Mixing tech and touch saves $427 a month

Combining telemedicine with human intervention

Many managed health care plans fall short when it comes to managing chronic illness, states a recent National Committee for Quality Assurance report. Outsourcing may provide an answer to that need.

By combining telemedicine with human intervention, HiLIFE, a San Francisco company, has created a system that intervenes before patients get out of balance. "The LifeMasters-supported self-care system reduces chronic disease admissions and saves money and lives by changing patient behavior," says David E. Goodman, MD, the company’s founder.

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 (ED) visits or hospitalizations during 1996.

In addition to reporting high satisfaction and compliance for both patients and physicians, there was a 66% reduction in ED claims, a 59% reduction in bed days, and an 83% reduction in skilled nursing facility admissions.

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

Managing care instead of just providing it

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, says Christobel Selecky, CEO of HiLIFE. "We leverage the human component in much the same way as banks use ATMs to teach us to be our own tellers," she says. "This system teaches patients to be their own case managers. Patients feel in control, yet doctors are getting the information they need to make course corrections in the treatment plans."

The technology enables physicians to manage care instead of just providing it, she says. Doctors are given the tools they need to manage large populations of patients in a way that satisfies patients and ensures good quality of care. Patients are given the tools they need to take responsibility for their own health. "With chronically ill patients, that’s critical because much of their success depends upon their own behavior," says Selecky.

"Patients with chronic disease 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."

People in self-care have a high recidivism rate, as do participants in weight-reduction programs. "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 these premises:

1. Between 25% and 40% of hospitalizations for chronic disease are preventable.

2. Controlling chronic disease 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 patients with chronic disease communicate with their physician during their monthly exams, but in the interim, conditions can deteriorate. Legs can swell and complaints of fatigue and dyspnea can develop in the case of CHF, for example; 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 of 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 cross the threshold, a nurse calls the patient as well as the physician and often manages to avert a medical emergency.