Kvedar: Connected health turning 'business models upside down'

BOSTON—The focus on value-based compensation “turns our business model upside down and opens the door for all kinds of virtual care options,” said Joseph Kvedar, MD, vice president of connected health for Partners HealthCare, speaking at the mHealth + Telehealth World Congress on July 21.

Providers are no longer bound by in-person encounters—something “we all need to be taking seriously and planning for.”

He also cited the new CPT code for chronic care management which specifically allows for someone in a medical practice to monitor a patient for 20 minutes a month that does need to be face-to-face. That “creates a nice framework” for telehealth. It’s also ideally suited for the patient-centered medical home team-based care that is becoming so prominent, Kvedar said.

Wearables have grown rapidly and now it’s easy to get data out of such devices and certainly to display them for patients, he said. That effort is worth the time. “We have to reevaluate the importance of tracking people throughout their life, not just when they’re in the office or the hospital.”

Kvedar’s group at Partners is focused on creating a future around connected health, improving patient care through the use of wearables, apps, coaching and other tools to engage people in their own care. “We win the game by spreading human resources across more patients.”

The hassle of traveling to a doctor, paying for parking, waiting for a visit and more just isn’t necessary anymore. Healthcare is “really the only service left that conducts its business that way.”

The combination of electronic tools and patient engagement allow for more self-care which requires a feedback loop and motivational context. Even the most basic software can flag those patients who have had a change that indicates the need for more attention.

Kvedar acknowledged that the majority of wearable users are those who already are fit and healthy. The other patient segment is those who are sick, inactive and unmotivated. “We spend a lot of energy crafting outreach programs to reach these people. We’re getting there but it’s a long journey. There’s always a chunk of people who don’t engage.”

Partners’ heart failure telemonitoring program is “the poster child for this work.” Starting in 2003, Kvedar partnered with Partners’ home care group to get patients to take their vitals once a day. Those who didn’t upload their data got a call from a nurse. However, “if nobody watches, patients stop doing it pretty quickly. They figure if their doctor doesn’t care why should they even though it’s their health.” Those vital signs “helped us monitor the population very effectively.” They experienced a 50 percent reduction in readmissions.

The benefit of the data far outweighs “that little extra pain [of gathering data] because objective information is such a good tool for holding people accountable and educating them about the opportunities they have to improve their health,” Kvedar said.

Providers need to get beyond this idea that patient-generated data is only for the fit and well, he said, because it actually represents the 99 percent of patients’ lives not spent in the hospital or a doctor’s office. “That’s clinicians in the 21^st century have to think about it.”