Home Health Monitoring

Transcription

1 Home Health Monitoring deployment to date What s driving demand for Home Health Monitoring technologies? Health Spending and Information and Communication Technologies Creating new vistas for Canadian healthcare Fall 2013 Home Health Monitoring The market landscape A TELUS Health White Paper

2 Table of contents 2 Introduction Home Health Monitoring deployment to date What s driving demand for Home Health Monitoring technologies? Health Spending and Information and Communication Technologies Creating new vistas for Canadian healthcare 7 References

3 The future of healthcare is friendly In its 2012 report, the Canadian Institute for Health Information (CIHI) reported that for the third straight year, growth in healthcare spending was less than that in the overall economy. The proportion of Canada s gross domestic product (GDP) spent on healthcare in 2012 was expected to reach 11.6 percent down from 11.7 percent in 2011 and the alltime high of 11.9 percent in As government funders focus on controlling healthcare costs, the emphasis is placed more on improving productivity than on cutting programs. Not surprisingly, the use of information and communication technology (ICT) in healthcare is gaining momentum. Healthcare professionals throughout Canada are already working with electronic systems and seeing easier access to information needed for care, improved communication and coordination with colleagues, more efficient ways of working, and other benefits. There exist real opportunities to increase efficiency of information exchange across the entire healthcare system and support individuals to remain independent at home. Home Health Monitoring (HHM) technology is one such opportunity. It plays an integral role in the lives of patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), diabetes or congestive heart failure (HF). HHM empowers these patients, who are frequent users of the healthcare system, to monitor their own health from the comfort of their own home, and provide their healthcare team with detailed information about their health in real time. Healthcare providers can closely monitor patients and take action before situations become acute, averting the use of costly emergency visits or hospital readmissions. The future of healthcare is friendly. TELUS Health technology enables healthcare providers to deliver more proactive support. It empowers patients to manage their own health. And, we believe our technology can make an integral contribution to transforming Canada s healthcare system. 1

4 Introduction The Canadian healthcare system, like those around the world, is confronting the weighty challenge of adapting and transforming its service delivery to meet the needs of the increasing aging population today and in the years to come. With our aging population comes an inevitable increase in chronic disease that, in turn, will place stress on the healthcare system and intensify the pressure to control the high costs of delivering quality care. Today, seniors represent just 14 percent of the population, yet use 40 percent of hospital services in Canada and account for nearly half of all provincial and territorial government health spending. Existing healthcare systems that were designed to respond primarily to infections and acute illnesses are no longer suitable for populations that are living longer and are in need of more supportive and preventive services. It is critical for healthcare leaders to understand Home Health Monitoring (HHM) because it represents a key opportunity to simultaneously improve patient outcomes and reduce the costs of Addressing this complex challenge healthcare. will rely on leadership from multiple stakeholder groups from point of care, to hospital administration, to policy-makers, to funders. Across this spectrum, it is critical for healthcare leaders to understand Home Health Monitoring (HHM) because it represents a key opportunity to simultaneously improve patient outcomes and reduce the costs of healthcare. For example, HHM programs focused on patients with chronic conditions such as chronic obstructive pulmonary disease (COPD) and heart failure (HF) can help patients who are frequent users of the health system to be discharged earlier and not be readmitted to hospitals. Interest in HHM technologies is gaining momentum. HHM deployment in clinical settings is covered more and more often in industry publications. Additionally, there are public programs that leverage HHM: in the US with Accountable Care Organizations (ACO) and in Canada through provincial telehealth programs like the Ontario Telemedicine Network (OTN). A number of recent studies from Canada, the US and the UK make it clear that HHM services reduce re-admissions to hospitals, as well as average length of stay and visits to the emergency room. Patient satisfaction using HHM is also consistently high and can have important impact on a patient s quality of life and their ability to have more control over their own healthcare. In the years to come, widespread adoption of these empowering services and technologies will be essential in order to meet patient demand and to respond to the profound demographic shift that is happening in Canada. This paper focuses on the current HHM market landscape and is one in a series produced by TELUS Health to help healthcare leaders assess the value of using Home Health Monitoring solutions to transform the delivery of healthcare. 2

