October 2008, as determined by the Google keyword tool made available to advertisers would like to know which keywords to purchase and how many results to expect. The Index Pages indicates just how many web pages Google has in its database competing for the given keyword.

After you do a search, Google generally shows 10 results per page, plus a sprinkling of results from other Google services like news, books, blogs and videos. I only counted actual search results, not Google promoted links. When I searched for the issue term, I looked up to four or five pages deep, and I noted the page that either BarackObama.com or JohnMcCain.com came up in the list, along with the actual placement rank.

Not just for “economy” but for many of the top issues, BarackObama.com appeared on the first or second pages, including first page results for the hottest issues as measured by actual search queries: healthcare, energy, and immigration. JohnMcCain.com was also on the first page for healthcare, and made page one for climate change and national security, but in general the John McCain website had far fewer search results for far fewer issues than Barack Obama.

In the book Click: What Millions of People Are Doing Online and Why it Matters, Bill Tancer provides an inside view into just how much data about our online behavior is routinely collected and what those clicks reveal about the thoughts and intentions of a population. As head of Global Research for Hitwise, a web analytics company now part of credit ratings giant Experian, Bill Tancer has at his fingertips a continuous datastream from 25 million Internet users, collected anonymously through Internet Service Providers (ISPs). It must be even more fascinating to see Google’s data, as the most common act we do when we are interested in something is to type it into a search engine.

After reading Bill Tancer’s book, I put some of the ideas to the test with my own research based on web analytics made publicly available for free from Google and from Compete.com. If Internet behavior is an indicator of the intentions of a population, then what can we learn about the current political campaigns of Barack Obama and John McCain? For a sense of perspective, I also included Hillary Clinton in my comparison. The Compete.com graph shows unique monthly visitors to BarackObama.com, JohnMcCain.com and HillaryClinton.com. Despite steady growth in visits to JohnMcCain.com in recent months, BarackObama.com led JohnMcCain.com in website visits for September by over 2.4 million monthly uniques visitors, with 5.5 million unique visitors to BarackObama.com compared to 3.1 million unique visitors to JohnMcCain.com.

BarackObama.com v. JohnMcCain.com v. HillaryClinton.com on Compete.com

On Google.com/Trends, Google reveals trends in the data it collects and records on what people have been typing into the search engine. I compared searches for Barack Obama, John McCain and again Hillary Clinton for all searches originating in the United States over the past 12 months. While searches for John McCain briefly overtook Barack Obama around the time of the Republican Convention, Barack Obama has had a steady lead.

Barack Obama v. John McCain v. Hillary Clinton in Google Trends

Zooming in to searches conducted in the past 30 days, we can see that interest in both candidates continues to increase as we get closer to election day on November 4. Barack Obama’s lead over John McCain in search traffic has accelerated, and by the end of October, Google searches for Barack Obama led John McCain by about 2.5 to 1.

30 Day Google Trends: Searches for Barack Obama v. John McCain v. Hillary Clinton

Google also gives us the top locations for search traffic, so we can easily see the top geographic hot spots for presidential candidate search terms, which should correlate to what people are thinking and talking about.

Top Regions for Presidential Searches on Google

Not surprisingly, there is a high overlap between the areas with the most searches for presidential candidates and the battleground states where the campaigns are the most intense. All of the key battlegrounds except Florida are in the top 10 regions in terms of presidential candidate search traffic, with the hottest races in Indiana, Ohio, North Carolina and Missouri at the top of the list.

Battleground States Map from New York Times

One of the insights Bill Tancer demonstrates in the book Click is how traditional television media can drive search traffic. A television advertisement can raise awareness of an issue, and then lead us or even explicitly give us a “call to action” to go to the Internet to dig deeper.

It is easy to jump to conclusions, because with the free web analytics used here, we don’t know what motivates the search behavior. It might easily be buzz about a parody of a candidate on Saturday Night Live, Steven Colbert, or the Daily Show with John Stewart, with a flurry of web searches to catch the clip on YouTube or Hulu.com. Some things we know for sure. First, the objective behavioral data of the Internet has proven many previously untested assumptions to be wrong. Second, despite the fact that campaigns produce more 30 second television sound bites than ever, our ability to dig deeper and learn more for ourselves means that it is a completely new world this time around.

Yes, We Can! – Si, Se Puede!

Song & video by Will.i.am of The Black Eyed Peas. Inspired by Barack Obama’s ‘Yes We Can’ speech.

http://www.yeswecansong.com

http://www.barackobama.com

It was a creed written into the founding documents that declared the destiny of a nation.

Yes we can.

It was whispered by slaves and abolitionists as they blazed a trail toward freedom.

Yes we can.

It was sung by immigrants as they struck out from distant shores and pioneers who pushed westward against an unforgiving wilderness.

Yes we can.

It was the call of workers who organized; women who reached for the ballots; a President who chose the moon as our new frontier; and a King who took us to the mountaintop and pointed the way to the Promised Land.

Yes we can to justice and equality.

Yes we can to opportunity and prosperity.

Yes we can heal this nation.

Yes we can repair this world.

Yes we can.

We know the battle ahead will be long, but always remember that no matter what obstacles stand in our way, nothing can stand in the way of the power of millions of voices calling for change.

We have been told we cannot do this by a chorus of cynics…they will only grow louder and more dissonant ……….. We’ve been asked to pause for a reality check. We’ve been warned against offering the people of this nation false hope.

But in the unlikely story that is America, there has never been anything false about hope.

Now the hopes of the little girl who goes to a crumbling school in Dillon are the same as the dreams of the boy who learns on the streets of LA; we will remember that there is something happening in America; that we are not as divided as our politics suggests; that we are one people; we are one nation; and together, we will begin the next great chapter in the American story with three words that will ring from coast to coast; from sea to shining sea –

Yes. We. Can.

Featuring: Jesse Dylan, Will.i.am, Common, Scarlett Johansson, Tatyana Ali, John Legend, Herbie Hancock, Kate Walsh, Kareem Abdul Jabbar, Adam Rodriquez, Kelly Hu, Adam Rodriquez, Amber Valetta, Eric Balfour, Aisha Tyler, Nicole Scherzinger and Nick Cannon

This is the presentation I gave for the Emerging Opportunities in Home Management and Health Applications session of the Connections Digital Living Conference hosted by Parks Associates and CEA, May 4, 2006.

