By Stella Dawson
WASHINGTON, April 12 (Reuters) – Baby boomers wired to their
iPads and smart phones are giving U.S. health experts some new
ideas about ways to cut the soaring costs of medical care in
graying America.
Some of the ideas might sound like “Robo-Granny”. An
astronautical engineer at the Massachusetts Institute of
Technology has made a skin-tight undersuit equipped with sensors
that can constantly monitor the vital signs of its elderly
wearer and feed the data into a computer that fires off health
alerts. It was first designed for a landing on Mars.
There’s also Paro, the robotic seal which has fur, big eyes
and responds to voice commands, a low-cost companion that the
AgeLab at MIT is testing to help calm elderly people with
dementia. Then there is the magic carpet with a built-in sensor
that monitors gait to check for risk of falling.
Other ideas are simpler and already are being tested by
governments and private health insurers. Marilyn Yeats, 79, is
suffering from congestive heart failure and uses a personal
healthcare computer, Connect, provided by the health insurer
Humana Corp. She calls it My Little Nurse for helping
her keep track of her blood pressure, weight, temperature and
whether she is taking her medicines on time.
“It rings me up every morning at 10 am, and there I am, on
my machine measuring myself, and if I have gained weight, it
asks me additional questions. I say it is like having your own
nurse come into your house every day.” said the Naples, Fla.,
resident.
If these programs succeed, home technologies could help slash
billions of dollars from the nation’s $2.6 trillion healthcare
bill by keeping elderly people in their homes for longer and out
of expensive hospitals and nursing homes.
The United States spends far more on health care than any
other country at 17.9 percent of GDP compared with the OECD
average for advanced countries of 9.5 percent. And yet dollar
for dollar it gets results that are consistently in the bottom
third of developed countries along with Mexico or Hungary, as
measured by average health outcomes.
Cutting healthcare costs is essential if the United States is
to tame its $15 trillion government debt load. Medicare, the
healthcare program for the elderly consumes 15 percent of U.S.
budget spending. It is the biggest single expense after defense
and the pension program Social Security.
Medicare costs are growing rapidly as the 79 million baby
boomers — roughly equivalent to the entire population of
Germany — retire over the next 20 years, threatening to push
the U.S. debt load to $25 trillion in a decade.
Left unchanged, the Medicare hospital fund is forecast to go
bankrupt by 2024. The ratings agency Standard & Poor’s, which
already has downgraded the U.S. credit standing, has warned of
further action within three years if the United States and other
advanced G20 countries fail to get to grips with the costs of
aging. It singled out healthcare as the biggest factor.
New technologies hold out promise for lowering costs. But
they run into a basic problem — the fee-for-service payment
model, which pays U.S. healthcare professionals for delivering
treatments, diagnostic service or surgical procedures, rather
than for keeping someone healthy and out of the hospital.
“We have to rethink entirely how we are paying our doctors,
and the longer we fail to look at the results they deliver for
the healthcare they provide the more we will fail,” said Prof.
Amitabh Chandra, a health economist at Harvard University.
LOW-TECH SAVINGS
Initial studies on home health computers are sufficiently
encouraging that Humana, the largest healthcare insurance
company in the United States, is testing 1,000 patients in 34
states. They conduct daily self-monitoring and weekly video
check-ins with a nurse. Its aim is to see whether it reduces
emergency medical visits.
The Center for Disease Control in a study last year
estimated that fewer emergency hospital stays could save $7
billion annually. One night in an intensive care unit can cost
$10,000, in a nursing home over $200, while staying at home with
a health monitor could cost as little as $10.
A Stanford University study last year found that two
clinics using a similar product called Health Buddy saved
between 7.7 percent and 13 percent per elderly person per
quarter. UnitedHealthcare, which insures one out of every five
Americans on Medicare, is also running a program.
The Obama administration, in its 2010 healthcare reform
legislation now before the U.S. Supreme Court, is seeking to
encourage this type of experimentation in healthcare delivery to
cut costs. One initiative would pay healthcare providers a set
price for each medical condition rather than reimbursing for
each service. Douglas Elmendorf, director of the Congressional
Budget Office. Elmendorf said the idea is to create incentives
for doctors to treat patients more effectively by allowing them
to pocket the difference if they save money.
“It is a period of great ferment, and how successful that
will be is a big question,” he said.
HOME AS CLINIC
A telehealth project conducted by the National Health
Service in Britain has excited health information technology
advocates here in the United States.
Britain collected 12 months of data on 6,191 patients in
using home health monitoring, half of whom had chronic
conditions such as heart failure and diabetes. It found that
emergency hospital admissions fell by 20 percent, patient stays
were cut by a quarter and re-admissions by 14 percent. The
results, released last December, were sufficiently impressive
that the British government plans to roll out telehealth
monitors to three million homes over the next five years.