5 Home Health Monitoring deployment to date Home Health Monitoring (HHM) is a new and growing market. It is also a complex market one that is comprised of heterogeneous home services, community services as well as facility-based monitoring. Because it is in its early stages, the HHM market is challenging to define and track; however, estimates by several leading market research firms affirm that it is growing and showing no signs of receding. For example: By 2015, the US HHM market is projected to reach $295 M (Frost & Sullivan, 2012) Telehomecare in Canada and Western Europe was estimated at $225M in 2011 (Parks Associates, 2011) In 2012, an estimated 308,000 patients globally were monitored for congestive heart failure (HF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension and mental health conditions and this is projected to reach 1.8 million patients worldwide by 2017 (inmedica, 2013) The reasons for this growth are clear. Patients with chronic conditions who are equipped with HHM services are readmitted to hospital less often because their health is proactively monitored and they are empowered to manage their own health more effectively. Furthermore, patients are embracing HHM services. In almost all studies, patient satisfaction with HHM technology and programs was 80% or higher. At the same time, the cost of technology is decreasing as solutions evolve. What is less clear, and a central question in the HHM market landscape is: where will continued investment and leadership in evolving critical HHM technology come from? Looking ahead, there are multiple opportunities to innovate, develop, deploy and fund new technologies and a range of stakeholders who can pave the way. Specialized provincial government funded programs, innovative hospitals as well as home care services delivered by private businesses can all play important roles. Interesting examples can be found in the US, where HHM programs seem to be gaining momentum through the public sector. In 2012, the Centers for Medicare & Medicaid Services (CMS) instituted meaningful use programs that penalize US hospitals for readmission rates that are above average. The policy behind the programs was developed by the Medicare Payment Advisory Commission (MedPac) to encourage better discharge planning and care. As a result, in 2013 hospitals face up to a 1 percent penalty for readmissions related to acute myocardial infarction, heart failure and pneumonia. In 2014, the penalty will go up to 2 percent and up to 3 percent in 2015, with four more conditions added to the list. This program is motivating hospitals to implement HHM programs because doing so can significantly reduce readmission rates. In addition, CMS offers financial incentives to help healthcare organizations link together to become Accountable Care Organizations (ACOs). ACOs are incented to deliver better health outcomes at a reasonable cost and use 33 measures to demonstrate improvements of both cost and quality of care. These measures encourage better patient engagement and empowerment, improved care coordination and patient safety, and better management of at-risk patient groups all of which can be enabled through HHM technologies. Historically in Canada, telehealth a foundation and forerunner to the range of HHM services available and emerging today has been program-led and funded by the provincial Ministries of Health. However, this funding model is not sustainable as beleaguered budgets are already required to address a multitude of public services that are in high and ever-increasing demand. 3

6 What s driving demand for Home Health Monitoring technologies? The increasing demand for HHM technologies and services is linked to the growth in home and community services, which in turn, is driven by the need to achieve a more sustainable model for healthcare delivery due to the demands of our increasing aging population. By 2036, the number of Canadians age 65 and older is expected to nearly double to 25% of the population. This shift will bring an inevitable increase in chronic disease, such as diabetes, congestive heart failure, cancer, and Alzheimer s, all of which require continuous monitoring and management. At the same time that healthcare requirements are increasing, public funding for health services is limited and must also address great demand for social services, education and other essential public services. Table 1, which is adapted from the Conference Board of Canada s paper on Home and Community Care Economic Footprint, highlights the supply and demand drivers for home services. Table 1 - Demand and Supply Drivers for Home and Community Services Demand Drivers Aging demographics Risk factors and disease trends Availability of caregiving support Societal and client preferences Availability, affordability and awareness of services Healthcare reform, i.e., early discharge from hospitals, increased use of technology Supply Drivers Government funding Cost of service delivery and technology Number of home and community care providers, regulated and unregulated Number of caregivers family and friends Number of home and community care volunteers Number of organizations in home and community care industry Concerns about increasing healthcare costs and the capacity of the healthcare system financial sustainability Policy interventions such as expansion of or caps on home and community care services, long-term care, or acute care beds 4

7 Health Spending and Information and Communication Technologies Home Health Monitoring The market landscape The significant growth of the aging population and the associated healthcare needs is, without question, demanding new, creative and cost-effective solutions. Broadly speaking, information and communication technologies (ICT) are essential enablers to establishing a new mode of healthcare delivery in Canada. And, on a localized level, HHM is critical to delivering home and community care that will yield the highest impact for patients and the health system alike. Yet, the healthcare sector has invested less in ICT compared to other sectors, like banking or airline industries, which have embraced technology to transform and enhance their service delivery. But what kind of investment are we looking at? Potential spending on HHM, taken as a subset of the overall ICT health spending, is difficult to size with certainty although several recent reports provide a solid starting point. According to a report by the Conference Board of Canada, the total public and private spending on home and community care in 2010 was estimated to be as much as $10.5 billion, accounting for more than 5 percent of total health spending. In its 2008 report, the Canadian Home Care Association estimated expenditures for localized ICT (including hardware, software, services and personnel) as a share of total hospital costs in Canada to be 1.5%. Based on this information, the size of investment for ICT in home and community care in Canada could potentially be as high as $150 million (1.5% of $10 B) industry. However, since few home care leaders have a dedicated ICT budget, it is more likely that investment in ICT for home health monitoring is much less than in a hospital environment. When healthcare leaders make ICT a strategic imperative, they will open up game-changing possibilities. While it is generally accepted that expenditures on ICT have not been a priority for healthcare in general and even less so in the home and community care market, this is beginning to shift as ICT costs continue to drop and the value of HHM solutions, such as Remote Patient Monitoring (RPM), are gaining acceptance by healthcare providers and the general public. RPM technologies offer a compelling example of increased HHM uptake. They have matured dramatically in recent years. Standalone, disparate solutions have become integrated applications that connect to hospital information systems and fit within physician workflows. Medical devices that support RPM are today less invasive, more comfortable and flexible for patients. Today s RPM applications allow monitoring devices to communicate with a variety of caregivers, monitor patients 24-7 and provide continual support. The convergence of technologies is creating a perfect storm for a new era in healthcare delivery models. At the same time, commercial-grade products have become less expensive and more intuitive, while consumer products are delivering greater functionality at lower price points. The convergence of technologies products and advancements in personal devices, tablets and smart phones is creating a perfect storm for a new era in healthcare delivery models. The call to healthcare providers is to deploy these new and widely available technologies to deliver better, more costeffective health services. When healthcare leaders make ICT a strategic imperative, they will open up game-changing possibilities not only for the health of Canadians, but for Canadian innovation to be leveraged worldwide. 5

