Continua’s Chuck Parker on connected health (transcript)

This is the transcript of my recent podcast interview with Continua Health Alliance Executive Director Chuck Parker.

David Williams:            This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Chuck Parker,  Executive Director of the Continua Health Alliance.  Chuck, thanks for being with me today.

Chuck Parker:            Thank you.  I appreciate the opportunity.

Williams:            Chuck, what is Continua and why is there a need for it?

Parker:            Continua Health Alliance is an association of organizations throughout the world that are focused on the interoperability of personal health care devices.

The real need was to create an ecosystem for these interoperable devices and ensure that they have the appropriate connection mechanisms, the standardization mechanisms to make sure that they all can communicate together. The goal is an end-to-end solution for individuals who need to monitor themselves with health conditions in the home or to provide that information to others who may be caring for them.

So in essence, the Alliance was formed to help standardize the industry of personal health care devices.

Williams:            When you talk about personal health care devices and connected health, what kind of devices and systems does that mean in practice?

Parker:            Continua looks at about twelve different device classes. These are things such as weight scales, blood pressure cuffs, pulse oximeters, glucometers, and thermometers.  We also consider activity monitors and we’re adding devices as we go along.

These devices, when paired, can help an individual with a chronic disease manage their disease state more effectively. They can enable an elderly person to live more safely at home for a longer period of time. And they are also for those individuals who may want to monitor their health conditions before they ever require medical attention.  It could be used by performance athletes who want to monitor their conditions and see how well they’re performing over a period of time.

This is where we focus our efforts. When we talk about connected health it means taking that device information, collecting it and presenting it in a standardized way for personal health records or electronic health records.

Williams:            A related concept to “connected health” is the “connected home.” You appear to be moving into that space through a relationship with Continental Automated Buildings Association.

Parker:            CABA is a recent liaison that we are working with to take a look at how to automate the entire home.

What this really means is that there is some underlying technology put in place.  Currently we use ZigBee wireless network meshing to collect data throughout the home. The reason for that is that we want these devices to be mobile.  We want to be able to pick these devices up anywhere in the house, put them on, measure, and then put them down again and not have to worry about plugging into a computer and having the right phone settings.  We want to make sure that this is easy to use.

What we’re working on directly with this association is the “connected home,” to ensure that homes of the future have the ability to monitor these devices, to pick that information up and transfer it seamlessly. It doesn’t take a lot of user interaction to set that connection up.

Williams:            Traditionally there has been a major separation between devices and services aimed at the homebound elderly –often 85 plus– and younger athletes looking to optimize their performance. But you’re talking about those two things together.  Do you think there is more of a convergence coming or do they remain very separate kinds of markets?

Parker:            I think there is a convergence there.  Where the difference comes in is who pays.  I think that’s really the only significant difference that we see in the future.

The device types themselves are similar. If I’m monitoring my cardio activity, that device, that relatively simple device, is somewhat the same that I would put on an older person who wanted to see what their heart rate is. The underlying technology is somewhat very similar.

You may mix it with different components, so I may have additional components with my elder care to make sure that I’m doing the right things. But still even a performance athlete wants to use a cardio monitor, weight scale, blood pressure cuff to understand that they’re not doing anything damaging to the heart or vascular system by getting one’s blood pressure to the wrong point.

So there is a convergence of these markets because the devices’ underlying structure is somewhat similar. But what we do is we mix and match them in different ways.  So I may add a glucometer in the future for somebody who has diabetes, but I would still be using, in essence, the same weight scales and the same blood pressure cuffs.

Williams:            What about the evolution of some of the devices themselves?  I’m thinking especially about the gigantic leaps that cell phones have made over the past few years, especially the iPhones and Android phones.  Do they threaten some of the more specific health-related devices that people have been working on for a long while?  Do those go together over time?

Parker:            I do believe so.  We forecast that we’ll see smart phones or feature phones that have the capability of capturing this information.  Slowly at first, but eventually the majority of the market will be based on the cell phone, because there again, we want something that’s mobile with us. If I’m a mobile individual and I want to go out and I need to measure myself at a restaurant for example because I’m not feeling well, I want the ability to do that with my cell phone.

There’s widespread adoption of cellular handsets, so this will make it a little bit easier for us if we can ubiquitously put that type of technology inside either feature phones or smart phones and then be able to use it relatively easily by individuals.

There’s always that background statement that elders are resistant to technology. It’s somewhat true when you look at computer technology, but if you go back and look at that same population, you’ll see that there is widespread use of cell phones.  So they already understand how to use this relatively small form factor device. It’s a technological device, so we have that capability built into those devices that becomes something that’s a little less intrusive and a little less scary for them to use. We see that it would help us in the adoption rate, at least potentially for that market segment.

