In its “Heart Disease and Stroke Statistical Update 2013,” the AHA reported that between 1999 and 2009, the rate of deaths from cardiovascular disease (CVD) fell 32.7 percent, but still accounted for nearly one in three deaths in the U.S.  However, the organization estimates that heart health will only improve another 6 percent if current trends continue.

“Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop,” said Alan S. Go, M.D., chairman of the report’s writing committee and chief of the Cardiovascular and Metabolic Conditions Section of the Kaiser Permanente Northern California Division of Research, Oakland, Ca.  “If not, we’ll quickly lose the momentum we’ve gained in reducing heart attack and stroke rates and improving survival over the last few decades.”

The data show that 68.2 percent of adults age 20 and over and 31.8 percent of children are overweight or obese. Meanwhile, 32% of adults, 17.7% of girls and 10 % of boys report fewer than an hour of aerobic activity in the past week.

The AHA is calling for healthcare systems to support and reward providers who help patients improve their health behaviors, insurers to cover preventive health services and reward positive health behaviors, and the education community to support healthy diets and physical activity for children among other interventions.

A Vision of Connected Health: Executive Summary

To really bend the health cost curve downward, we must engage patients directly and shift from the current model of  late diagnosis and treatment (“sick care” ) to a more cost-effective system that focuses on healthy lifestyle promotion, disease prevention and highly-coordinated care from the most appropriate providers. This is particularly true for low-income patients, a growing number of whom suffer from chronic diseases.  As health costs rise, more of these patients are being moved into capitated health plans. The rest usually have limited coverage or no health insurance at all, and have great difficulty accessing health promotion programs or medical care.

How can we provide care to these patients with increasingly limited resources? Fortunately, a host of new “connected health” technologies can now support patient education, treatment compliance, shared-decision making, motivation for life-style changes, patient triage, medical record access, health professional training and other activities that could dramatically improve patient outcomes while lowering costs.  Used in conjunction with service innovations, such as group medical appointments, health coaches, remote monitoring and telemedicine, such technologies can lead to better coordinated care, lower costs and higher quality.

Presently, health costs are consuming a growing portion of family, business, local and federal government resources.  According to the actuarial firm Milliman, the average cost to insure a family of four in the US has grown from $8,414 in 2001 to $20,728 in 2012, or more than 100% of family income at the official poverty level and over $5,000 per person per year.  Simultaneously, key health indicators including obesity, blood pressure and chronic diseases such as diabetes are also increasing, leading to clearly unsustainable costs.

This trend comes with tragic human costs as well.  If we continue on this path, one child in three in the US will develop type II diabetes.  For minority children, one in two will become diabetic.  These children are innocent bystanders in a growing epidemic of chronic disease. We must provide them and their parents the health programs that will allow them to avoid this fate. The tools to implement effective health programs for this vulnerable population are available now.  An optimal platform will both empower patients through health promotion and help them obtain the best quality care from the most appropriate provider, when needed.

The US health system is difficult to navigate and more expensive than that of any other comparable country. The poor have particular difficulty accessing and affording quality health care.  As a result, diagnosis and treatment are often delayed and usually takes place in the emergency room, worsening health outcomes and raising costs.    

It’s been well documented that US health care services are fragmented, plagued by waste and hampered by distorted financial incentives that reward per procedure rather than for optimal patient outcomes. Moreover, doctors and other health professionals are usually not trained or incentivized to promote life-style management such as nutrition, and find it difficult to change patient behavior.   Such behavioral counseling is also poorly reimbursed, which has led many medical students to choose specialties over primary care, leading to a shortage of family physicians.

However, the explosion of information technologies, particularly mobile phones, provides an unprecedented opportunity to improve health promotion and care for the underserved. Today, most of the poorest people have access to a mobile phone.  Healthcare providers, meanwhile, are using smartphones and tablets for a growing number of medical applications, including diagnostic instruments, for telemedicine consultations and to access a wealth of new resources such as health information databases and decision support tools.  Over the last few years, there have also been multiple innovations in preventive care, wellness, diagnostics and treatment that have demonstrated high-impact on patient health, and can be used more effectively through a health care platform designed to more easily “connect” various services and stakeholders required to provide quality care to patients.

The future of health care is “connected health”: Care that is cost-effective, accessible, highly-integrated and easily personalizable.

• Cost-effective health care starts with disease prevention, continuous monitoring of health indicators, early detection and lifestyle management
• Accessible health care leverages modern communication technologies
• Integrated health care requires continuous aggregation of data from all stakeholders throughout the health care continuum

Connected health is an optimal care delivery model where patient data is continuously aggregated from multiple stakeholders. This data is used to “connect” the patient to the optimal tool or provider that can address needs immediately and in the most appropriate cost-effective manner. Patients needing routine screenings could see a specially trained nurse practitioner, those with minor symptoms can quickly determine if they need a medical appointment at all using self-assessment tools. Access to the right specialist can be quickly arranged, at the earliest signs of potentially serious disease.

Expected outcomes of connected health:

• Improved health from regularly tracking key health indicators such as weight and blood pressure, especially if with the patient is working with a coach or a peer group
• Increased access to affordable health care
• Increased ability to self-manage through tracking and improving basic health indicators like weight and regular exercise
• Increased use of preventive care services, such as screenings and vaccinations
• Decreased emergency room visits
• Decreased rates of unnecessary hospitalization
• Greater use of “right-skilled” providers, e.g. lower-cost resources such as nurses for common ailments with known treatments, lifestyle management for chronic diseases, etc.
• Overall cost reduction for patients, payors, and even providers, particularly under capitated systems

What methods of care will Connected Health empower:

• Health promotion
• Early detection and prevention through better access to  family history and medical information
• Expedited diagnosis through faster connections of patients to doctors who are experienced with treating the suspected disease
• More effective treatment through better collaboration among doctors and specialists, decreasing time to diagnosis while reducing costs
• Increasing shared-decision making between doctors and patients, thereby improving health outcomes
• Effective disease management through continuous monitoring of health conditions, just-in-time patient education to facilitate self-management, aggregated health data overtime for better overall outcomes and risk detection
• Proven and tested methods for continuously improving self-management

Achieving “Connected Health” vision

Grameen Research and ClickMedix are designing novel health promotion and delivery systems that leverage ClickMedix’s mobile-phone enabled connected health platform, allowing each step within the health care continuum to be implemented cost-effectively.  We are also reaching out to other innovators who can contribute to this unique and forward-looking new care delivery system.  The first program will be implemented within Grameen communities of ultra-poor women entrepreneurs and their children in New York City.  The goal is to improve their access to health care while building a sustainable health service revenue model.

For further information, please contact:                

Vidar Jorgensen

Founder and President Grameen America and Grameen Research

Advisor, Grameen Trust and Grameen Health Trust

Email: vidar@wchnet.com

www.grameenamerica.com

www.grameenresearch.org www.grameenhealth.com

Ting Shih

CEO & Founder | ClickMedix

Email: ting@clickmedix.com

http://clickmedix.com