Health Affairs examines successes and missing links in connected health

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Health Affairs
Health Affairs examines successes and missing links in connected health February articles outline best practices and holes in adoption and use You can successfully integrate technology into patient care, but it isn't easy. Just ask Kaiser Permanente Northern California (KPNC) and its 3.4 million members. Robert M. Pearl of the Permanente Medical Group provides a case study of KPNC's experience with Internet, mobile, and video technologies and identifies the two largest barriers to their use: the lack of reimbursements under the fee-for-service system and the financial and other resources needed to truly integrate these technologies into existing models of care. The health system has been at the forefront of electronic medical record adoption, as well as the use of subsequent technological tools that integrate with these data, and has seen continuous progress with a more than doubling of virtual patient "visits" in five years from 4.1 million to 10.5 million virtual visits annually. The author suggests that the ultimately positive experience at KPNC will become more common as the wider US health system catches up with these technologies and incentivizes their use through payment models such as ACOs and federal requirements that push providers to approach patient care as "pay for value" versus "pay for volume."

Texts and apps can also help you manage your diabetes. Shantanu Nundy of Evolent Health and coauthors analyzed how the widely used, familiar technology of mobile phones (mHealth) could help patients better manage their chronic conditions. Examining a group of seventy-four adults enrolled in an automated text messaging–based diabetes care program, they found better control of HbA1c glucose levels, higher patient satisfaction, and an overall net cost savings of 8.8 percent over the course of the six-month program. They also observed an overall decrease in costs for both the treatment and control groups, suggesting this type of approach can help health care organizations achieve the triple aim of better health, better care, and lower costs. The authors advocate for changes to the policy environment to enable mHealth's fuller potential through measures such as increased interoperability with electronic health records, clearer regulatory guidance, and stronger accountability for population health.

"The doctor will see you now" has a whole new meaning in nursing homes and could bring cost savings. David C. Grabowski of Harvard Medical School and A. James O'Malley of the Geisel School of Medicine at Dartmouth conducted a randomized study of eleven facilities in a for-profit nursing home chain in Massachusetts to determine if switching from on-call physician care during off hours to two-way videoconferencing reduces hospitalizations and/or costs. They found that facilities that were more engaged in telemedicine could reduce hospitalizations and save Medicare a net $120,000 each per year. They suggest that the findings are useful for emerging models such as ACOs, managed care, and integrated care; and policy makers should consider ways to maximize the potential benefits of telemedicine by aligning incentives.

Want to increase telehealth adoption among U.S. hospitals? Look to state legislatures. Julia Adler-Milstein of the University of Michigan School of Information and coauthors determined that state policies are influential. According to their findings, states that wish to promote the use of telehealth should explore private payer reimbursement and relaxing licensure requirements to achieve that goal. Overall, they found that 42 percent of US hospitals had adopted telehealth by late 2012 with significant variation across the country: Alaska was the highest with 75 percent, and Rhode Island had minimal adoption. Market forces and individual features of the hospital also influence telehealth adoption rates. Factors that positively influence adoption rates include serving as a teaching hospital, being part of a larger system, having greater technological capacity, and higher rurality. Factors negatively affecting adoption include high population density, being for-profit, and operating in a less competitive market.

In a related Entry Point piece, The Honorable William H. Frist, M.D. shares his views of how empowered consumers and advances in IT will together affect the landscape in Connected Health And The Rise Of The Patient-Consumer.

Also of interest in the February issue:

Despite Increased Use And Sales Of Statins In India, Per Capita Prescription Rates Remain Far Below High-Income. Statin use has increased substantially in North America and Europe, with resultant reductions in cardiovascular mortality. However, little is known about statin use in lower-income countries. To get some answers, Niteesh Choudhry of Harvard Medical School and Brigham and Women's Hospital and co-authors conducted an observational study of statin use in India. They found that between February 2006 and January 2010, monthly statin prescriptions increased from 45.8 to 84.1 per 1,000 patients with coronary heart disease—an increase of 0.80 prescriptions per month. However, only a fraction of those eligible for a statin appeared to receive the therapy, even though there were 259 distinct statin products available to Indian consumers in January 2010. The authors concluded that low rates of statin use in India may reflect problems with access to health care, affordability, underdiagnoses, and cultural beliefs. New Neighborhood Grocery Store Increased Awareness Of Food Access But Did Not Alter Dietary Habits Or Obesity; Steven Cummins of The London School of Hygiene and Tropical Medicine and coauthors.

### The February issue received funding from the California HealthCare Foundation, Kaiser Foundation Health Plan and The Permanente Medical Group, AT&T, Intel-GE Care Innovations™, the Leona M. and Harry B. Helmsley Charitable Trust, Aetna Foundation, and Carlos Slim Health Institute.

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online. Additional Web First papers are published periodically, and health policy briefs are published twice monthly at http://www.healthaffairs.org. You can also find the journal on Facebook and Twitter. Tap into Health Affairs content with its iPad app. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.