Home Is Where the Care Is – Or At Least Should Be
Part 1 of a series
It’s no secret that chronic conditions such as diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer are pervasive in America – and on the rise. In fact, a 2014 Rand study found that 60 percent of Americans had at least one chronic condition, and 42 percent had more than one. As the Baby Boomer generation ages, those numbers are expected to continue rising.
This increase in chronic conditions isn’t just a problem for those who have them. It’s an issue for all of us. Patients with chronic conditions cost more, and take up more healthcare resources than those who do not have these conditions. A Milliken Institute report found that the total direct cost for treatment of chronic conditions totaled $1.1 trillion in 2016. While that is less than was spent in 2010, it is still one-third of the total amount spent on healthcare in the U.S. each year.
One reason for this inordinately high percentage of spending is the venue in which care is often provided. Patients with chronic conditions account for 81 percent of hospital admissions as well as continuing growth in emergency department (ED) visits.
These, of course, are the two most expensive care locations. They are also the most disruptive to the lives of patients and their families.
Why is there such a high percentage of hospital admissions/readmissions and ED visits? There are two primary reasons.
The first is a lack of engagement among patients (or their families) in their own care. Some may not understand the importance of taking their water pills, weighing themselves, monitoring their blood pressure, etc. each day so they can report any changes to their primary care physicians. Others may understand but choose to ignore the instructions – they don’t see the need or don’t want to be bothered. Still, others may be willing but are unable to do what’s required, such a patient with early-stage Alzheimer’s remembering to take their medications on time and in the proper dosage.
No matter what the reason, the result is often the same – an unplanned visit to the ED or an avoidable hospital readmission.
The typical industry solution to this issue has been to increase the frequency of visits to the primary care physician’s office, where nurses can take regular readings and monitor changes. Yet while this method can help spot and correct negative trends in some cases, it still has many issues and drawbacks.
The most significant is that even weekly readings are still only a point in time. An elevation of blood pressure, heart rate, etc. could be a result of the stress of an office visit, especially for an elderly patient with multiple chronic conditions.
And even if everything is fine during the visit Wednesday, by Thursday conditions could have changed, creating a deterioration that won’t be detected for another week. In the meantime, the patient could have an adverse event that sends him or her to ED or hospital.
Finally, there is still a cost for those visits to the office. It may not be as much as a hospital stay or ED visit, but there is still a cost. All those visits can add up over time, resulting in a lot of money being spent on what is still an inadequate and disruptive solution.
What is rapidly proving to be a better approach for managing chronic conditions (and other issues as well) on a daily basis is technology-based remote patient monitoring (RPM). With RPM, patients are provided with devices such as a digital scale, pulse oximeter, glucose meter (for diabetics), and blood pressure measurement equipment that can be used to take daily readings.
These readings are then reported to a centralized call center which monitors them for significant changes. If the data indicates a potential issue, clinicians are alerted so they can create the appropriate intervention to avoid the issue escalating into a hospital admission or ED visit.
For example, a sudden weight gain can be an indicator that a patient with CHF hasn’t taken her water pill today. Once the alert is received, a nurse care manager at the call center or physician’s office can call to ask if she has taken her pill, then ask her to re-weigh herself later. If the weight goes down the issue has been averted. If not, it could be an indicator that a more serious intervention is required. Great software can even automate these interactions with the patient, creating efficiency and scale for the care team.
RPM has tremendous potential to reduce the cost of caring for individuals with chronic conditions while lowering the disruption to patient and family lives an ED visit or hospital admission can create. In our next post, we will look at how it is being used in a real-world application.