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    Delivering Accountable Care with Remote

    Monitoring for Chronic Disease Management

    me

    Produced by

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    Health expenditures in the United States neared$2.6 trillion in 2010, accounting for 17.9 percent othe U.S. Gross Domestic Product (GDP)1, with chronic

    disease capturing the lions share of the cost. Nearly

    1 out of every 2 adults, or 133 million Americans, had

    at least one chronic illness in 20052, and every year

    chronic disease, which includes cancer, diabetes

    heart disease and stroke, causes 70 percent of deaths

    in the U.S. and comprises approximately 75 percent

    of medical care spend.3 The explosion of chronic dis

    ease is not just an American phenomenon; it is the

    leading cause of mortality in the world, responsible

    for 63 percent of all deaths.4 In 2008 alone, 36 million

    people died from chronic disease, according to the

    World Health Organization.

    In an effort to bend the cost curve and address chronic condi

    tions, leading healthcare organizations have implemented various solutions. Remote monitoring for chronic disease manage

    ment has been widely deployed because it targets the area of

    greatest spend. It also affords convenience for both patients and

    clinicians, enabling the former to track and self-manage thei

    conditions within their daily lives and the latter to receive critica

    information anywhere and anytime in order to provide real-time

    quality care. Numerous studies have quantified both the clinica

    and financial value of implementing such programs (See Table 1

    and Figures 1-3).

    Accountable Care: Changing theDynamics for Managing Chronic DiseasesDespite documented successes, in general remote monitoring

    for chronic disease management has been stuck in pilot mode

    While there are a handful of reasons for this inertia, the main

    driver is lack of economic incentive, according to Donald Jones

    vice president of global strategy and market development fo

    global telecommunications leader Qualcomm Life. What really

    drives healthcare is when workflow can be improved, direct and

    measurable costs can be reduced, or market share can be in-

    creased, he said. At the end of the day, quality usually has to

    be hand in hand with one of these drivers in order for something

    to be implemented. As the path to unsustainability grows ever

    shorter, new accountable care models are being developed to

    replace the current fee-for-service model, moving from pay fo

    volume to pay for quality, which contributes to a more receptiveenvironment for remote monitoring.

    The passage of the Affordable Care Act (ACA) has moved up

    the timeline for implementing new payment models. The ACA

    incorporated provisions for participation in accountable care or

    ganizations (ACOs), which tie provider reimbursements to qual

    ity metrics and reduced cost for an assigned patient population

    Under the Medicare Shared Savings Program, which began in

    January 2012, participating entities that meet quality and perfor

    mance standards are eligible to receive payments for shared sav

    ings. Also under ACA, the Hospital Readmission Reduction Pro

    *The largest randomized control trial of telecare and telehealth in the world.

    Reductions in:

    Reductions (%)

    Figure 3: Results of 3 Million Lives - Whole System

    Demonstrator (UK) trials (2012)*

    Elective

    Admissions14%

    15%

    20%

    45%

    A&E Visits

    EmergencyAdmissions

    Mortality Rates

    0.0 10% 20% 30% 40% 50%5% 15% 25% 35% 45%

    *Analysis comparing five independent clinical studies demonstrating the effectiveness of home healthmonitoring across a combined 17,917 patients.

    Figure 2: NEHIs Detailed Technology Analysis

    Home Telehealth (2009)*

    Average Decrease inHospitalizations

    49%

    Decrease inMortality Rates

    Average Decreasein ED Use

    69%

    69%

    0% 10% 20% 30% 40% 50% 60% 70% 80%

    *Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day ReadmissionRates in a Case-managed Medicare Population, Med Care, 2012**Virtual Monitoring Reduces Hospital Readmissions for Spectrum Health Heart Patients, 2010

    Figure 1: Reduced Hospital Readmissions Using

    Remote Monitoring Solutions

    Readmissions Reduction (%)

    Geisinger

    Health Plan* 44%

    SpectrumHealth**

    73%

    0% 10% 20% 30% 40% 50% 60% 70% 80%

    1. Centers for Medicare and Medicaid Services

    2. Rand Health3. Centers for Disease Control and Prevention4. World Health Organization

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    Table 1

    Chronic Condition Program, Study Benefits

    Congestive heart failure(CHF)

    Noninvasive Home Telemonitoring for Patientswith Heart Failure at High Risk of RecurrentAdmission and Death, Journal of the AmericanCollege of Cardiology, 2005

    35% drop in inpatient length of stay; 10%reduction in office visits; 65% drop in homehealth visits

    The Veterans Healthcare Administration,Care Coordination/Home Telehealth: The System-

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    gram, which took effect October 1, 2012, reduces payment rates

    for excess readmissions within 30 days for Medicare patients. Par-

    ticipation and compliance with these programs will drive hospi-

    tals and other healthcare organizations to revisit their successful

    pilots or build strategies around best practices of proven pilots

    for remote monitoring for chronic disease management.