Connections Digital Living Conference Transcript

• Wiring the world for a new model of health care
  Steve Brown, CEO, Health Hero Network
  Emerging Opportunities in Home Management and Health Applications
  Connections Digital Living Conference, May 4, 2006
• Health Hero Network
  Our mission is to create a better system of care serving people who struggle with chronic conditions
• US Healthcare in 2006
  16% GDP
  $2,100,000,000,000
• US Healthcare in 2015
  20% GDP
  $4,000,000,000,000
• Portion of healthcare spending on people with chronic conditions
  78%
• What does it all add up to?
  $69,900,000,000,000
  -Present value of unfunded liabilities in Medicare,
  Federal Reserve Governor Edward Gramlich, April 21, 2005
• What’s Our Diagnosis?
  The current model of institution-centered care, based on crisis response, with inadequate attention to managing chronic conditions, is not sustainable and must change
• Chronic Conditions Defined
  Conditions that can’t be cured but must be managed
  Often caused or made worse through behavior
  Lifestyle factors: Smoking, obesity, stress
  Can be improved through behavior change
  Medication compliance, diet, exercise
  Early detection and intervention
  Patients cannot be passive
• Disease Management Defined
  Disease Management Association of America:
  “Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.”
• A Brief Look at the Past … and Future?
  Early-Mid 1990s: Managed Care
  Payers monitoring physicians
• A Brief Look at the Past … and Future?
  Late 1990′ – Present: Disease Management
  Payers monitoring patients
• A Brief Look at the Past … and Future?
  The Future: Physicians monitoring patients
  Accountability to payer
  Technology Supported Chronic Care
• What’s “Telehealth” Got to Do With It?
  Chronic care improvement
  = Moving health care to the home
• How to Move Healthcare to the Home
  Nurses with phones?
  Nurses with cars?
  Doctors with phones and cars?
  Technology!
• VA Chronic Care Model
  Daily education, monitoring and feedback at home
  Personalized care management and support
• Health Buddy – Patient Interface
  Symptom management, education, feedback
  FDA cleared communication hub for third party medical devices
• Health Buddy – Provider Interface
  Daily patient status and reports
  EMR integration
  Content development tools
  Clinical programs include
  CHF*
  COPD*
  Hypertension*
  Diabetes*
  Asthma
  Coronary ArteryDisease
  Post CABG
  Osteoarthritis
  Sleep Apnea
  Obesity
  Cancer
  HIV/AIDS
  Dementia
  Depression
  PTSD
  Schizophrenia
  Bi-polar
  Spinal cord injury
  Palliative care
  *NCQA Certified
• VA Chronic Care Results
  Veterans Administration Community Care Coordination Service, Florida
  63% reduction in hospital admissions
  60% reduction in hospital bed days of care
  Published in: Disease Management, Volume 5, Number 2, 2002
  Veterans Administration Heart Failure Study
  81% reduction in inpatient bed days
  Published in: Telemedicine and e-Health Volume 11, Number 1, 2005
• Model at Work Outside VA
  New England Medical Center SPAN-CHF II
  72% reduction in HF hospitalizations
  63% reduction in cardiac hospitalizations
  Presented at Heart Failure Society of America, 2005
  Henry Ford Health System Obesity Study
  >10 lbs weight loss in treatment group
  <.01 lbs weight loss in control group
  To be Published 2006
• Medicare Modernization Act:Section 721
  Section 721: Chronic Care Improvement Defined for Medicare FFS
  1. ELEMENTS OF CARE MANAGEMENT PLANS.—A care management plan for a targeted beneficiary shall be developed with the beneficiary and shall, to the extent appropriate, include the following:
  (A) A designated point of contact responsible for communications with the beneficiary and for facilitating communications with other health care providers under the plan.
  (B) Self-care education for the beneficiary (through approaches such as disease management or medical nutrition therapy) and education for primary caregivers and family members.
  (C) Education for physicians and other providers and collaboration to enhance communication of relevant clinical information.
  (D) The use of monitoring technologies that enable patient guidance through the exchange of pertinent clinical information, such as vital signs, symptomatic information, and health self-assessment.
  (E) The provision of information about hospice care, pain and palliative care, and end-of-life care.
  2. CONDUCT OF PROGRAMS.—In carrying out paragraph (1)(C) with respect to a participant, the chronic care improvement organization shall—
  guide the participant in managing the participant’s health (including all co-morbidities, relevant health care services, and pharmaceutical needs) and in performing activities as specified under the elements of the care management plan of the participant;
  use decision-support tools such as evidence based practice guidelines or other criteria as determined by the Secretary; and
  develop a clinical information database to track and monitor each participant across settings and to evaluate outcomes.
• Medicare Modernization Act:Section 722
  Section 722: Chronic Care Improvement Required in Medicare Advantage
  (2) CHRONIC CARE IMPROVEMENT PROGRAMS.—As part of the quality improvement program under paragraph (1), each MA organization shall have a chronic care improvement program. Each chronic care improvement program shall have a method for monitoring and identifying enrollees with multiple or sufficiently severe chronic conditions that meet criteria established by the organization for participation under the program.
• A New Hope
  Creative public policy can unlock resources for programs that improve chronic care and save money
  Creative business solutions can enable private sector to take risk and guarantee results
  Information technology can enable systems of care that ensure best practices and measure performance

Washington, DC – December 12, 2005 — Health Hero Network is demonstrating its home health monitoring technology today at the once-a-decade White House Conference on Aging (WHCoA). The hands-on technology exhibition is hosted by the Center for Aging Services Technologies (CAST) to show technologies available to help meet the demands of the rapidly growing population of aging Americans and their caregivers. Health Hero Network will demonstrate how its Health Buddy® system can transform care for seniors with chronic illnesses by coaching and educating them to manage their conditions at home and enabling care providers a daily connection to check on their patients.

Health Hero Network develops the Health Buddy system, which provides coaching, education and monitoring for patients with chronic conditions. A countertop appliance called the Health Buddy appliance is used in the patients’ home to provide a daily dialog of questions about the patient’s condition, as well as reminders and information for improved self-care. Care providers access the responses on a secure website, so they can monitor multiple patients simultaneously and intervene early if a condition is at risk of deteriorating.

