The Centers for Medicare and Medicaid Services reported that in 2009 US healthcare spending increased 5.6% to $2.47trillion and represented 17.3% of the US economy. The increase from 2008 to 2009 is the largest jump in healthcare spending since 1960, and it is remarkable that in a year in which the US economy contracted by 2.4% healthcare and the federal government were the only sectors to show an increase. This growth is also occurring from a high base, starting at a level 30% to 50% higher than most industrialized countries, and is unsustainable.
Part of the healthcare cost problem is the way that most healthcare services are provided. Hospital Care represents 31.1% of all healthcare costs and is notoriously expensive. The average cost for 1 day in the hospital in 2002 was $1,290, nearly double the average cost from 1990 and since 2002 hospital costs have increased by more than 50%. Professional Services, which in the Center for Disease Control (CDC) data includes Physician and clinical services, Dental services and other professional services represents another 31.3% of total healthcare costs and Nursing home care a further 5.9%. All of these services are provided onsite, in facilities and environments that are costly to maintain and where costs are increasing rapidly and represent more than 68% of the total healthcare expenditure in the US in 2007.
Cost however, is only part of the problem with this centralized model of healthcare delivery. Hospitals, clinics, Doctors offices and even nursing homes are notorious for spreading disease. According to a February 2003 article in The New England Journal of Medicine between 5% and 10% of all patients admitted to an acute-care hospital acquired one or more infections. The CDC estimates that there are 1.7million hospital acquired infections each year resulting in approximately 99,000 deaths, various sources have estimated that these terminal cases alone result in over $6billion in healthcare costs each year. These economic costs pale in comparison to the pain, suffering and loss of life resulting from these infections.
The centralized model also provides a setting that is at best impersonal and often dehumanizing. By design the institutional feel of hospitals, clinics, Doctors’ offices and nursing homes can increase the physical discomfort of patients through raised levels of anxiety, disorientation, helplessness and even depression. Also the very nature of such institutions entails interruptions at odd hours by staff and other patients and a constantly changing cast of care providers that further add to the discomfort of the patient.
Treating patients in the home is much less costly and provides a familiar setting for the patient. It is also usually an environment that is more comfortable, lowers the risk of spreading infection and adds to the patient’s sense of control over their treatment. The difficulty is that up until now much of the technology for cost and accessibility reasons needed the centralized model to be effective.
Telemedicine involves the use of telecommunications either through traditional phone networks, cell phone networks or the internet to diagnose, treat and monitor patients across large distances. Early use has focused on telecardiology and teleradiology where EKG and X-Ray information is transmitted over communication lines and monitored and analyzed at locations remote from the patient. Recently, new procedures now allow surgeons to perform certain procedures remotely and many hospitals have implemented remote nursing stations that can monitor patients from many facilities from one centralized location.
Telemedicine is also being used in the home healthcare setting to provide emergency alerts through personal emergency response systems and the monitoring of patients vital signs such as heart rate, blood pressure, cholesterol and glucose level. The latest advances in home healthcare telemedicine have been in the area of medication management, which given the costs of poor medication compliance represents an enormous opportunity to not only save costs but to also greatly improve medical outcomes and save lives.
Over 50 million people in the US are on three or more prescriptions. While many of these medications are critical to improving the health of the patient the average compliance rate with their medication regime is only 50%. Poor medication adherence according to the Center for Disease Control represents a significant healthcare problem resulting in increased costs and poor medical outcomes. The current poor rate of medication adherence results in 10% of all hospital admissions (30% of all hospital admissions for elderly), 22-40% of all Skilled Nursing Facility admissions, 125,000 deaths per year and from $150billion to $300billion in annual cost/waste.
And this problem will only get worse as longer life spans and relatively low birth rates increase the nation’s average age over the coming years. The older we get, the more medications we require and as the number of prescriptions increases so too does the amount of non-compliance. As a result, the cost to the health care system due to poor adherence is rising significantly.
There are a number of ways to improve compliance that have been tested by the medical community. Adherence rates can be significantly improved through better education, the monitoring of patients in the home, and improved medication management. Medication management devices help by organizing dosages, providing reminders to take pills and sending alerts to care givers when dosages are not taken. Telemedicine based medication management devices significantly improve compliance rates by utilizing all three of these strategies.