With the growth of medical costs exceeding the nation’s overall inflation rate, healthcare providers, employers and insurers are stepping up their efforts to contain costs by maximizing the effectiveness of disease management and prevention programs targeting those with, or at risk for developing, chronic conditions. For organizations across the healthcare spectrum, the answer lies with the development of consumer-facing wireless and mobile technologies. Delivering real-time intervention, interactive communications and targeted clinical decision support is possible via the cell phones and other mobile devices ubiquitous among U.S. consumers.

The California HealthCare Foundation reports that if left unchecked, U.S. health spending will reach nearly $2.4 trillion in 2008 and will represent 19.5 percent of the nation’s gross domestic product by 2017. A major contributing factor is a dramatic change in the profile of diseases contributing most heavily to death, illness and disability among Americans. According to the Centers for Disease Control and Prevention, conditions including cardiovascular disease, chronic respiratory disease and diabetes account for more than 75 percent of the country’s medical care costs. As such, they are among the more prevalent, costly and preventable of the nation’s health problems.

Wireless Convergence

Given that costs associated with chronic conditions consume the majority of healthcare expenditures, it makes sense that finding ways to control and manage them has been the focal point of many cost-containment strategies. An estimated 90 percent of private health plans and 88 percent of large employers offer disease management programs. Yet, these programs have been only moderately successful. By 2030, the number of Americans with at least one chronic condition will increase from 125 million to 171 million.

Non-compliance with prescribed therapies is a key factor in this increase — one traditional disease management programs have failed to adequately address. Just 50 percent of those currently suffering from chronic conditions adhere to the treatment and medications prescribed by their physician. This lack of compliance costs the U.S. healthcare system more than $100 billion in direct costs. The key to containing rising healthcare costs and reducing the incidence of chronic disease is to transition from “just-in-case” to “just-in-time” healthcare by leveraging wireless technologies and point-of-care clinical decision support to drive real change in patient behaviors.

Driving this transition is the convergence of existing clinical wireless solutions with cellular/mobile technologies that make use of medical devices and user-generated data to collect and analyze information about an individual’s chronic condition or activities relating to overall health and wellness. Mobile collaborative care solutions can be accessed when and where they are needed and deliver to the patient clinically relevant instructions and recommended actions in real-time. This bidirectional communication and tailored intervention closes the gaps in traditional disease management programs. Existing programs are limited in their ability to provide real-time interventions and support based on immediate needs. They rely on patients to self-monitor their health and determine if and when to seek care. As a result, many wait until their conditions require emergency intervention.

To overcome this patient inertia, mobile collaborative care capitalizes on the immense popularity of cell phones, which are owned by 72 percent of Americans. Further, advanced cellular features enable greater connectivity and a broader range of applications that can be delivered across mobile networks. This allows cell phones to wirelessly connect with medical devices to collect real-time biometric data, communicate it back to remote monitoring services for analysis and deliver actionable information back to patients and providers. It enables focused patient management and wide-scale population health management in which cell phones, referred to by the authors of a TripleTree industry analysis on telemedicine 2.0 as the “perfect CRM tool,” are used both to collect data and deliver just-in-time interventions.

“Like steam, water, electricity and the Internet, the cell phone is fast becoming a technology that resides in the background of our lives and enables the ubiquitous connectivity of always-on computing,” wrote the TripleTree authors. “This trend will facilitate the adoption of wireless products and services that are able to monitor, diagnose and report on our health and wellness, all in the background, all without our direct involvement. It will be analogous to turning on the lights without having to know how to run a power grid.”

Just-In-Time Intervention

Leading the emergence of mobile collaborative care are a handful of technology companies focused on introducing applications that deliver real-time intervention, 24/7 clinical support and health information to consumers via their mobile phones, and facilitate direct communication with physicians or other caregivers. These integrated mobile solutions for collaborative care address the key issues preventing traditional disease management and prevention programs from achieving maximum results, both in terms of cost containment and improved health outcomes.

Specifically, they provide the tools necessary to enable physicians and caregivers to detect critical signals before a crisis begins, encourage compliance and adherence to prescribed therapies, facilitate continuous, on-going collaboration between physicians, caregivers and patients, as well as reduce input errors, thereby increasing the quality of the data that is collected, and also, empower patients to maintain active control over their health and wellness. Most are designed as either stand-alone solutions, or can be integrated with existing disease management programs to drive improved results. They are based on advanced protocols and scripts that tie into evidence-based best practices for a range of chronic conditions and can be customized according to the specific health needs of the targeted patient population.

Patients receive medical reminders via their cell phones to take medications, test blood glucose levels and to check their blood pressure, in addition to many other kinds of medical alerts. In the case of medication reminders, an image of the medication can also be delivered to help ensure the appropriate drug and dosage is being taken at the time specified. This is important for medication compliance, as 50 percent of patients who leave their physician’s office with a prescription are unclear as to the directions, dosage and other important information. Depending upon the targeted disease state, patients may be prompted to respond to a series of questions designed to evaluate their current health status.

For example, an asthma patient may be asked if they are feeling short of breath or suffering from any chest tightness, or if they’ve used their emergency inhaler in the past 24 hours. A patient with congestive heart failure may be queried about their sleep quality, number of pillows used, presence of edema and so on. The patient responds using their phone’s keypad or, if they prefer, through an interactive voice response system. Data can also be wirelessly collected from medical devices, such as Bluetooth-enabled scales, blood pressure cuffs and glucometers, and automatically transmitted back to the solution vendor’s remote monitoring database.

The information is automatically analyzed according to the specified protocols and actionable information is delivered back to the patient when necessary. For example, in the case of a diabetic whose glucose levels are high, the system would alert the patient to eat certain food types to bring levels down or prompt them to take other appropriate actions, including seeking emergency treatment in severe cases. Pre-set triggers can also be established that determine if and when the patient’s physician or other authorized caregiver is altered. This allows for immediate intervention, such as changes to care routines or prescription medications, to avert a health crisis. Patients are also able to alert their provider to specific symptoms such as chest pains or blurred vision and receive immediate information on the most medically appropriate course of action.

Because making the right decisions regarding diet, exercise and other lifestyle activities is critical to managing chronic conditions, mobile health solutions also provide patients with just-in-time health and dietary education information. This equips them with the tools they need to modify their behaviors and make smart choices to ensure their conditions are controlled.

The Solution is Everywhere

Ultimately, it is not that disease management programs are ineffective. Rather, they are limited in their ability to fully address such key issues as non-compliance with prescribed therapies for controlling chronic conditions. Until health plans, employers and providers deploy the consumer-facing tools necessary for just-in-time interventions and support, their efforts will fall short of their goal of facilitating the behavioral changes necessary to effectively control and even prevent chronic conditions.

The good news is that the advanced wireless technologies and clinical decision support required for disease management programs to achieve maximum results already exist; they need only be integrated into collaborative care efforts and delivered across the nation’s most ubiquitous communication device — the cell phone.

Jeffrey Wolf is CEO of GenerationOne Inc. Contact him at [email protected] .