Pilot project uses TV for self-management

Interactive TV gives patients control, reduces costs

"Must-see TV" could find itself with an expanded meaning — in the health care arena — based on an innovative communication program recently launched by Royal Philips Electronics (Andover, MA), Comcast (Philadelphia), and cardiovascular care provider Cardiovascular Associates of the Delaware Valley (CADV; Haddon Heights, NJ).

Focusing on patients with congestive heart failure (CHF) — and who also are likely to have a variety of comorbid conditions — the pilot project is evaluating the use of an interactive television platform to reduce the heavy costs traditionally associated with this demographic group, and, when standard management fails, their frequent hospitalizations or deaths.

Using a platform dubbed Motiva, the broader intent of this initiative is to encourage these patients to be more actively involved in maintenance of their conditions, according to Jay Mazelsky, general manager of the new ventures business unit for Philips.

Besides its interactive features, the Motiva system creates "a media-rich environment that allows an experience that the patient finds engaging and incorporates into their life," he notes. This should translate to important modifications of behavior that produce greater compliance with drug regimens, improved tracking of changes in disease status and greater use of relevant health care direction and information, Mazelsky adds.

The key components of Motiva include:

• Weight, blood pressure and other vital signs of the patient are sent daily to a data center so that they can be tracked by CADV clinicians, enabled by Philips home monitoring devices and a wireless set-top on the TV, and a modem supplied by Comcast. This information, especially the tracking of weight, is particularly important for this patient group, Mazelsky notes, since if CHF is not controlled it is characterized by an overload of extracellular water, thus additional weight.

• The vital signs data then are analyzed and tracked by what Mazelsky calls "a system of flags and alerts" that CADV clinicians can use to guide their contacts with the patient. They can either use the interactivity of Motiva to send messages reminding them to take their medications or to see their doctor at regular appointment times, or they can call the patient to better assess his or her overall condition, if that seems needed.

• Built into the system is a strong patient education component. Here, the patient can use his or her TV remote — featuring enlarged buttons designed for use by the elderly or those with difficulty seeing — to select from a menu of preprogrammed health topics, presented as video modules, the topics ranging from diet to smoking cessation to diabetes care. The Motiva program so far offers about 20 such modules, with more to come, says Mazelsky.

Jeffrey Kramer, MD, fellow of the American College of Cardiology (Bethesda, MD) and principal investigator for CADV at the Motiva project, says the system enables what he calls "a virtual house call" on a daily basis. "It has the potential to help us optimize clinical care . . . enhance the patient’s quality of life while simultaneously reducing the cost of urgent clinic visits and emergency hospitalizations."

And Mark Coblitz, senior vice president of strategic planning at Comcast, points to that company’s network investments "to securely deliver interactive targeted and user-friendly video, data and voice services" as an expanded offering to customers.

The key to Motiva’s success, Mazelsky says, "is that when [patients] wake up in the morning, this becomes part of their routine and they want to make it part of their routine. You can’t force compliance. You have to provide an experience and activities that engages patients and allows some level of self-management."

The current study, which will involve around 60 patients, grows from an earlier project in Europe, Mazelsky explains, with a somewhat less sophisticated interactive technology, that project comparing remote patient and nurse-call management with what he termed "usual care."

The results of that effort were "exciting," he says. In particular, over a period of 400 days, investigators found a 26% reduction in mortality and nearly a 28% reduction in hospital stays for those remotely managed vs. the usual care group.

More long-range opportunities provided

The current effort is the first for the Motiva system, which he says is distinguished by being "broadband-enabled," thus offering "the capacity to send a lot more data in and out of the home." Additionally, this "very wide bandwidth will provide, down the road, the opportunity to do other things," he says. Those other things would include expanding the virtual house call to what he calls "virtual doctors’ office visits — it provides that type of scalability."

Assuming the success of Motiva, Philips is poised to return to Europe with a fully commercialized program, Mazelsky says. "It’s under discussion and there’s a lot of interest there. Europe is less fragmented in terms of health care, so it makes sense to talk to that market."

The pricing for a commercialized Motiva hasn’t been determined yet, he says, but he believes it will be comparable to less interactive, standard remote monitoring services in the $45-$100 per-month range per patient and should prove so cost-effective that it ill be broadly covered by Medicare and private insurers.

"Today, the typical heart failure patient costs the U.S. about $20,000 to $22,000 for hospital readmissions, pharmaceutical regimens, and facility services," he says. And with an annual cost of $226 billion in the U.S. alone, it is "one of the most expensive, very prevalent chronic conditions out there, with 5 million people suffering from heart failure."

Mazelsky makes no specific predictions concerning the market opportunity for Motiva ultimately, but says: "When you look at the tens of millions of the chronically ill, even a small percent being covered by a disease management component such as Motiva, it’s a billion [dollar]-plus market in the U.S. alone, five years out."