July 16, 2002

BROADBAND AND E-HEALTH: JOINED AT THE HIP

"Slow broadband deployment is the key limitation in our high technology economy." Andrew Grove, Chairman, Intel

Here's a pop quiz -- the answer might surprise you: What percentage of US households have high-bandwidth Internet connections? What percentage of South Korean households? (Answer below)

Several recent reports have examined the compelling advantages of broadband (high-speed) Internet and have highlighted some of the most promising health care applications. This brief reviews key excerpts and highlights some of the surprising findings. 

Broadband: A 21st Century Technology and Productivity Strategy 
Office of Senator Joseph I. Lieberman, May 2002 
Click for Press release or Full report

Broadband applications for e-medicine include (Table 1):

	Remote monitoring of patient vitals
	Virtual physical examinations
	Remote consultations between health professionals
	Remote consultations between patients and physicians
	Public health training programs
	Automated patient inquiry handling

"The Broadband Difference: How online Americans' behavior changes with high-speed Internet connections at home"
Pew Internet Project; June 23, 2002

There are three major ways in which broadband users distinguish themselves from their dial-up counterparts. For high-speed home users, broadband lets them use the Internet to:

	become creators and managers of online content;
	satisfy a wide range of queries for information, and;
	engage in multiple Internet activities on a daily basis.

Because of their active information gathering, home broadband users report that the Internet helps them in various dimensions in their lives:

	Nearly half (47%) say the Internet has improved the way they get health care information.
	The extra time spent online due to broadband -- and the wider range of online activities done by broadband users -- comes at the expense of the use of traditional media, shopping in stores, working at the office, and commuting in traffic.
	Broadband users do not report that the Internet has had much impact on the time they spend with family, friends, or attending social events.

"The Age Wave Meets the Technology Wave: Broadband and Older Americans"
Senior Net, June 2002

Broadband technology may have the greatest impact on the lives of seniors in the area of health. One of the most innovative uses of broadband networks will be to help people remain independent as they age and become more frail.

But we have not yet made the changes to our health care system that are required to make telemedicine part of the mainstream. In addition, the quality of applications that can be delivered over low-speed networks is severely limited. The growth of high-speed networks will make it possible to deliver a much broader range of high-quality health services to patients at home or wherever they may be.

The answer to the pop quiz: while less than 10% of US households currently have broadband Internet access, over 50% of South Korean households have high-bandwidth connections! ...and what's more surprising is how broadband REINFORCES South Korea's "hypersocial culture" 

RECENT REPORTS PROFILE THE CHRONICALLY ILL

"Medicare: Cost and Prevalence of Chronic Conditions"
Partnership for Solutions, July 2002

"A Portrait of the Chronically Ill in America, 2001"
The Foundation for Accountability and the Robert Wood Johnson Foundation, 2002

REFORMING GOVERNMENT PAYMENT FOR MEDICARE -- DM AND OTHER PROMISING OPTIONS

"Report to the Congress: Assessing Medicare Benefits"
Medicare Payment Advisory Commission, June 2002

Full report

The Medicare Payment Advisory Commission (MEDPAC) advises the U.S. Congress on Medicare issues. This report examines options for expanding the benefit package to cover additional services: prescription drugs, mental health, case and disease management, preventive, vision, hearing, and dental. The report acknowledges that "although adding benefits in those areas would raise Medicare spending, spending by other payers would fall."
Although the report devotes several pages to disease management coverage options (see pp. 54-55), its conclusions are bland. "To better meet the health care needs of beneficiaries with chronic conditions and potentially reduce total health care spending, policy makers may want to consider covering case and disease management services as part of fee-for-service Medicare." 

The report suggests several issues to consider in pending disease management demonstration projects:

	What services should Medicare pay for and who should deliver them?
	How could financial incentives be used to encourage providers to offer cost-effective, clinically appropriate services?
	How could benefits be managed cost-effectively?

AHRQ REPORT LISTS TOOLS TO IMPROVE PATIENT AND PROVIDER DECISION MAKING

"Expanding Patient-Centered Care to Empower Patients and Assist Providers"
Agency for Healthcare Research and Quality (AHRQ), May 2002

This report describes tools developed by the Agency for Healthcare Research and Quality (AHRQ) that are currently available to help patients and their providers make better decisions. It suggests that a broader application of existing tools, as well as the development of similar tools for different areas of care, will improve the quality of care from the perspectives of patients, providers, and health plans.

WHAT HAPPENS AFTER EVERYBODY HAS A CELL PHONE?

"Invisible Mobile Ignites Telecom"
Forrester Research, May 2002

In Europe telecom companies are challenged by the already-high penetration of wireless voice services. Over 70% of the population already has a cell phone, so opportunities to create new users are limited. 
Telecom companies are exploring new ways of developing data driven applications for cellular service. This report highlights promising applications, including a fascinating discussion of patient monitoring opportunities. 

EMPLOYERS GIVING MORE CHOICE TO EMPLOYEES

"Increasing Consumer Choice in Health Care: Five Steps Employers Can Take Now"
National Center for Policy Analysis; June 17, 2002

1. Let employees know what health care costs
2. Allow cash-outs
3. Eliminate community rating
4. Increase employee choice
5. Increase direct pay

ENGAGING EMPLOYEES IN ONLINE HEALTH COMMUNICATIONS -- 5 TIPS FOR EMPLOYERS

"CIGNA Survey Shows Online Disconnect: While Most Employers Now Offer Online Benefits, 4 of 5 Workers Say Effort Still Misses the Mark"
Cigna Press Release; June 24, 2002

Full Description of 5 Tips for Employers

1) Keep it simple
2) Online education
3) Personalization wins out
4) Make it interactive. The most popular online health care services include:

	Opportunity to select a doctor
	Ordering prescriptions
	Reviewing the status of medical claims
	Determining co-payments and deductibles
	Reviewing health plan options, and
	Accessing health and wellness information.

5) Broad, integrated company commitment

COST EFFECTIVINESS STUDIES OF TELEMEDICINE ARE LACKING

"Systematic Review of Cost Effectiveness Studies of Telemedicine Interventions"
British Medical Journal; June 15, 2002

Conclusion: There is no good evidence that telemedicine is a cost effective means of delivering health care.

...There is little published evidence to confirm whether or not telemedicine is a cost effective alternative to standard healthcare delivery.

The authors found that only 55 of 612 identified articles presented ANY actual cost benefit data, and that only a subset of these articles addressed the issue adequately (see Table A ).

REVIEW OF STUDIES EXAMINING ASTHMA DM

"Disease Management Balancing Cost and Quality: Studies of the benefits of disease management services for the treatment of asthma"
National Pharmaceutical Council, April 2002

ADA PERSPECTIVES ON THE STATE-OF-THE-ART IN DIABETES CARE

"More Than the Patch: New Medical Technologies"
New York Times; June 2, 2002

American Diabetes Association (ADA) Scientific Sessions Online; June 14-17, 2002

"The Role of Primary Care Professionals in Managing Diabetes"
Clinical Diabetes, Volume 20, Number 2, 2002

WORTH REVIEWING!

"Telemedicine payment expansion sought.
One measure would require that Medicare pay physicians the same fee for remote monitoring as for face-to-face encounters."
American Medical News; July 8/15, 2002

"Routine maintenance: Disease-management programs continue to grow, but lack of physician and patient cooperation remains a sore spot"
Modern Healthcare; July 1, 2002

Disclosure -- No clients were mentioned this issue.

E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC (http://www.bhtinfo.com).  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

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