Are Employers the Future Leaders in Chronic Care Management?

Speaking at a meeting of employers, clinicians, and technologists in New York last week, Harvard Medical School’s Jeremy Nobel was optimistic about the potential for technology to change the management of the chronically ill. Nobel suggested “we are under appreciating the potential of information technology if we think it’s just about the information.” He thinks the integration of remote monitoring devices with personal health records will change relationships, coordination, and behavior among patients and providers.

Nobel admitted that, as one who’d used an EMR back in the early 1980s, technology adoption often happened slower than he expected. He cited leading employers’ desire to impact health care costs as a potential instigator in getting these technologies -- and the change in care management processes they facilitate -- adopted and funded.

EMC, the Massachusetts-based information infrastructure vendor, has been one of the most aggressive employers in using online tools to try to change its employees’ behavior, mostly using tools from WebMD. Senior director of benefits, Delia Vetter explained that their Healthlink portal has seen significant participation. For example, approximately 90% of employees have taken an online health risk assessment (if they don’t, they see a 12% increase in premium contribution). All claims are imported from a data warehouse into a personal health record (PHR), giving employees and families a three year history of office visits, medications and conditions. Employees receive reminders and messages alerting them to their health issues based on their individual data.

EMC now has almost 75% of employees using its PHR, and has been driving the message about the total cost to both the company and employee for drugs and services. Healthlink includes tools which show employees the actual cost of care (not just their share) for drugs and services.

Now EMC is moving to more aggressive management of its chronically ill employees. It’s been successful in a diet program to reduce hypertension costs — claiming up to a $1,000 per capita saving for patients with multiple co-morbidities. Last month it started a remote monitoring program for hypertensive patients in conjunction with Partners Healthcare with the aim of catching problems before they become critical. Participants use devices from Body Media which upload their blood pressure to a portal provided by Vision Tree. Based on those results, combined with an algorithm developed by clinicians at Partners, the participants are sent automated messages and suggestions for self-management. A study will assess the impact of the program versus a control group.

Members of Continua, the alliance of providers and technology vendors promoting interoperability and reimbursement for remote monitoring, were a major presence at the meeting. Dave Whitlinger, Continua’s President, ended the meeting with a call for companies in the alliance to “drink their own champagne” — to get their own employees using their technologies to better manage their health.

Is that the way forward? With Medicare struggling with disease management and providers struggling with reimbursement and technology issues, employers might just be the best hope for significant technology adoption in the management of the chronically ill.

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