    Unleashing Innovative Technologyto Bring Greater Value

    While successful pilots have been studied as early as 2005, tech-nology developers continue to innovate and bring increasingly

    more robust solutions to market. In December 2011, Qualcomm

    unveiled both a new company Qualcomm Life, Inc. in the mo-

    bile health space and its cloud-based 2net Platform and Hub,

    which are both FDA Class 1 MDDS medical devices. The Platform

    is designed to aggregate data streams from non-interoperable

    medical devices, which can then be turned into apps for mobile

    devices or interface with electronic health records (EHRs). Qual-

    comm Life is moving to apply analytics engines to data streams

    and the resulting information can be recorded in mobile de-

    vices or turned into predictive models with the help of partners

    that help patients with therapy management. The 2net Hub is a

    plug-and-play gateway designed to plug into a wall socket and

    provide connectivity for a wide range of medical devices and to

    transport data from those devices to the cloud platform.

    Companies can access Qualcomm Lifes software development

    kit (SDK) to write software and pull data from the cloud and make

    for example, dashboards or web portals that transform informa-

    tion into clinical, patient management or caregiver offerings.

    Our focus is to take our expertise at developing platforms,

    software and systems, and radio frequency-based solutions, ap-

    ply them to healthcare, increase connectivity so that information

    flows faster and better and is compliant with regulations, and

    then let the healthcare industry figure out how to get a value

    proposition out of that, Jones said. Qualcomms many long-

    term partners have taken the opportunity to derive value from

    collaboration.

    Partnering and Connecting toImprove HealthcareEntra Health Systems, an applied technology company focused

    on improving healthcare management, deploys 2net as a trans-

    mission platform for the companys offerings, including the

    MyGlucoHealth meter, a blood glucose meter with a wireless

    BlueTooth module for diabetic patients. Previously, patients

    transmitted their glucose readings and other biometric data via

    their mobile phones, PCs or Macs. The 2net Hub and MyGlu

    coHealth meter have provided accessibility and convenience fo

    patients, especially the elderly who are either home-bound or in

    assisted living facilities and may not have access to technology

    The standalone home-monitoring solution automatically trans

    mits the data. Across the board, its easier; you dont have to

    touch anything, said CEO Richard Strobridge.

    Patients can use the 2net Hub in conjunction with mobile apps

    enabling caregivers to view alerts and send text messages and

    testing reminders. Staff can log onto the clinical portal and

    quickly identify which patients have not tested and uploaded

    their data. The system automatically triages those patients, so

    instead of trying to have a constant engagement with a thousand

    patients, they can see which 50 patients are in the most trouble

    right now and reach out to them, Strobridge explained. In the

    four months since the hub and blood glucose meter have been

    in production, the company already has seen better outcomes

    Were seeing HbA1c levels starting to come down, and were

    seeing more engaged and motivated patients, he said. With

    more compliant patients, provider staff has seen a reduction in

    missed interactions and communications. Building on the suc

    cess of the launch, Entra Health Systems is rolling out 2net forits products across the country and across Europe in November.

    When U.S. Preventive Medicine (USPM), developers of preven

    tion, early detection and chronic condition management prod

    This is really going to

    revolutionize healthcare.

    Making the world a healthier

    place is USPMs ultimate

    goal, and by leveraging

    Qualcomm Lifes wireless

    technology the company will

    be able to achieve its goalmuch more efficiently.

    Jason FeyDirector of Mobile Solutions

    U.S. Preventive Medicine

    What really drives healthcare is when workflow can be improved, direct

    and measurable costs can be reduced, or market share can be increased.