“The White House Conference on Aging and the Center for Aging Services Technologies are calling attention to a looming crisis in this country – how to care for the largest population of older people the country has ever known,” said Steve Brown, CEO of Health Hero Network. “As the population of older people grows, so does the number of people with chronic conditions. Health Hero Network is acting now to address that issue before it becomes a crisis. We’re improving quality of chronic care by helping patients manage their own conditions, while also helping physicians care for the growing number of people with chronic illness.”

The Health Buddy system is currently being used in disease management, government, home care, hospital, Medicare, Medicaid, and research markets.

Health Hero Network will be showing its Health Buddy system at the CAST Imagine Pavilion (Booth #7) at the WHCoA on December 12-13, at the Marriott Wardman Park Hotel in Washington, D.C.

About CAST
The Center for Aging Services Technologies (CAST) is leading the national charge to develop and deploy technologies that can improve the aging experience in America. CAST has four focus areas: 1) driving a national vision of how technologies can improve the quality of life for seniors while reducing healthcare costs; 2) accelerating technology R&D pilots with seniors to prove out this vision, 3) advocating to remove barriers to the rapid commercialization of proven solutions; and 4) promoting national dialogue about standards to insure interoperability and widespread access to aging services technologies. Established in 2003, CAST (www.agingtech.org) has become a national coalition of more than 400 technology companies, aging services organizations, research universities, and government representatives working together under the auspices of the American Association of Homes and Services for the Aging (www.aahsa.org). The members of AAHSA serve 2 million people every day through mission-driven, not-for-profit organizations.

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com.

ALEXANDRIA, VA, – July 5, 2005 — The Centers for Medicare and Medicaid Services (CMS) has selected Health Hero Network, the American Medical Group Association (AMGA), and medical groups in Washington and Oregon to demonstrate how doctors can use home health monitoring technology to help Medicare patients with severe chronic illness live healthier, happier, longer lives – and reduce Medicare spending by preventing hospitalizations. The medical groups are Bend Memorial Clinic in Bend, Oregon, and Wenatchee Valley Medical Center in Wenatchee, Washington. The medical groups will implement a physician-led, technology-supported care management program for up to 2,000 Medicare beneficiaries with congestive heart failure, chronic obstructive pulmonary disease, and/or diabetes.

The group has named its effort the “ACCENT Project” — Advancing Chronic Care through E*Health Networks and Technologies. It is one of six projects selected by CMS under the Care Management for High-Cost Beneficiaries Demonstration. The CMS initiative will test approaches for transforming how doctors and hospitals provide care for high-cost Medicare patients with severe, complex chronic conditions. The goal is to improve the quality of life for these patients while significantly reducing costs. The ACCENT Project is notable among awardees because it will be conducted across multiple sites and because of its robust use of health information technology.

“The ACCENT Project will demonstrate that doctors and patients with severe chronic illness, supported by information technology, can establish a new partnership to provide exceptional preventive care for patients in their homes, and keep them healthier and living independently longer while reducing costs,” said AMGA President Donald W. Fisher, Ph.D. “CMS is rightfully coming to focus on creative new approaches to managing high-risk patients with chronic conditions. They are suffering under the current, crisis-driven approach to care, and they account for most health care spending. We look forward to partnering with CMS to show how medical groups supported by health information technology will produce great results for Medicare beneficiaries and taxpayers.”

CMS is requiring that Care Management for High-Cost Beneficiaries Demonstration awardees demonstrate improvements in the quality of care for high-cost Medicare patients who represent most of the program’s expenditures. Awardees are guaranteeing to CMS that they will save at least 5 percent of the total Medicare costs for the patients assigned to them.

The ACCENT Project’s key technology component is the Health Buddy system from Health Hero Network. Doctors and nurses at Bend Memorial Clinic and Wenatchee Valley Medical Center will use the Health Buddy appliance to coach patients at home about preventive behaviors that will keep them healthy. The doctors and nurses will use data generated by the Health Buddy appliance to spot problems and intervene early, before patients get so sick that they need to go to the emergency room or be hospitalized.

The ACCENT Project is slated to begin on January 1, 2006, and will last three years. CMS will assign to the ACCENT Project a patient population of approximately 2,000 patients who are already under the care of physicians at Bend Memorial Clinic and Wenatchee Valley Medical Center. Project coordinators will then actively recruit, enroll and manage CMS-assigned patients with the active cooperation of medical group physicians.

Beneficiary participation in the programs will be voluntary and will not change the amount, duration or scope of participants’ fee-for-service Medicare benefits. Fee-for-service Medicare benefits will continue to be covered, administered and paid under the traditional Fee-for-service Medicare program. Programs will be offered at no charge to the beneficiary. Organizations chosen for the demonstration will not be able to restrict beneficiary access to care or restrict beneficiaries to a limited number of physicians in a network.

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com.

About Medical Group Association
The American Medical Group Association (AMGA) represents medical groups, including some of the nation’s largest, most prestigious integrated healthcare delivery systems. AMGA advocates for the multispecialty medical group model of healthcare delivery and for the patients served by medical groups through innovation and information sharing, benchmarking, leadership development, and continuous striving to improve patient care. The members of AMGA deliver health care to more than 50 million patients in 42 states, including 15 million capitated lives. Headquartered in Alexandria, Virginia, AMGA is the strategic partner for medical groups providing a comprehensive package of benefits, including political advocacy, educational and networking programs and publications, benchmarking data services, and financial and operations assistance. For more information, visit www.amga.org.
Contact: Julie Sanderson-Austin, RN, VP, Quality Management and Research, 703/838-0033, ext 356, jsanderson-austin@amga.org

About Bend Memorial Clinic
Offering primary and specialty care since 1946, Bend Memorial Clinic includes 70 physicians representing 13 branches of medicine. It is the largest multi-specialty group east of the Cascades and functions as a comprehensive referral center for physicians and communities throughout the state. At Bend Memorial Clinic, your health is our passion.
Contact: Kim Barnes, Director Marketing & Business Development, 541-317-4370, kbarnes@bmcllp.com

