News Roundup: August 5, 2013
Health Homes: Who Knew?
Published by AARP Blog
July 31, 2013
A new model of care called “health homes” is quietly spreading through many states, as Medicaid programs work to improve care for people with chronic conditions. The problem: Few people know what health homes are — or worse, they confuse them with home health services.
What are health homes? Health homes are not a place (even though “home” is in the term). They represent an approach in which providers or health teams coordinate care across settings for people with chronic physical or mental health conditions.
Health homes provide care management; care coordination; health promotion; transitional care from hospitals to other settings; individual and family support; and referrals to community and social support services. Health homes are expanding because of the Affordable Care Act, which created an optional Medicaid State Plan Amendment (SPA) benefit for states to establish them. States get money, too. They receive a 90 percent enhanced Medicaid match for the first two years.
What is my state doing? According to a recent AARP Public Policy Institute study, more than 30 states are either participating or are working to implement health homes. The figure illustrates state efforts as of May 2013.
Who are they? States can choose who can be health home providers. For example, they can pick:
One provider such as a doctor, an advanced practice nurse, a clinic, a home health agency or another type of provider; or A team of health professionals that can include nurses, social workers and mental health professionals.
States can also target health home services to certain geographical areas, and they can target certain health conditions. Health homes can serve Medicaid recipients who:
Have two or more chronic conditions;
Have one chronic condition and are at risk for a second; or
Have one serious and persistent mental health condition.
Why are they important? The key to this new model is care coordination. It is important because many people with chronic conditions see a variety of providers who often do not communicate with each other. This approach could be a viable solution for integrating and improving care across primary, acute, behavioral health, and long-term services and supports.
To find out more, contact email@example.com or check out the Health Homes Information Resource Center.
The new 21st century house call
Published by Boston Globe
July 29, 2013
Keeping track of health measurements at home is pretty simple: Step onto a scale in the bathroom, take a glucose measurement on the way out the door, or strap on a blood pressure cuff while watching television.
Now, doctors increasingly want access to those at-home measurements in an effort to keep patients healthier and reduce health care costs.
Boston’s Partners HealthCare last month launched a system that allows patients to upload information from their medical devices, often wirelessly, directly into their electronic records in doctors’ offices. Patients can use glucometers, blood pressure cuffs, bathroom scales, and pulse oximeters (which measure blood oxygen levels) at home, to take regular measurements and send them to their doctors.
Partners is among the first health care systems to integrate such at-home devices into the electronic health record, said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center, who is not involved with the Partners technology.
As more at-home consumer health-tracking devices appear on the market, and growing numbers of people are collecting personal data on activities such as eating habits, movements, and sleep, their doctors want to tap into that data for preventive patient care, said Halamka, who helped pioneer electronic record technology among Boston hospitals in the 1990s.
“We want to watch how you’re living in the home,” he said. “We want to make interventions sooner rather than later and we want to keep you out of the hospital.”
WENDY MAEDA/GLOBE STAFF
Sandra Rice, 61, takes her measurements daily to monitor chronic hypertension.
Sharing at-home measurements makes particular sense for patients with chronic cardiac or weight-related conditions, Halamka said. Those patients are the likeliest to strain hospital resources by appearing in emergency rooms when simple preventive care might keep them healthy at home.
For now, Partners’ monitoring system links wirelessly to blood pressure cuffs. But patients must connect their glucometers to a computer to upload those readings. As the system expands, it could include devices such as pedometers and mobile health-tracking apps, said Dr. Joseph Kvedar, the director of Partners’ Center for Connected Health.
Another advantage to sharing patient-collected data with doctors is that it encourages patients to change their behavior, Kvedar said. And being involved in their own care helps patients make lifestyle changes, he said, citing a 2012 study of more than Massachusetts adults with hypertension.
That study found a significant decrease in diastolic blood pressure among participants who both took their readings and uploaded them to a Web interface where they could track and monitor their progress.
Participants who took blood pressure readings but did not use the Web program saw little improvement in their blood pressure and were less likely to seek medication or ask their doctors about making healthier choices.
“After a while people might lose interest in the charm of a number,” Kvedar said. So doctors have to encourage patients to “stay in touch” with the reality of their health data.
Before Sandra Rice, 61, of Lynn used her wireless blood pressure cuff to regularly take and send her readings to the doctor, she barely understood what the numbers in her blood pressure readings meant.
“That little machine is my accountability,” Rice said. She takes her measurements daily to monitor chronic hypertension. The moment she sees her reading flash on the monitor, it’s being transmitted wirelessly into her medical records at the hospital. She can then track her progress on her computer. “Seeing when it’s high makes me want to bring it back to where it should be — thinking, ‘Oh, man, I must have screwed up some place.’ ”
Rice, who used to go to her doctor in Salem every six weeks for blood pressure readings, now only goes to the office for regular checkups or if she has a high reading.
Kvedar said the system will soon have an alarm-like function that alerts doctors or nurses when something out of the ordinary appears in the data, such as a blood pressure spike.
The cuff also helped Rice’s physicians get a more accurate reading; her readings at the doctor’s office reveal “white coat syndrome,” meaning her blood pressure is higher when she sees the doctor because office visits cause her stress.
Still, home health-tracking isn’t right for everyone, said Dr. Erika Riley, an internist at Massachusetts General Hospital’s Beacon Hill primary care office.
“Some people can get so consumed by measuring their blood pressure that it can make them more worried,” she said.
Kvedar would not say how much the Partners system cost, but said patients are “not yet” paying anything. In the future some insurance companies may ask patients to pay for their own devices while Partners foots the bill for the monitoring system, he said.
Boston’s Atrius Health allows patients to access a website or app to order medication refills, view their medical records, lab test results, and follow their health trends, but it does not link to at-home health devices. That system costs the health system $1 million a year.
The up-front cost of such a system can be a barrier for some, said Dr. Michael Lee, a pediatrician and clinical director of the Atrius portal.
“I think the hurdle to make the integration is still extraordinarily high — there’s a cost hurdle and an effort hurdle,” he said. Lee added that Atrius is in talks to link health and nutrition apps and monitoring devices, such as the FitBit and scales that can transmit data wirelessly, into the Atrius portal.
The Westborough health tech company e-ClinicalWorks, whose technology is used by 80,000 doctors across the country for patient electronic records, is also working to link devices and apps to their Web- and app-accessible patient portal, said Girish Navani, chief executive officer of the company.
Despite cost and other barriers, most doctors agree that personal technology is changing health care.
Some devices such as a wireless blood pressure cuff will appeal to patients, Navani said. Patients are likelier to stick with devices that are portable and work wirelessly rather than one that needs to be plugged in.
The difference in “three or four clicks” is enormous, he said.
Halamka said the initial plunge to invest in personal patient technology can be difficult for some hospitals to take — both in cost and culture. Doctors sometimes distrust patients taking their own measurements, he said. And some doctors are also unwilling to sift through a constant stream of data, Lee said.
But the promise remains that once one system adopts the technology, said Halamka, it won't be long until the innovations “just domino all over.”