Nearly 50% of American adults have at least one chronic disease, and chronic disease care accounts for more than 75% of the country's total health care spending.
A new report from NEHI identifies 11 underused technologies that have the potential to lower costs associated with chronic disease, while also boosting health care access and quality.
The report, titled "Getting to Value: Eleven Chronic Disease Technologies To Watch," was developed with support from the California HealthCare Foundation. CHCF publishes iHealthBeat.
Emerging Technologies
For the report, NEHI researchers identified more than 80 technologies that were highlighted in literature or mentioned in expert interviews that have the potential to help patients with chronic diseases, especially those in California's safety-net population. They then narrowed the list to 11 emerging technologies with the most promise in terms of clinical benefit, cost savings and adoption, Erin Bartolini, health policy associate at NEHI, said.
NEHI organized the 11 technologies in an "adoption readiness spectrum," ranging from Class I tools, which have strong evidence supporting clinical and financial benefits, minimal barriers and strong potential for early widespread adoption, to Class IV technologies, which have limited evidence to support clinical and financial benefit and more significant barriers to adoption.
Class I technologies include:
- Extended care e-visits;
- Home telehealth; and
- Tele-stroke.
Class II technologies include:
- Mobile clinical decision support; and
- Virtual visits.
Class III technologies include:
- Medication adherence tools;
- Mobile asthma management tools; and
- Mobile diabetes management tools.
Class IV technologies include:
- In-car telemedicine;
- Mobile cardiovascular tools; and
- Social media promoting health.
Lessons Learned
Through its research and analysis, NEHI identified five cross-cutting themes about high-value chronic disease technologies that could have implications for patients, physicians, vendors, payers and policymakers:
- High-value technologies leverage existing technologies and consumer products;
- New technologies have entered an unclear regulatory environment;
- "Better mousetraps" do not necessarily mean successful technologies;
- The safety-net population is technology savvy; and
- Societal norms for appropriate use of patient data are yet to be determined.
Jennifer Covich Bordenick -- CEO of the eHealth Initiative -- said the technologies identified in the report that leverage existing platforms are the most promising. She said, "These are technologies that people are already using, so there is no need to introduce a new device. Moreover, people are already comfortable and using their smartphones, iPads, etc., which can be half the battle with adoption."
Contrary to common belief, many of the highlighted technologies "are ideally suited for the safety-net population because they directly address the resource challenges and access issues paramount in the safety-net delivery system, and many of the assumed hurdles for technology adoption may not be as significant as previously thought," according to the report.
Bartolini said, "There [were] some data that we were able to find that really a lot of people in the safety net may use a smartphone or have a personal computer in their house," adding, "So really the idea that these technologies are out of reach for the safety-net population isn't necessarily the case." She said that "because a lot of people in the safety net may have these technologies at their fingertips ... they can access these [chronic disease care] technologies with no additional cost."
Barriers
The report notes that "health care stakeholders and policymakers often tout technology innovation as the panacea for clinical outcomes and cost savings. However, time and again, promising technologies fail to achieve their true potential because of the myriad barriers to their adoption."
NEHI warned that if certain barriers are not addressed, they could derail the adoption of high-value technologies with the potential to improve chronic disease care. In its report, NEHI outlined nine key barriers and offered recommendations on how to overcome them. They include:
- Overcoming high upfront capital costs;
- Generating return-on-investment data;
- Easing cross-state licensure for telehealth technologies;
- Overcoming misaligned incentives from fee-for-service programs;
- Incorporating ease of use into technology design;
- Addressing concerns for misuse of patient data;
- Addressing provider resistance to telemedicine;
- Addressing provider resistance to engaged patients; and
- Overcoming data integration challenges for the safety-net delivery system.
Of the barriers cited in the report, Covich Bordenick said she believes data integration will be the hardest to overcome. She said, "We don't want this to be a missed opportunity. With these new technologies, we could have capability to track and respond to the needs of patients on a real-time basis. This is not just about pushing information out to patients. It is about working in concert with patients during the 300+ days [of the year] that they are not at the doctor's office."
Bartolini remains confident that all of the barriers can be addressed. She said, "Whether it's reimbursement, whether it's medical licensure, whether it's starting to think about how we deal with an influx of patient data, these are things we know we need to address. And we need to start thinking about these [issues] tactfully and how we [can] overcome them."
Insight for Developers
NEHI hopes its report will help technology developers as they design new health care tools.
Bartolini said developers should "think about the patient in the design of these technologies. Really thinking about how a patient would use this technology, how does it fit into their daily life, how can they connect with the physician, how will the physician engage with the patient." Bartolini added that if technology manufacturers and designers "start to think about this from the beginning, then I think that would really help accelerate adoption when [the technologies] come to market."
Covich Bordenick encouraged developers to focus on patients with chronic diseases. She said, "This is an ideal group to develop tools for. These are motivated patients. A lot of times we are dealing with health IT and trying to figure out how to get patients engaged. People dealing with chronic conditions are usually 'active' patients. Generally, they are interested in staying engaged in their care and staying well."
She added, "You don't need to design a fancy flashy tool to convince them. It can be simple -- just figure out how you can fit into patients' lives as they live them now."