Mixing tech and touch saves $427 a month

Makes patients partners in their own care

By combining telemedicine with human intervention, a San Francisco company called HiLIFE has created a system that intervenes before congestive heart failure (CHF) patients get out of balance, company officials say.

"The LifeMasters supported self-care system reduces CHF admissions and saves money and lives by changing patient behavior," says the company’s founder David E. Goodman, MD.

A group of patients at Brown & Toland Medical Center in San Francisco participated recently in a pilot study of the LifeMasters program. They had New York Heart Association Class 3 and 4 CHF and were identified as high utilizers — multiple emergency department visits or hospitalizations during 1996.

In addition to reporting high satisfaction and compliance on parts of both patient and physician, there were the following benefits:

• 66% reduction in emergency department claims;

• 59% reduction in bed days;

• 83% reduction in cardiac skilled nursing facility admissions.

"For the pilot program, we were able to save the facility an average of $427 per enrolled patient per month. The system costs about half that." System pricing is reduced dramatically when the patients’ disease state is less severe. It also varies based on the individual patient’s needs and the size of the hospital’s contract.

Teaches patients to be own case managers

Doctors need to receive timely and actionable information about their patients, HMOs require a method to track outcomes, and patients are best off when they become involved in their own care. Christobel Selecky, CEO of HiLIFE says, "We leverage the human component in much the same way as banks use ATMs to teach us to be our own tellers. This system teaches patients to be their own case managers. Patients feel in control, yet the doctor is getting the information he needs to make course corrections in the treatment plan."

In addition, she says, the technology enables physicians to be managers, rather than providers, of care. It gives doctors the tools they need to manage large populations of patients in a way that satisfies patients and ensures good quality of care. It gives patients the tools they need to take more responsibility for their own health. "With chronically ill patients, that’s critical because much of their success depends upon their own behavior," says Selecky.

"CHF patients don’t understand a lot about their illnesses," says Sandra Feaster, RN, director of clinical services at HiLIFE. "We emphasize education. There are three important components to improve these patients’ health status: nutrition, medication, and activity. For one thing, patients have to be instructed to read food labels."

Similar to participants in weight-reduction programs, people in self-care have a high recidivism rate. "CHF — any chronic illness — is discouraging," says Feaster. "We set up weekly phone appointments with patients to discuss their problems and focus on their individual needs. People come into the program at different levels of ability and willingness to change. Our job is to define those levels and work with them to help them lead a healthier lifestyle."

LifeMasters is based on a couple of premises:

• 25% to 40% of hospitalizations for CHF are preventable.

• Controlling CHF depends on how well patients care for themselves and on the availability of timely information that allows physicians to intervene early.

This step toward re-engineering health care delivery could transform what is typically an impractical, labor-intensive function — keeping in touch with patients — into a manageable, cost-effective system that decreases resource utilization.

Most CHF patients communicate with their physician during their monthly exam, but in the interim, conditions can deteriorate. Legs can swell, and complaints of fatigue and dyspnea can develop, any of which can lead to hospitalization or worse. When asked, "Why didn’t you call the doctor?" often a patient will say, "I thought it would get better."

To combat that lack in feedback, the SelfCare system monitors the patient’s condition continually. While in the program, patients wear pagers and are prompted at medication time. They call an automated telephone system daily and answer questions regarding salt intake, weight, or ankle edema. Their responses are transmitted to a computerized database and compared to thresholds set by the physician.

If a patient doesn’t call in, or if self-reported data in a particular area cross the threshold set by the physician, a nurse contacts him or her as well as the physician and often manages to avert a medical emergency.

[For more information, contact: HiLIFE, 401 Marina Blvd. S.,San Francisco, CA 94080. Telephone: (650) 873-6000.]