“It shows you can really do simple things with simple
technology. It’s about getting the right information into the
right hands at the right time,” said Louis Burns, chief
executive of CareInnovations, a joint project of GE and Intel
Corp. which developed Connect.
Dr. Jeff Kaye, a gerontologist at the Oregon Center for
Aging and Technology, is out to prove the case for wide rollout
of telehealth devices in the United States. The center has wired
400 homes of the elderly with sensors and computers that feed
medical and behavioral data into a computer bank. He wants to
expand the project to 10,000 homes nationwide, a large enough
sample to produce compelling scientific evidence of its value.
Software programs sift through all the data to check for
developing trends or changes in personal habits such as whether
someone is getting up more frequently at night, or communicating
less with friends, or walking differently. These could signal
the onset of dementia, Parkinson’s or a stroke. A nurse can call
or arrange a doctor’s visit.
Without the data, Kaye said he might miss important signals
in a short monthly visit.
“If you think that the average appointment is 15.7 minutes
long, half of that time I am talking and half of that the
patient is talking, that leaves only about five minutes to
actually reach the diagnosis and prescribe the treatment. It is
crazy,” he said.
Collecting reams of highly personal health information
sounds intrusive, and adult children often protest. But if it
keeps Dad in his home longer and if he controls who sees the
information, most people welcome it, Kaye said.
The gerontologist is a huge advocate for these technologies.
But he is no starry eyed evangelist. While it might be
relatively cheap to turn the home into a health check-up center,
comparable to the cost of a home burglary alarm, someone has to
read all the print-outs and spotting diseases early can increase
the medical bill further, Kaye and other experts say.
Under the fee-for-service payment model, where every time a
doctor reads a chart, orders a test or consults with a patient a
bill is generated, home monitoring devices would be scarcely
affordable. And even if the technologies do help keep someone
healthier, a longer lifespan pushes up the total healthcare
bill. A 90-year-old is far more likely to have multiple chronic
conditions from heart failure, diabetes and cancer to dementia.
“The simple connection from better health information
technology to cost savings is very aspirational,” said Harvard
economist Chandra.
In fact, longevity increases the bill. The MacArthur
Research Network on an Aging Society estimated in a December
2009 study that by 2050, Americans will live between three and
eight years longer on average than the government projects,
adding $3.2 trillion to the Medicare and pension program.
PAYING FOR RESULTS
The job of Dr. Richard Baron, group director at the Center
for Medicare and Medicaid Innovation at the U.S. Department of
Health and Human Services, is to cut through this knot. His task
is to improve the quality of care for America’s oldest and
poorest, while lowering costs. His agency is distributing $900
million in grants this year to test various projects, including
those including home technologies.
A specialist in geriatric and internal medicine, Baron was
early to adopt email contact with patients, switch to electronic
medical records and use some basic home health monitoring under
a state-funded project at his Philadelphia practice in 2004.
“Patients loved it. Email was hugely popular,” he said.
The business challenge was how to make technology cost
effective. Rather than charge for each email a doctor sent or
electronic chart read, Baron focused health results – what does
the patient want and how can we use technology to achieve that?
“If people are rewarded for the rates at which they use the
technology, they will find ways for the technology to reward
them. If they are rewarded for the way in which they solve the
health problem, they will find ways to make that happen,” Baron
said.
Studies by the OECD, McKinsey Global Institute and by
Thomson Reuters have shown that 30 percent of U.S. health care
spending is unnecessary. Experts point to the fee-for-service
payment model as a major reason where doctors, surgeons,
hospitals and other specialists have no incentive to coordinate
care. This is a particular problem for elders who frequently
have a number of chronic diseases.
Rand Corp. forecast that converting from paper to electronic
medical records could save $162 billion a year by allowing
doctors to coordinate treatment and reduce unnecessary
procedures. But in a sign of how complex it is to change the
dynamics of the healthcare system, a study in the Health Affairs
journal last month found that access to computerized image
results was associated with a 40-70 percent increase in doctors
ordering extra tests, possibly because they were just a mouse
click away.
For Baron, the study says less about electronic records than
it does about the need to change incentives. Used differently,
electronic records can make it easier to track whether people
are having the regular tests they need.
This is the vision shared by Eric Dishman, director of
health innovation at Intel, who carries a black rotary telephone
around to speaking engagements to symbolize a U.S. healthcare
system badly in need of a refresh.
By 2030 when all the boomers have turned 65, he wants to see
elders using sensors like the MIT biosuit and smart phones to
perform their own health checks. He wants to cut visits to
hospitals and clinics by 50 percent and relegate nursing homes
to the history books.
“Certainly 10 years out, we’d better be in that situation,
or we will be in an economic crisis in the United States,” said
Dishman.
(Reporting By Stella Dawson)
