mHealth: Infrastructure-independent care is path to cutting chronic disease costs
BOSTON--Most stakeholders agree that the current U.S. model of healthcare is unsustainable, said keynote speaker Joseph Smith, MD, PhD, chief medical and science officer at West Wireless Health Institute in La Jolla, Calif., during his remarks at the World Congress Second Annual Leadership Summit on mHealth July 29.
“There’s a bleak future that’s in front of us unless something changes,” said Smith. Already, 96 percent of Medicare spending is on chronic disease, and between 75 percent and 85 percent of every dollar spent on healthcare in the U.S. is spent on costs related to chronic diseases, Smith said. The cost of lost economic output from patients who are struggling with chronic disease is staggering, he said. “Per disease, it’s more than $200 million annually in the U.S.”
But there is some good news, he said. “We are well on the path to building infrastructure-independent healthcare. If we’re going to dramatically decrease the cost of healthcare, we have to get people away from those costly collisions that occur when chronic disease meets the complex healthcare system. The notion of infrastructure-independent healthcare is one that moves care to where you are, when you need it,” said Smith. “There are many things that have to happen, but we believe that we can get there.”
For starters, the care process needs to get away from episodically diagnosing and intermittently treating people, he said. A transition to a continuous, iterative care model means “no more waiting for people to get so sick that we rescue [them],” said Smith. “You wouldn’t drive a car only opening your eye every minute to see how you’re doing. Similarly, with a chronic disease that changes a little bit every day, why would you only see your doctor every six weeks?”
Healthcare providers can improve outcomes and lower costs by prediction and prevention, according to Smith, “and the path to that is in near, on or in-body sensors, which provide actionable, diagnostic information linked to learning systems and titratable therapy.”
These sensors are not figments of science fiction, said Smith: “I’m a cardiologist, and I’ve come to this belief honestly—this is what I’ve been doing. Prototypical solutions are pacemakers and defibrillators. Pacemakers have been around for 50 years.”
Furthermore, the U.S. already uses wireless sensors to monitor an aging infrastructure. “We put travel and stress detectors in highways and roads because we love our cars,” he said. “We have collision avoidance systems in our cars now. We certainly have built in the technology that allows us to do a better job of protecting our cars and ourselves when we’re in them than if we’re struggling with chronic disease. We have the technologies, we just decided to apply them to our automobiles.”
Nevertheless, more of these technologies are working their way into healthcare, he said. “We are gradually moving toward the notion of putting sensors in on or near people to monitor their conditions” and make adjustments in a way that will prevent them from having costly collisions” with the healthcare system, he said.
“We have the opportunity to take advantage of the world’s most widely disseminated infrastructure: More people have access to cell phones than flush toilets, so why wouldn’t we bring that widely distributed infrastructure to address people’s need for healthcare?”
Smith acknowledged that moving healthcare to an integrated infrastructure won’t be a fast or simple process. Behavior modification will be necessary, both to get clinicians onboard and to get patients to more actively participate in their care, he said. In addition, the perceived lack of a business model has hampered efforts to move care in this direction, although that is changing, he said. For example, when Medicare announced it would no longer pay for patient rehospitalizations within the first 30 days, “that created a business model,” said Smith.
"We need an enlightened public policy that will encourage adoption” of providing chronic disease care where and when patients need it, he said.
“There’s a bleak future that’s in front of us unless something changes,” said Smith. Already, 96 percent of Medicare spending is on chronic disease, and between 75 percent and 85 percent of every dollar spent on healthcare in the U.S. is spent on costs related to chronic diseases, Smith said. The cost of lost economic output from patients who are struggling with chronic disease is staggering, he said. “Per disease, it’s more than $200 million annually in the U.S.”
But there is some good news, he said. “We are well on the path to building infrastructure-independent healthcare. If we’re going to dramatically decrease the cost of healthcare, we have to get people away from those costly collisions that occur when chronic disease meets the complex healthcare system. The notion of infrastructure-independent healthcare is one that moves care to where you are, when you need it,” said Smith. “There are many things that have to happen, but we believe that we can get there.”
For starters, the care process needs to get away from episodically diagnosing and intermittently treating people, he said. A transition to a continuous, iterative care model means “no more waiting for people to get so sick that we rescue [them],” said Smith. “You wouldn’t drive a car only opening your eye every minute to see how you’re doing. Similarly, with a chronic disease that changes a little bit every day, why would you only see your doctor every six weeks?”
Healthcare providers can improve outcomes and lower costs by prediction and prevention, according to Smith, “and the path to that is in near, on or in-body sensors, which provide actionable, diagnostic information linked to learning systems and titratable therapy.”
These sensors are not figments of science fiction, said Smith: “I’m a cardiologist, and I’ve come to this belief honestly—this is what I’ve been doing. Prototypical solutions are pacemakers and defibrillators. Pacemakers have been around for 50 years.”
Furthermore, the U.S. already uses wireless sensors to monitor an aging infrastructure. “We put travel and stress detectors in highways and roads because we love our cars,” he said. “We have collision avoidance systems in our cars now. We certainly have built in the technology that allows us to do a better job of protecting our cars and ourselves when we’re in them than if we’re struggling with chronic disease. We have the technologies, we just decided to apply them to our automobiles.”
Nevertheless, more of these technologies are working their way into healthcare, he said. “We are gradually moving toward the notion of putting sensors in on or near people to monitor their conditions” and make adjustments in a way that will prevent them from having costly collisions” with the healthcare system, he said.
“We have the opportunity to take advantage of the world’s most widely disseminated infrastructure: More people have access to cell phones than flush toilets, so why wouldn’t we bring that widely distributed infrastructure to address people’s need for healthcare?”
Smith acknowledged that moving healthcare to an integrated infrastructure won’t be a fast or simple process. Behavior modification will be necessary, both to get clinicians onboard and to get patients to more actively participate in their care, he said. In addition, the perceived lack of a business model has hampered efforts to move care in this direction, although that is changing, he said. For example, when Medicare announced it would no longer pay for patient rehospitalizations within the first 30 days, “that created a business model,” said Smith.
"We need an enlightened public policy that will encourage adoption” of providing chronic disease care where and when patients need it, he said.