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Transcript of QualComm White Paper_0
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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
Produced by MedTech Media, a division of HIMSS Media. 2012
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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.