In a world where most folks change jobs every couple of years, people are often amazed to hear that I started work in connected health 19 years ago. Implicit in their amazement is a question, “Why did you stick with it so long?” The quickest response is that the work we started back then is not yet finished. A more accurate answer is a bit more complex. First, we have never wavered from a clear vision of how healthcare delivery needs to change. We’ve been able to recruit a truly stellar team of people to work with. And, we’ve had some good luck along the way. In this post, I want to tell the story of a couple of those serendipitous moments, what they meant to us and how we moved beyond them.
The first goes back to circa 2000 when the Medicare payment structure for home health changed to prospective payment. The Center for Connected Health was formed in the mid 90’s with a vision that connected health could be an antidote for capitation. Capitation never really took hold in the mid ‘90s, and thus connected health stayed largely in the realm of pilots and experiments. But, when prospective payment hit home care, the leadership of what was then called Partners Homecare saw telehealth as an opportunity to succeed under this new payment model. We then had our first real customer.
The serendipity comes in when we sat down with our home care colleagues to talk about where to focus our efforts. We chose congestive heart failure (CHF), because it was costly, prevalent and the source of a lot of home nursing visits. What we didn’t appreciate was just how suited CHF is to connected health as an intervention. CHF management is mostly about fluid management. Weight is a pretty good proxy for fluid status, and dietary interventions (largely around salt and fluid intake) are usually effective at controlling fluid. Thus the feedback loop of daily weight combined with just-in-time nursing interventions, usually by phone, resulted in a reproducible improvement of patient care, a decrease in hospital admissions and a net lowering of the cost of care. With this early success, we formed the connected health initiative and began to work in other areas of chronic illness management including hypertension, diabetes, mental health and asthma/COPD. Some of these programs were more successful than others, but the impressive results that we saw in CHF spurred us on to work in these other areas. Had we started with COPD, where the relationship between any one variable and clinical deterioration is much less clear, we probably would have not gone in this direction at all.