How can healthcare providers deliver better outcomes to patients at lower cost with less intervention, using fewer case managers, and achieving greater profitability? Smarter telemedicine.
Monitoring difficult-to-reach, chronically ill patients remotely is the key to keeping them healthy. Currently, such patients are managed so inefficiently that any improvement would be helpful.
One surprising company going after this low-hanging fruit is Qualcomm, a company I have been advising. It aims to bring its leadership in mobile chips to smart healthcare devices that report regularly to the cloud. This market is so important to Qualcomm that it has created a separate subsidiary, Qualcomm Life, for its diverse healthcare activity.
Remote healthcare devices require all the usual high-mobility characteristics — like power efficiency, sophisticated communications capabilities, and the ability to convert analog signals to digital data. But they also need to handle patient privacy carefully and be compliant with systems that enable that compliance to be externally audited.
At the heart of Qualcomm Life is 2net, a remote healthcare gateway technology. A 2net hub, plugged into a wall, can capture readings from diverse medical devices deployed in the home. The patient doesn’t have to do anything except use the device. The device retains the data until it wirelessly encounters the hub, which then transfers the information to a cloud service. Then the data is passed on to customer systems like care-coordination portals, hospital Web pages, or electronic medical records repositories. Devices can communicate with 2net today for both diagnostics (weight scales, blood-pressure cuffs, coagulation meters) and treatment (CPAP machines).
Since it was first deployed in the market in 2011, 2net has evolved. Originally, it was an embedded module in a built-for-purpose medical device. Now, it can be just software in a smartphone, which can then act as a 2net device and communicate with healthcare apps.
On top of the 2net core platform, Qualcomm has built a separate care-coordination platform called HealthyCircles. Acquired in 2013, HealthyCircles provides a secure software-as-a-service (SaaS) product that lets caregivers, patients, and family members share information on patients receiving care in their homes. This further facilitates the deployment of 2net-enabled devices and helps device manufacturers and service providers get to market quickly with a complete service.
Jim Mault, a doctor who helped build the HealthVault service at Microsoft and later created HealthyCircles before selling it to Qualcomm, says chronic outpatient care is a good market. “Early detection creates the opportunity for early intervention, avoiding a big hospital bill,” he says. Mault also notes that about 20% of people generate 80-85% of healthcare costs, because they have serious ailments like cancer, heart failure, lung disease, and diabetes.
Managing the chronically ill directly with case managers is expensive and doesn’t scale. The managers can’t check on patients frequently enough, especially the sickest, who need more attention. A case manager might spend an hour tracking down one patient, talking to his or her doctor, and speaking with family members. The next 10 calls may go to patients who are fine. If the case manager knew they were fine, he or she wouldn’t have to call.
Managing by exception using electronic data is much more efficient. This is one of the things 2net and HealthyCircles enables. Remote devices like home blood pressure meters, heart rate monitors, and pulse oximeters send data at regular intervals to a cloud platform, which raises an alert only when a preset threshold is breached.
This avoids the hassle and expense of unnecessary facility visits. Sicker patients can be “pinged” more frequently. Instead of hospital visits twice a month, an ill but stable patient can be monitored daily — or even every hour. A provider need take action only when it receives an alert.
Thus, a case manager who might normally be able to handle a couple of dozen patients can, says Mault, “take care of a couple of thousand without having to call the patients to know what’s going on.”
HealthyCircles’ Triage Dashboard identifies for a case manager the 20 or 30 patients out of perhaps 1,000 who need attention at any given time.
This type of system enables a new kind of health care.
Here’s how it works today: a patient gets a high blood pressure reading at a doctor’s office. The doctor writes a prescription, expecting the patient to stop by Walgreens on the way home. At the follow up appointment six months later, the doctor discovers the outcome. Why six months? Because that’s the next time the insurance company will pay for an appointment.
During those six months, a doctor didn’t see the patient unless he or she came into the emergency room with an acute problem. The doctor didn’t know that the medicine had never been picked up, that the patient had stopped taking it, or that it didn’t work. Or maybe the condition cleared up, or an even worse scenario unfolded, undetected. In the extreme, waiting six months could cause the doctor to miss a chance to prevent a stroke, precipitating a potentially huge bill for emergency room treatment, rehabilitation, and loss of productivity, not to mention family emotional trauma.
But with remote home monitoring, a doctor would know the lay of the land in two weeks. A few days later, a case manager could intervene. Didn’t pick up the meds? Line up a social worker or financial assistance. The meds had no effect? Get the doctor to prescribe a different one. Working fine? Make an appointment for a year hence. Any of these scenarios is preferable to the current approach.
People who know Qualcomm may not be aware that the company is in new esoteric markets like remote health monitoring. But this example, like Intel’s investing in drones and Apple’s moving into cars, is part of a larger trend which sees traditional tech companies branching out into new and adjacent areas as their core markets mature.