    Donald JonesVice President, Global Strategy and

    Market Development Qualcomm Life

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    ucts and services that improve health outcomes and reduce

    healthcare costs, decided to create its own mobile application,

    it partnered with Qualcomm Life. Qualcomm Life has a philoso-

    phy of using their technical expertise to make the world a health-

    ier place, as do we, said Chairman and CEO Christopher Fey.

    The shared philosophy was the starting point for leveraging their

    respective core competencies to make healthcare more efficient.

    Clients of the companys online health management program,

    which is embedded in evidence-based clinical methodology,

    wanted to be able to interact with the program via their smart-

    phones. Collaborating with Qualcomm Life and design firm

    Fjord, USPM built Macaw, an extension of its online program and

    a standalone full-featured app. Macaw integrates and filters data

    from third-party health and fitness apps and wireless devices,

    and transforms it into evidence-based clinical recommenda-

    tions for end users. By deploying Macaw into our population, as

    well as the new application in the disease management offering

    that were creating, users can manage their health in a way that

    theyve never been able to do before through the wireless con-

    nectivity of all of these different devices into a single dashboard,

    said Jason Fey, director of mobile solutions.

    Macaw also enables biometric data to be sent to physicians, careproviders and other entities, giving them access to information

    that will help them more effectively manage their patient popula-

    tions around different disease conditions. This is really going to

    revolutionize healthcare, he said. Making the world a healthier

    place is USPMs ultimate goal, and by leveraging Qualcomm

    Lifes wireless technology the company will be able to achieve its

    goal much more efficiently, according to Fey.

    Moving Forward to True Accountable CareWith economic incentives and an innovative wireless infrastruc-

    ture in place, the time is ideal for healthcare organizations to

    move past the pilot stage and roll out and scale remote monitor-

    ing for chronic disease management. While some organizationsnew to remote monitoring may consider doing a pilot first, Jones

    argues against such a strategy. More often than not, when health-

    care organizations decide to run a pilot they rely on vendors to

    help fund and implement the project, which results in organiza-

    tions not taking full ownership to make sure it works, according

    to Jones. Often, a byproduct of lack of ownership is lack of buy-in

    from leadership on down to the end users, which can doom an

    implementation especially when it touches on multiple areas of

    the organizations, such as workflow, procedures and job respon-

    sibilities, as remote monitoring does.

    Instead, Jones encourages hospitals and other healthcare orga-

    nizations to think entrepreneurially. For example, hospitals with

    a system in place that monitors patients for the first 30 days af-

    ter being discharged in order to comply with federal mandates

    can leverage that system by offering services or devices to family

    members to purchase after the 30th day. Family members es-

    pecially those who live remotely from the patient can continue

    to monitor their loved ones, patients can proactively manage

    their condition and hospitals can recoup their investment costs.

    This type of offering can differentiate healthcare organizations

    in todays increasingly competitive healthcare market. The tra-

    ditional way of thinking about remote monitoring managing

    healthcare expenses down is a very limited way of thinking,

    Jones warned. Instead, lets improve the patients life and life-

    style help patients do better self-management and lets come

    up with new business models that are revenue producing or ex-

    pense avoiding for healthcare providers, he said.

    While Jones anticipates that healthcare organizations will likely

    take anywhere between a year to two years to devise a strategy

    and meet mandates, early adopters of remote monitoring and

    entities that had assumed financial risk before the passage of

    ACA already have a decisive market advantage. Through educa-

    tion of successful pilots and by adopting best practices, health-

    care organizations can accelerate and level the playing field as

    they roll out remote monitoring initiatives. These are transfor-

    mative times in the healthcare industry, and a lot of the trans-

    formation is going to be fueled by the wireless world mobile

    health and technology solutions, acknowledged Ron Loeppke,

    MD, vice chairman of USPM. The bottom line is that its all aboutbetter health and better healthcare at lower costs - being able to

    empower an individual as they work with their provider to yield

    better health outcomes.

    These are transformative times in the healthcare industry, and much of the

    transformation is going to be fueled by leveraging the power of prevention

    in the wireless world through mobile health and technology solutions.

    Ron Loeppke MD, MPH, FACPM

    Vice ChairmanU.S. Preventive Medicine

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    About Qualcomm Life

    Qualcomm Life is defining and connecting the wireless health network to improve lives and advance the capabilities of medical devices. By focusing

    on device connectivity and data management, we empower medical device manufacturers and service providers to deliver wi reless health quickly andeasily to those who need it. Our mission is to mobilize healthcare.