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From HR Magazine, January 2002
Technology Enhances DM ToolsThe aim of a DM program is to get employees with chronic illnesses into programs that will monitor their status and encourage compliance with medical advice. If the patient follows treatment instructions, any medical intervention can often be handled in a physician's office, rather than in an expensive emergency room visit. "The use of disease management has grown rapidly in the past five years," says Dr. Victor Villagra, vice president for strategic medical affairs of CIGNA HealthCare in Jersey City, N.J., and immediate past president of the Disease Management Association of America. "It is the centerpiece of medical management strategy."
Product of the Internet Age
High-tech DM systems offer a variety of advantages to caregivers and patients, as well as employers footing health insurance bills. These include automated data-entry, expanded service availability and a greater tendency for patients to stick to their treatment regimen. Standing Stone Inc. of Westport, Conn., has developed a number of technology-driven DM tools, including CoagClinic, a web-based tool for managing anticoagulation therapy; CholesterolClinic, geared toward ongoing cholesterol therapy management; and DMClinic, which provides guidance in managing diabetes. "We provide health care professionals with an open architecture to integrate disease management with other technology tools," says Albert J. Bartosic, Standing Stone's president. At the backbone of Standing Stones' products and other systems are monitoring devices that patients use from home or work, then transmit information to clinicians. "They let us monitor patients' symptoms in a cost-effective way," says Christobel Selecky, chief executive officer of LifeMasters Inc., based in Irvine, Calif. LifeMasters provides DM services to insurers, managed care programs and employers. Patients enrolled in the LifeMasters program receive digital scales or other monitoring tools. "We teach them how to use the tools, and they enter that info into our database via touch tone phone or web page," Selecky says. LifeMaster nurses monitor readings and contact patients if data indicates their condition is worsening. Sometimes, medical deterioration may be due to the advance of a disease. However, half the time it's caused by the patient not following the prescribed treatment regimen, Selecky says. "When that's the case, the interaction with the nurse presents an opportunity to coach the patient." Besides congestive heart failure, chronic illnesses LifeMasters addresses include coronary artery disease, diabetes, chronic obstructive pulmonary disease, asthma and hypertension. Although only a small number of plan participants suffer from these ailments, they often account for a large chunk of employers' medical expenses, in treatment costs as well as absenteeism and lower productivity. "A lot of employers are frustrated that their health plans aren't moving as quickly as they want in terms of reduction in claim costs," she says.
Wonder of the Web "The web provides patients with a more engaging and interesting way of interacting than a touch-tone phone," she says. Still, the majority of LifeMasters' patient population opts to use its telehealth services. "About 12 percent of our patient base use the web, compared to about 82 percent who use the phone." iTelehealth Inc. of Frederick, Md., works with health care providers to integrate telephone- and video-based DM tools. Elderly DM patients feel more comfortable with such devices than computers, says iTelehealth's president, Loretta Schlachta-Fairchild, RN, Ph.D. "The goal is to give patients tools they feel comfortable with so that they can take the lead in managing their own disease," she says. Many experts agree that the best DM systems are those that combine automated measurements with a human response. "In terms of disease management, live interaction with the patient still gets the biggest bang for the buck," says Joel Hoffman, a partner at Ernst & Young in Philadelphia. "The premise of disease management is one-to-one interaction between trained clinicians and people with chronic diseases." The value of web-based tools is they "are really geared toward getting patients to take ownership for their own care, interacting earlier and more often with clinical professionals trained to help using a myriad of proven tools," he says.
The Next Frontiers
DM technology will follow the industry mobility trend. "Look for disease management tools to be increasingly portable, miniaturized and technology based," says Schlachta-Fairchild. "The tools that will gain the widest acceptance will be those that can be customized to the patient and their disease." The aging workforce is likely to boost the need for health-care cost containment. "There is going to be a lot of development in the area of baby boomer disease management," says Vince Kuraitis, a principal at Better Health Technologies, based in Boise, Idaho. His company serves as a kind of matchmaker between health care organizations and the makers of high-tech DM tools. Kuraitis sees a growing interest in proactively treating chronic conditions that often slip under the DM radar. "Right now, it's not always cost-effective to apply disease management to conditions like depression, back pain or migraines." But a system that relies on low-cost communications methods, such as e-mail or web-based databases, allows patients to receive DM-style treatment without incurring significant medical costs, he says. Initially, disease management targeted costly, high-severity cases, says Stephanie Pronk, a senior consultant with Watson Wyatt Worldwide Inc.'s Minneapolis office. However, for most patients with chronic conditions, the severity of their illnesses is low or moderate. Advances in technology will help health care professionals begin to address the concerns of that patient population, she says. Also, predicts CIGNA's Villagra, "we will see significant use of wireless communication technology. The devices patients use to measure their treatment will actually be transmitters that send back information automatically." Bruce Kehr, chairman and CEO of InforMedix Inc. of Rockville, Md., agrees that the development of affordable consumer-connected products that enable disease managers to monitor patients is critical. His firm has invented a product called the Med-eMonitor, which is being used in conjunction with several clinical drug trials. The device electronically prompts patients when it's time to take medication. "The system records the patients' medication compliance, health status, quality of life and physiologic values," he adds. That data is stored in a remote database, allowing a researcher or caregiver to monitor the patient's status. Despite the advances, technology-based DM still faces many challenges, including resistance from caregivers. "While the medical industry has always embraced technology from the viewpoint of procedures, it's often slow of adopting technology in terms of assisting health care professions vis a vis managing practices and tracking patient treatment," says Standing Stone's Bartosic. Some experts predict that, because of the time needed to realize a positive return on investment, DM technology will remain focused largely on patients with chronic illnesses. "It certainly is important to consider turnover statistics," Pronk says. Many employers require a worker to be on staff for a year or more before they or their dependents are eligible for DM programs, she says. "What's important to employers and insurers is addressing the chronic illnesses that are costing them money now," Selecky says. "But, I don't see a lot of employers being willing to pay for a proactive system. The payoff is so long-term, and, with turnover, an employer may never see the benefit of this treatment." Ultimately, it's not the technology that dictates the value of a DM program, but how it fits with a DM program's overall approach, experts say. "Technology holds great promise for advances in disease management, but in the end it's just a tool," CIGNA's Villagra says. "The best programs are those that use a broad array of communication venues, including Internet-based, telephony-based and good old hard-copy mailings." [SIDEBAR] What to Look For What should you look for in an online disease management (DM) program? It's important to study which programs a DM plan has in place, what percent of the people with the targeted disease enroll in those programs and what the results are, says Dr. Charles M. Cutler, chief medical officer of the American Association of Health Plans (AAHP) in Washington, D.C. In addition, Mindi McKenna, president of eHealthCoach Inc. in Kansas City, offers these recommendations:
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