About Wenatchee Valley Medical Center
Wenatchee Valley Medical Center, established in 1940, is a multi-specialty group with offices in seven communities in North Central Washington, serving an area of approximately 12,000 square miles. The medical center was founded on a commitment to serve patient needs by providing the highest quality healthcare and services in an atmosphere of concern and caring, with an organizational commitment of assisting in the development of one of the nation’s best rural healthcare delivery systems. Today, approximately 210 physicians and midlevel providers represent over 30 specialties and subspecialties and provide comprehensive medical and ancillary services to patients.
Contact: Richard Bennett, Assistant Administrator, 509-663-8711 ext. 5084, rbennett@wvmedical.com

=========================================================

HEARING

before the

SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

__________

WASHINGTON, DC

__________

JUNE 30, 2005
STATEMENT OF MR. STEPHEN J. BROWN, PRESIDENT AND CEO, HEALTH
HERO NETWORK, INC., MOUNTAIN VIEW, CA

Mr. Chairman and Committee members, I am Steve Brown, and I am the CEO of Health Hero Network, a technology company in Mountain View, CA.

We serve people struggling with chronic illness. Our technologies are designed to enable caregivers to coach and monitor patients at home. I am going to talk about some of the commonsense things that Senator Lincoln talked about, and I am also going to talk about some of the programs we are involved with, which hopefully will make the CBO happy about the results as well.

My view is that health care does not start when we are wheeled into the emergency room, and it does not start at the doctor’s office. Health care starts at home, with our own behavior and with prevention.

Most people in Medicare have a chronic illness. For them, prevention means reducing the complications of chronic illness and living independently longer. From our work with the Veterans’ Administration, we have seen that when caregivers and patients work together on daily management and prevention, they can improve the quality of life and reduce costs.

To illustrate this point, I am going to introduce Wally Browning from Huntington, WV, who recently was interviewed in his local paper. I included this in the written testimony.

Wally Browning is a Vietnam veteran. He served our country in Vietnam, and now he is being served by the VA and by Health Hero Network.

Wally has congestive heart failure, one of those high-cost, high-risk conditions that require very close attention and management. It is also one of the leading causes of hospital admissions for Medicare.

Every day a nurse at the VA checks in on how well Wally is doing, remotely, by sending message to a device installed in Wally’s home, called Health Buddy, and I brought that for you to see too.

With simple push buttons, Wally is able to answer questions that appear on the screen and tell his nurse how he is doing; tell his nurse about new symptoms transmit data about his blood pressure and his weight and also get feedback and coaching from his nurse about his condition and about his health program and about healthy choices that he needs to make.

A VA nurse uses a computer with a secure Internet application to analyze Wally’s data every day and flag potential problems before they become worse. The result has been fewer emergencies, fewer stays in the hospital, greater peace of mind, and cost savings for the VA. As Wally puts it, after he checks in with his Health Buddy, he feels like he is good for another day.

Wally is like 20 million Americans with complex chronic illnesses who are at risk of going to the hospital any day. Many of these hospital admissions can be prevented if we coach and monitor patients at home.

The reason our health care system is in trouble, even though we spend nearly $2 trillion a year on it, is that we are not paying for the right model of chronic care. For 40 years, Medicare payment has been based on episodic, face-to-face encounters with a doctor, usually in reaction to a crisis.

But chronic illness is not episodic. It is long-term, and it needs to be managed every day. If we want to prevent hospitalizations, we need to coach and monitor patients at home before a crisis occurs.

We know it is possible because we are doing this every day across America for thousands of veterans. According to the VA, hospital admissions for patients in the program were 63 percent lower than for a comparison group with similar high-riskconditions.

Last year, we worked with the Information Technology Association of America to look at the question. What if Medicare could achieve similar results to the VA with similar patients? The answer published by the ITAA–and that report is also in the written testimony–is that we would save over $30 billion a year.

As a result of your leadership and that of your colleagues, the Medicare Modernization Act starts to recognize that people with complex chronic illness need continuity of care and prevention rather than more episodic crisis management. That is a major step forward for Medicare, and now the challenge is execution.

We are participating in two large-scale chronic care improvement pilots authorized by the Medicare Modernization Act. We are also working with the American Medical Group Association and its physician groups, like the one in Bend, OR, to create a chronic care model based on coaching and monitoring patients at home, under the supervision of their primary physician.

Part of the wisdom of the recent Medicare initiatives is in recognizing how technology can play a vital role in transforming the model of care for chronic illness. Information technologies can extend care into the home and coach patients to improve their own lives and change their own behavior. Caregivers can detect early and deliver the right care at the right time before there is a crisis.

Health care and prevention starts at home, and the right technology can help people struggling with chronic illness and connect them to better care. I thank you for inviting me to testify today.

http://aging.senate.gov/hearing_detail.cfm?id=270687&

WASHINGTON, DC – June 8, 2005 – Health Hero Network, Inc. today is demonstrating its new Health Buddy® system on Capitol Hill to show health policy leaders how technologies can improve chronic care by coaching and monitoring patients at home. As one of the few companies invited to participate in the Tech Demonstration Day, Health Hero Network will show how the Health Buddy® system is playing a leading role at the Veterans Administration (VA) in improving quality of care and reducing costs for the VA’s highest risk patients with severe chronic illness. The Health Buddy system will also be included in upcoming landmark Medicare demonstration programs.

The seminar and all-day technology demonstration is hosted by the eHealth Initiative and the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics.” The event is attended by Congressional leaders and government decision makers who are committed to improving the quality of health care.

“Coaching and monitoring patients at home is a key element of transforming and improving chronic care,” said Steve Brown, Health Hero Network’s CEO. “The attendees of today’s event will have the opportunity to see first hand how information technology can enable chronic care improvement by connecting people at home with chronic illness to proactive and preventive healthcare services.”

The eHealth Initiative is a non-profit affiliated organization whose mission is to drive improvement in the quality, safety, and efficiency of healthcare through information and information technology. The Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” is now in its 12th year

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com.

In the 2004 election, I had offered to help Steve Poizner campaign for a state legislature seat. Steve had an extraordinarily positive spirit that clearly served him well as an entrepreneur. He had achieved great success in business, but remained humble and dedicated, walking door to door to get to know his community and to listen to their concerns. I admired his attitude and approach, and decided to help out.

