Telehealth Care Management

A couple of years ago, telehealth in all its incarnations became the hottest of hot trends, one which has since cooled dramatically.  As with many such trends, there is usually a core of value which needs to be identified and implemented over time in a way that maximizes that value.   The use of telehealth tools to help with disease management has a history of ambiguous results in research, with a number of studies finding some improvement in quality but inconsistent overall spending reductions.  An article in Health Affairs reports on an intervention with Medicare beneficiaries who had congestive heart failure, diabetes or chronic obstructive pulmonary disease.  The intervention included use of a telehealth tool that gathered information from patients at home, applied risk algorithms to the data and provided it to care managers.     (HA Article)

The study compared about 1767 beneficiaries in the intervention group (anyone who was offered use of the telehealth device was included, even though only around 40% actually used it) with an equal number in a matched, randomly selected control group.  The analysis examined trends in spending within the intervention group and between the intervention and control groups.  Average quarterly spending for the intervention group declined over the study period.  Compared to the control group, quarterly spending on patients in the intervention group was 8-13% lower, with the largest effects in the congestive heart failure subgroup.  An interesting side finding was that by the second year of the intervention, the study group had a 2.5% lower mortality rate than the control group.

It should be noted that the full actual cost of the telehealth tool is not included as an offset to the health spending savings, but based on an estimate of that cost, there would still be significant spending savings.  Drug spending was not included in the analysis and doing so might have reduced the savings, because care management programs often increase drug spending, while hospital and ER costs go down.  As noted above, mortality was lower in the intervention group, so while on a short term basis there might be savings, the fact that these people live longer might mean that their total spending over the period of their coverage by Medicare may be higher than it otherwise would be.  Notwithstanding these quibbles, given that the program seems to provide better care, it provides further reason to encourage the use of telehealth in managing chronic disease.