8 Creating new vistas for Canadian healthcare Within the current market landscape, there is a growing recognition of technologies role as a critical enabler to transforming the healthcare system. As leaders consider the road ahead, in particular related to broad deployment and adoption of HHM services, there are a number of well known challenges to acknowledge: Limited capital investment in technology Finding capital funds for investing into new IT is becoming more difficult, whereas allocating operating budgets may be a more acceptable financial approach. Effort to train resources Educating healthcare service providers to work with new devices and electronic record technologies. Shift of accountability to include patients Motivating patients to capture health indicators and actively participate in managing their own health. Lack of reimbursement to providers or incentive models Current fee schedules have limited flexibility or scope to reimburse individual care providers to use HHM solutions. Technology must be user-friendly and easily integrated into clinical workflows. As healthcare providers make progress in addressing these challenges and new health policies emerge, it will become possible to deploy HHM faster and more broadly. Another key consideration in progressing with HHM is to maintain focus on clinical workflow and productivity. While HHM is in many respects a technology discussion, it will only deliver an important return on investment if it aligns with clinical workflow and has leadership support and engagement from the planning phase of a project. In other words, success with HHM services depends as much, if not more, on the overall clinical and administrative design of the service as it does on the actual technology. From a technical standpoint to gain the greatest value and actualize the savings and benefits of HHM there must be an upfront design effort to ensure strong implementation. Technology must be user-friendly and easily integrated into clinical workflows with the right level of support, training and incentives to ensure high-level adoption by clinicians and ongoing participation by patients. Since 2000, TELUS Health has invested more than $1 billion in healthcare and continues to make ongoing investments. Our commitment is to provide the best healthcare information technology solutions in Canada and leverage our unparalleled telecommunications network to give healthcare providers lifesaving reach nation-wide from coast to coast to coast. To learn more about our solutions, our services and our unwavering commitment, please visit our website: telehealth-and-home-care-monitoring or contact Nicholas Zamora, Chief Clinical Advisor of TELUS Health at nick.zamora@telus.com,

9 References 1. Accessed October 17, Home and Community Care in Canada: An Economic Footprint by Greg Hermus, Carole Stonebridge, Louis Thériault, and Fares Bounajm; Conference Board of Canada. May Integration through Information Communication Technology for Home Care in Canada, Canadian Home Care Association 2008 Report. 4. Chronic Disease Facts and Figures - Public Health Agency Canada; Chronic Disease Infobase A. Broemeling et al, 2008; Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada: Implications for Policy and Practice. 6. Home and Community Care in Canada: An Economic Footprint by Greg Hermus, Carole Stonebridge, Louis Thériault, and Fares Bounajm; Conference Board of Canada. May Malkary, G. Health without bounds: trends in remote patient monitoring Spyglass Consulting Group. March Smith, T. & Sweeney, R. Fusion trends and opportunities. Medical Devices and Communications. September Steventon A, Bardsley M, Billings J et. al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomized trial. BMJ 2012; 344:e Darkins, A., Ryan P. et al. The Systematic Implementation of Health Informatics, Home Telehealth and Disease Management to Support the Care of Veteran Patients with Chronic Conditions. Telemedicine and e-health, December Pare G, Poba-Nzaou P, Sicotte C. Home telemonitoring for chronic disease management: an economic assessment. HEC Montreal Effective Home Management of Chronic Disease. Health Innovation Report p Pare G, Sicotte C, St.-Jules D, Gauthier R. Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease. Telemedicine and e-health 2006; Volume 12 (2): Best Care at Lower Cost: The Path to Continuously Learning Healthcare in America, Institute of Medicine of the National Academies, 2012 pg Canadian Institute for Health Information, All-Cause Readmission to Acute Care and Return to the Emergency Department (Ottawa, Ont.: CIHI, 2012). 16. Diabetes: A Hidden Healthcare Cost Driver in New York: An Analysis of Healthcare Utilization and Trends of Patients with Diabetes in New York State; A. Mathias et al, September 2010, HANYS Quality Institute. 17. L. O. Hansen et al., Interventions to Reduce 30-Day Rehospitalization: A Systematic Review, Annals of Internal Medicine 155, 8 (2011): pp D. Kansagara et al, JAMA, October 19, 2011 Vol 306, No JAMA. 2011;306(15):

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