On election day, I went to my assigned polling places, checked lists to see who had voted, and called people to “get out the vote”, offering a ride if to the polling place if needed. I couldn’t see how my small effort could make a difference, but in the end, Steve lost by only a few votes. I regretted not making more calls.

We have intractable challenges in health care, which will consume $1.7 trillion in the United States this year. We seek leaders with the courage and the humility to take on the challenge of reform. Do you think that anything will change in the next four years?

Have you ever had an experience where you go to the doctor and find yourself filling out the same three-page form asking for the same information that you have filled out many times before?

Or an experience where the one medication that really seems to work for your child is not covered by your insurance without an appeal, and each time you need a refill, they seem to have lost the results of your appeal and need to start over?

I remember one visit to a local medical center that I won’t name other than to say that it is in the heart of Silicon Valley. Without an electronic medical record, I remember the doctor asking me in earnest, “Think, Steve, think! When did you have your last tetanus shot?”

We all have stories and personal experiences of the inefficiencies of our healthcare system.

Some of us may have started to see some new ideas based on the Internet making their way into the mainstream, ideas that open our eyes to new possibilities for a better and more efficient healthcare system. We can go to the Internet to research treatment options, schedule doctor visits, get personalized advice and feedback, and look up our own personal medical records. Maybe Silicon Valley ideas can help transform healthcare, as they have in other major fields.

Yet healthcare costs continue to explode, and it is bankrupting our government. Let me tell you why.

In San Jose, California, just south of Silicon Valley, a farm worker will show up at the Valley Medical Center emergency department with a foot ulcer that has become unbearable and has gangrene, a complication of diabetes. He has been to the hospital many times before, but no one will have any records, or know his history. He will spend 10 days in the hospital, where his foot will be amputated. He doesn’t have insurance, and now he won’t be able to work, either.

Then he will be sent home, where no one will be helping him manage his diabetes until the next crisis, when the cycle will repeat.

Any doctor will tell you that this is the most expensive and most painful way to treat diabetes. The tab will be picked up by Valley Medical Center and passed on to taxpayers, one way or another.

Just across Highway 101 from wealthy Palo Alto, a child lives with asthma in East Palo Alto. She will go to the Stanford Hospital emergency department for the 10th time this year, unable to breathe, parents in a panic. This time the child will be admitted to the hospital for three days.

Then she will be sent home with no support in monitoring and managing her asthma to prevent the next crisis. The cycle will repeat.

Med-Cal will be charged tens of thousands of dollars, not to mention the missed school days, the missed work for the parents, and the mental trauma of constantly living from crisis to crisis.

Within a few miles of the headquarters of Google, Yahoo, Cisco Systems, Intel, Sun, Hewlett Packard, and eBay, an 85-year-old woman lives alone in Mountain View with congestive heart failure. She will have a doctor’s appointment tomorrow. Everything will appear to be fine.

Tomorrow evening she will have difficulty breathing. By Friday she will be retaining fluids. No one will know. But she won’t call her doctor because she just had a visit and everything was fine.

Saturday she will feel worse and her legs will be swelling, but it is the weekend and she doesn’t want to bother her doctor. On Sunday, she will dial 911, and will be admitted to El Camino Hospital, where she will stay for 10 days to get stabilized.

Then she will be sent home again, alone, with no one monitoring or managing how she is doing, and the cycle will repeat.

Medicare will be billed tens of thousands of dollars.

Do any of these cases sound familiar? How many of you know someone with diabetes? Asthma? Congestive heart failure? How about emphysema or COPD? Hypertension? Coronary artery disease? Depression, or another mental health issue?

Do you know what these conditions have in common? They are all chronic conditions that need to be monitored and managed every day. If they aren’t, they get worse until you end up in the hospital.

Just how big is this issue? Chronic disease accounts for a vast majority of the $1.7 trillion that will be spent on healthcare in the United States this year. In the State of California, chronic disease accounts for most of the $200 billion we will spend on healthcare.

This year, there will be over 450,000 hospital admissions in California for the 7 chronic conditions I mentioned. That’s right, 450,000 acute care hospitalizations, costing $15 billion, for chronic conditions that can and should be monitored and managed before they become an acute crisis.

In public health these are called “ambulatory care sensitive hospital admissions”, which means, hospital admissions that you might have been able to prevent, if you had better care before you ended up in the hospital.

Here is the interesting part: If you look at who is paying the bills for hospitalizations that result from our failure to properly care for patients with chronic disease, over 70% is paid for by government: Medicare, Medi-Cal, cities and counties.

So how can we do it better? Let me share a few stories from my experience as CEO and founder of Health Hero Network, a Silicon Valley technology company focused on improving chronic care.

Our product is the Health Buddy® system, a home health monitoring system that links patients at home with care providers on a daily basis. A simple countertop messaging device connected to the phone line educates patients about their disease, guides them in daily self-care, and monitors symptoms. The data is transmitted to nurses and doctors, who use web-based tools to quickly see which patients are having problems before the condition becomes a crisis.

Working together, we have shown that public health nurses can monitor and educate uninsured farm workers with diabetes, heart failure, and hypertension. By improving self-care at home, and by identifying problems early when they still could be treated in a community health center, these program have cut hospitalizations in half, and saved millions of dollars per year.

We have shown that hospital case managers can monitor, educate, and support children with asthma covered by Medicaid. Kids learn about medications and symptoms, and begin to recognize and prevent impending asthma attacks. These kids gain confidence that they can live normal lives, while cutting their need to go to the emergency department to a fraction of what would have been expected.

We have helped nurses and doctors at the Department of Veterans Affairs to reduce hospital admissions for chronic diseases like heart failure, diabetes, COPD, hypertension, and depression by an unbelievable 63%, while improving quality of care and support for aging veterans. As a result, the VA is rolling out home health monitoring programs through its medical centers around the country as part of a national chronic care improvement program.

Home health monitoring programs at the VA are an important part of a technology-enabled transformation that has improved quality and access while reducing overall costs by 24%, according to the Undersecretary of Health at the VA who initiated the programs, and this transformation is just getting started.

If Med-Cal could achieve results like the VA, the savings would be $8 billion per year, one billion more than the structural budget deficit that is forcing Californians to compromise on education, roads, and lots of other important things we all care about.

Our experience at Health Hero Network is just one small example of a transformation in healthcare that is starting to take hold around the country. At our last count, 46 states have recognized the opportunity to improve the way they handle chronic care in their Medicaid programs, and have initiated Medicaid transformation projects and chronic care improvement programs.

Sadly, though, California’s response so far has been that “things are so bad right now that we can’t even think about fixing it.” The only ideas to be discussed come down to either cutting services or raising taxes.

That is why we urgently need fresh thinking in our government. We need leaders with the vision to see that it is possible to transform services in ways that improve quality and health care access, and lower costs at the same time. We need leaders with the guts to take on healthcare transformation precisely because our health system is in crisis.

Silicon Valley innovations in technology and the Internet have enabled transformation in just about every other industry to improve services and lower costs.

If the State of California can partner with Silicon Valley to transform healthcare across this state, not only will we improve quality of life for those who suffer from chronic disease, we will also remove a drag on our State budget, and on the economy.

One day we will have a smarter healthcare system in California that can serve those who need it most – without breaking the budget.

One day we will have a new model of care in California that empowers and supports citizens proactively rather than in reaction to a crisis after crisis.

The tools for transforming healthcare are made right here in Silicon Valley. This will be a new growth industry for California, creating jobs and serving a growing need around the world.

This can happen and will happen when we choose leaders who have the vision and courage to step forward and make a difference.

ITAA Press Release: Chronic Care Improvements Could Yield $30 Billion Savings

10-May-04

Arlington, VA – A new white paper from the Information Technology Association of America (ITAA) finds that improvements to the care of Medicare patients with severe chronic conditions could prevent 1.7 million hospitalizations and produce net savings of over $30 billion annually.

“With the Medicare system standing at the brink of insolvency, we know that something must be done,” said ITAA President Harris N. Miller. “By changing Medicare’s emphasis from treating sickness to preserving wellness, America stands to reap enormous rewards. This white paper demonstrates that adopting a technology-based model of chronic care delivery–already proven at the U.S. Veterans Administration–can save taxpayers’ money while helping health care recipients lead longer, happier and healthier lives.”

The ITAA white paper notes that eight million Medicare beneficiaries with five or more chronic diseases-diseases like coronary artery disease, diabetes, hypertension and asthma-account for over two-thirds of the program’s $302 billion in 2004 spending. Moreover, at least 45 percent of the U.S. population, nearly 132 million people, suffers from one or more chronic diseases.

ITAA based its estimate of a $30 billion annual savings by extrapolating the savings produced in a model Veterans Affairs initiative that is focused on improving communication and coordination of chronic care delivery. In one instance, the integrated, technology-based chronic care delivery programs at the Veterans Integrated Services Network in Florida showed a 40 percent reduction in emergency room visits, a 63 percent decrease in hospital admissions, a 60 percent drop in bed days of care, a 64 percent decrease in nursing home admissions, and an 88 percent reduction in nursing home bed days of care. Patient satisfaction rates topped 90 percent. The VA is striving to expand care coordination to 1.2 million veterans by 2008.

ITAA said elements of a technology-based chronic care program must include:

* Communication to support frequent contact with individuals living with chronic disease. The communication should be able to provide the disease management professional with information about the health of the Medicare beneficiary and provide a vehicle for the professional to give feedback to that beneficiary. Such a solution should rely on modern electronic or Internet-based tools to enable frequent and reliable communication between caregiver and patient;
* Personalized patient guidance and education. Technologies exist that can easily guide patients and enable self-assessment, and self-care education. In-home communication devices or Internet-based applications can be integrated with clinical information databases to allow for personalization of patient guidance and self-care education;
* Coordination of care. Technology solutions provide a flow of relevant clinical information that designated care coordinators can use to facilitate collaboration among a patient’s health care providers;
* Quality improvement. An integrated system of electronic communication devices, decision-support tools, and clinical information databases is the best way to ensure and monitor the implementation of evidence-based practice guidelines;
* Accountability. Electronic systems that guide and educate patients and decision-support tools should be integrated with clinical information databases to measure chronic care improvement program outcomes.

ITAA called on policymakers to gain the benefits of chronic care transformation by requiring that Medicare chronic care improvement programs mandated under the Medicare Modernization Act of 2003 embrace approaches that integrate in-home monitoring and communication devices, decision support tools, and clinical information databases; use the authority granted by the Medicare bill to push for faster, more wide-ranging roll-outs of proven chronic improvement strategies; and use the power of the Centers for Medicare and Medicaid Services to push the U.S. health care delivery system to adopt the chronic care improvement model.

The new white paper, titled Chronic Care Improvement: How Medicare Transformation Can Save Lives, Save Money, and Stimulate an Emerging Technology Industry, is available on the ITAA website.

The Information Technology Association of America (ITAA) provides global public policy, business networking, and national leadership to promote the continued rapid growth of the IT industry. ITAA consists of over 400 corporate members throughout the U.S., and a global network of 53 countries’ IT associations. The Association plays the leading role in issues of IT industry concern including information security, taxes and finance policy, digital intellectual property protection, telecommunications competition, workforce and education, immigration, online privacy and consumer protection, government IT procurement, human resources and e-commerce policy. ITAA members range from the smallest IT start-ups to industry leaders in the Internet, software, IT services, ASP, digital content, systems integration, telecommunications, and enterprise solution fields. For more information visit www.itaa.org.

Introduction

One of the greatest opportunities for improving care for Medicare beneficiaries is chronic disease management enabled by eHealth technologies. Effective chronic care requires systematic monitoring and management of patients by their health care providers before conditions become acute, painful and costly. The benefits of eHealth enabled chronic care have been established by leading health care institutions including the Department of Veterans Affairs, which recently published results from over two years of demonstration projects showing 63% reduction in hospital admissions and a significant improvement in the quality of life. Results were for patients enrolled in eHealth enabled disease management programs with major conditions that affect Medicare, including heart failure, diabetes, and respiratory disease.

Unfortunately, most chronic disease management services enabled by eHealth technology – such as in-home patient monitoring technologies and electronic clinical information tools for health care professionals – are not reimbursable under the current Medicare payment system, which generally pays for only face-to-face episodic care. As a result, providers have not adopted these technologies and the development of many quality
improvements enabled by these tools has been slowed.

Congress can remove a significant barrier to more effective chronic care management by updating the Medicare payment system so that 21st century care management solutions can be adopted and used to modernize the health care delivery system. This is a key priority of our organization, the eHealth Initiative (eHI), a non-profit entity with over 100 members representing many of the stakeholders in the health care industry, including hospitals, practicing clinician organization, payers, manufacturers, health care information technology suppliers and academic institutions. eHI’s mission is to drive improvement in the quality, safety and cost-effectiveness of health care through information technology.

Properly reimbursing chronic disease management services that are enabled by eHealth technology tools has many proven benefits including:

• Reducing emergency department and hospital costs by detecting patient problems before they become a crisis.

• Improving patient compliance by educating, motivating and monitoring patients, and by providing patients with timely and relevant information.

• Improving safety and quality by providing timely, relevant, and actionable information to healthcare professionals through quality assured processes that can be continuously improved.

• Increasing access to timely and appropriate care by replacing the current model of isolation and crisis with an efficient and cost-effective model of care based on in-home monitoring, communication and support.

• Providing continuity of care, particularly for the elderly, underserved, and chronically ill who need care the most, through integrated, interconnected monitoring and information systems, rather than fragmented and episodic care.

• Increasing accountability of disease management services as information technology solutions can standardize and streamline quality processes and reporting.

Overall, this translates into better health care for all Americans and holds promise for stemming the dramatically rising costs of medical care.

Remote Health Care Monitoring: An Illustrative Example
Recent legislative efforts to reimburse disease management services coupled with information technology were put forth in the 107th Congress. One example of an approach that could serve as a model for provider-based disease management services, if it were expanded to include a wider range of chronic care, is the Medicare Remote Monitoring Services Coverage Act (S. 1607, H.R. 3572) sponsored by Senators Jay Rockefeller (D-WV) and Olympia Snowe (R-MN) and Representatives Anna Eschoo (D-CA) and Richard Burr (R-NC). The approach in this bill was to use the existing Medicare physician fee schedule, but to redefine the notion of a patient encounter to include certain kinds of remote monitoring determined by the Secretary of Health and Human Services to provide comparable data. Congress should encourage and expand on creative approaches such as the Medicare Remote Monitoring Services Coverage Act and other similar legislation as a way to begin to reimburse health care providers for disease management services with proven benefits in terms of quality of care, access to appropriate care, and cost-effectiveness.

Remote health monitoring and management solutions designed specifically for elderly patients with chronic conditions have been successfully deployed at a wide range of healthcare institutions, including over 20 medical centers and clinics of the U.S. Department of Veterans Affairs. One example of this is Health Hero Network, a model of chronic care management and monitoring in use at the Department of Veterans Affairs,
Mercy Health System, Kaiser Permanente, and other leading healthcare providers. Health Hero Network uses a simple in-home device called Health Buddy that enables care providers to collect data based on clinical protocols and surveys while delivering personalized daily patient education and therapeutic regimen reinforcement. Patients with conditions such as heart failure, diabetes, respiratory disease, and other
conditions use Health Buddy to electronically answer personalized daily questions about disease symptoms, medication regimens, and knowledge, thereby becoming educated in their condition and learning to apply that knowledge toward improving self-care behaviors. Care coordinators and other authorized medical professionals access monitoring results and other patient information on secure websites that include an integrated set of patient enrollment, scheduling and monitoring tools that enable nurses to stay abreast of their patients’ day-to-day conditions and prevent critical situations by providing early intervention. Reports are generated for hospitals or other care centers, and for public administration or insurance payers.

Economic Benefits
For patients with complex chronic conditions, the models of chronic care enabled by eHealth technologies such as in-home health monitoring and management replace isolation and crisis with continuous communication and support. The benefits of reduced hospital admissions, improved quality of care, and increased access to timely and appropriate care are well established. Rather than treating disease complications after
conditions become acute, patients are maintained in a healthier state and disease exacerbations are prevented.

Published results from studies involving over 1000 patients with heart failure, diabetes, and chronic respiratory disease have quantified these results in economic terms:

791 elderly, high-risk, high-cost patients with hypertension, heart failure, COPD, and diabetes participated in a yearlong eHealth demonstration at the Veterans Health Affairs in which most patients were monitored daily using eHealth technologies. Compared to matched comparison group data, the community-based care coordination program reported 40% reduction in emergency room visits, 63% reduction in hospital admissions, 60% reduction in hospital bed days of care, 64% reduction in nursing home admissions, 88% reduction in nursing home bed days of care, and significant improvement in quality of life. These results translate into substantial cost savings, especially for care of patients with complex chronic conditions who account for the greatest portion of healthcare
spending. (Meyer, Kobb & Ryan, 2002).

In a one-year study in Texas of a home-based telemedicine program for a high-risk, underserved population with diabetes, 169 patients were studied using comparative cohort data. The program reported reduction in inpatient admissions reduced by 32% (p <0.07), reduction in emergency room encounters by 34% (p < 0.06), reduction in outpatient visits by 49% (p < 0.001). Improved self-care behaviors were evident by the percent of patients who took their medications more regularly increasing from 41% before the program to over 94% nine months after implementation of the program. (Cherry, Moffatt, Rodriquez & Dryden, 2002).

Additional results from other published studies have demonstrated substantial cost savings due to reduced hospital admissions (Cherry, Colliflower and Tsiperfal, 2000; Vacarro, Cherry, Harper & O’Connell, 2001).

Without in-home monitoring, patient encounters are not optimized by are either based on a schedule or a crisis. The in-home monitoring model of care bridges the gap between visits by providing a means for daily communication with the patient, encouraging patients to adhere to treatment regimens, and allowing patients and care providers to identify problems and intervene early. Early intervention can ultimately reduce the cost
of care while increasing the overall well-being and quality of life for the patient.

Care Accessibility Benefits
eHealth technologies for in-home health monitoring and management enable daily communication and support to patients with complex chronic conditions, which is a substantial increase in access to care for patients who need care the most. Before in-home monitoring, these patients had access to care only once their condition had become a crisis. In-home monitoring provided daily access to appropriate and timely care. In
addition, because of the eHealth solution employed, it is possible to serve many more patients with the same nursing staff. With telephone based monitoring, it was demonstrated that one nurse could provide weekly monitoring to not more than 100 patients, and this was a full time job. In the Mercy Health System Telemedicine Disease Management Program a single nurse monitors 425 patients with heart failure, diabetes, or
hypertension on a daily basis in just a few hours in the morning, greatly improving the access to chronic care services where they otherwise would have been cost prohibitive.

Quality of Care Benefits
eHealth solutions enable care providers to detect complications before they become acute and result in hospital admissions. The highest quality care is care that reduces painful and costly complications, but instead maintains patients in a healthier state.

Other factors that prove a higher quality of care are the measures of patient self-care behavior, medication compliance, and quality of life. In a high risk, indigent population with diabetes, the percent of patients who took their medications regularly increased from 34% before the program to over 94% twelve months after implementation of the program.2 In a pediatric asthma study, the odds of having any limitation in activity were
significantly lower (p<.03) for children randomized to the intervention group, they were less likely to report peak flow readings in the yellow or red zone (p<.01), and less likely to make urgent calls to the hospital (p<.05) (Guendelman, et. al., 2002).

In a post cardiac bypass surgery study at the University of Nebraska, patients who were monitored using eHealth technologies had higher scores on their quality of life measurement and complained of less fatigue and anxiety then the patients in the control group. In the Veterans Administration study, quality of life was assessed using the Medical Outcomes Study 36-item Short Form health survey designed for veterans (SF-
36V). At Lake City, six domain change scores and one composite change score were significantly different (p<0.05) from baseline to 6 months in the program. Of these significant differences, four were positive changes in quality of life. The positive changes were in physical functioning (p=0.005), role-physical (p=0.018), social functioning (p=0.013) and the physical composite score (p=0.014). At Fort Myers, 8 out of the 10
domain changes and composite scores changed in a positive direction, and of those four were statistically significant. The significant changes were in physical functioning (p=0.023), role-physical (p=0.024), vitality (p=0.000) and the physical composite score (p=0.008) (Cherry, Dryden, Kobb, Hilsen, & Nedd, in press).

A myriad of enabling eHealth technologies such as remote monitoring can aid in chronic disease management and have proven quality, safety and cost-effectiveness benefits.

Eliminating Barriers to Chronic Care Management in Medicare: What Can Be Done?

As medical and information technology evolves, new models of care that extend the point of care to the patient home and use of clinical information systems and tools to improve care management processes will become more prominent. The eHealth Initiative is providing leadership in a groundbreaking proof-of-concept project demonstrating a new model involving electronic, standards-based health care data transmission and exchange in 2003. Relevant to the hearing today, project data elements specifically include a subset of those that are necessary to measure the quality of care delivered for those with diabetes and cardiovascular disease, as well as those that will assist with public health
surveillance and response and those that will assist with improving patient safety. Participants include large hospitals, public health agencies, and other key stakeholders in the public sector with interests in improving the quality and safety of health care. The public and private sector must continue to work together on this and other initiatives to eliminate barriers to better care management.

Specific steps this Committee and Congress as a whole can take to achieve better chronic care management in the Medicare program include:

• Working on relevant legislative language that can be attached to vehicles likely to move in 2003 including Medicare prescription drug reform and medical safety and bills.

This language could encourage:

o Reimbursement of physician services in remote monitoring and care coordination that can be quality-assured and accountable through the use of information technology.

o Inclusion of disease management in metrics of quality of care and medical errors that are tied to existing reimbursement in Medicare or accreditation.

• Encourage movement of legislation to redefine the physician-patient encounter to include remote monitoring and management that underpins disease management, so that health care providers will be reimbursed for services that are now proven to boost quality of care and reduce hospital admissions.

• Provide funding for larger scale demonstration projects focused on models of care implemented by health care providers to better coordinate care for those with chronic diseases such as diabetes and congestive heart failure. The need for these demonstrations has been highlighted by both Department of Health and Human Services Secretary Tommy Thompson and Institute of Medicine experts.

• Engage in discussions with knowledgeable experts about the cost and savings model assumptions for disease management and enabling technology.

Conclusion
eHI and our members stand ready to lend our voice and private-sector expertise in the movement to create a more sustainable model of care that will effectively address the aging population, increased chronic care demand, systemic quality, cost and safety challenges and provider workload and resource scarcity issues. We believe that adequately reimbursed chronic disease management services enabled by eHealth technology that result in increased health care quality, safety and cost-effectiveness must be part of this new care paradigm. The benefits have been demonstrated by the Department of Veterans Affairs and other leading health care providers, and our members are ready to deploy solutions to modernize and improve chronic care for Medicare beneficiaries.

Endnotes

1. Mercy Health Center – Diabetes

Cherry, J.C., Moffatt, T.P., Rodriquez, C., & Dryden, K.V. (2002). Diabetes Disease Management Program for an Indigent Population Empowered by Telemedicine Technology. Diabetes Technology & Therapeutics; 4 (6): 783-791.

2. Veterans Administration – CHF, Diabetes, Hypertension and COPD

Meyer M, Kobb R, Ryan P. Virtually Healthy: Chronic Disease Management in the Home. Disease Management 2002; 5: 87-94.

3. Application of Technology at Catholic Healthcare West – CHF

Cherry, J.C., Colliflower, S.J. & Tsiperfal, A. (2000). Meeting the Challenges of Case Management with Remote Patient Monitoring Technology. Lippincott’s Case Management: 5 (5): 191-198.

4. UC Berkeley and Children’s Hospital Oakland – Pediatric Asthma

Guendelman, S., Meade, K., Benson, M., Chen, Y.Q. & Samuels, S. (2002). Improving Asthma Outcomes and Self-management Behaviors of Inner-city Children. Archives of Pediatric Adolescent Medicine; 156: 114-120.

5. PacifiCare – Heart Failure

Vaccaro, J., Cherry, J., Harper, A. & O’Connell, M. (2001) Utilization Reduction Cost Savings, and Return on Investment for the PacifiCare Chronic Heart Failure Program, “Taking Charge of Your Heart Health”. Disease Management; 4 (3): 1-10.