When we look at the healthy individual, certainly they are using these phones quite extensively. It makes it easier for them if it’s not something else that they have to carry along with them.  You can use it with your existing device.

So the answer is yes.  We see that the cell phone and the mobile platforms are a significant growth pattern for us.

Williams:            You mentioned an important point before about who is paying being a big driver of the market. So I’m wondering, what kind of progress is the industry making in the different markets?  Traditionally it’s been hard to get health plans to pay for remote monitoring.  They’re usually looking for reduced medical costs.  Employers are looking at medical costs but also overall productivity.  On the individual side if someone is buying it either for themselves or a loved one, they may be looking for independence, peace of mind.  How is it going in terms of the companies in this space trying to make an economic argument that’s successful?

Parker:            We are definitely working with those commercial insurance companies.  One thing to note is that we are international so we don’t focus just on the U.S.  The U.S. is a unique market with its mix of private payers and government paid options, but we do look at this from a perspective of international alliances as well. We work closely with organizations like the NHS in understanding and helping them see the bigger picture of the cost reduction.

There have been studies done here in the U.S., specifically with the Veterans Administration. You have a very large deployment of this type of technology where they’ve seen significant savings in costs in being able to monitor and measure individuals directly at home.  We are seeing that there is true evidence that this does save money, and significant amounts of money. In some cases we’ve seen anywhere from 53 to 85 percent savings in individuals who have chronic disease states such as heart failure or diabetes.

What we’re also seeing is a willingness for individuals, particularly males 18 to 34, to invest directly in this technology by themselves.

We have seen self-funded employers pushing their carriers to help cover individuals and provide a way for them to do participate in “healthy living plans,”  to help their staff stay healthy.  It obviously helps reduce their costs.  We’ve actually seen returns on this anywhere from two-to-one to four-to-one on cost savings for companies who have gone this route as well.  A current study that’s going to be published by Partners HealthCare in conjunction with EMC is bearing this out specifically.

With that said, we’ve had some high interest from the private insurers.  UnitedHealthcare, for example, is very interested in this technology and exploring testing and pilots.  Rightfully said, it takes evidence-based guidelines and evidence-based medicine and demonstrations to show that this technology works.  We’ve been at this for four years and we’re starting to be able to demonstrate those results today.

From a physicians’ office perspective, they are seeing workflow gains. The reality is that we’re not able to produce enough doctors to manage the current crop of individuals that are aging into the healthcare system at the rate that they are.  So we need to make sure we can operate this more smartly and effectively.

What we’re seeing already from a quality measurement perspective is that the current quality standards require that a diabetic come into the physician’s office once every quarter to get the information.  Well, if we’re using remote monitoring technology –this is research that’s currently going on at Cleveland Clinic– we’re seeing that that drop to once every five months now.  So what that means is that we don’t have to bring the individuals into the physician’s offices.  We still get the same amount of information and the same quality of information, but we don’t have to bring that individual, which often involves arranging for transportation for that individual to go to the physicians’ office.  This is also taking up an office visit time that a physician can be using more appropriately for other individuals.  So the quality is still there and it’s just a matter now of beginning to work with physicians’ offices to help them understand what the workflow needs to be.

Williams:            There are some changes underway in the organization of physicians and hospitals. Particularly I’m thinking about Patient Centered Medical Homes and Accountable Care Organizations.  Does this concept of connected health play in directly there?  Do these new structures within healthcare actually make much of a difference?

Parker:            Oh certainly. If you take a look at the way that Patient Centered Medical Home is structured with level two and level three, some of those performance measures actually are about staying in contact with that patient directly at home as opposed to having to bring them into the physicians’ office.  So once you get to level three of the Patient Centered Medical Home, clearly there is a component of what we do.

The same thing with Accountable Care Organizations. With bundled payments or almost a return to capitation, you’re looking at how to keep individuals out of those expensive modes of health care and rewarding organizations for treating the patients where it’s most cost effective.  Here again, the evidence is overwhelming that if we can keep an individual at home longer, and when they do have crises we can bring them into a physician’s offices rather than the emergency rooms then it’s much more cost effective in the longer term.

By the use of these technologies, you certainly have much better visibility in what’s going on with an individual.  If they’re taking glucometer readings three times a day, I can begin to see the patterns and trends of that individual patient. If they have episodes over the weekend I know I can bring them in for treatment to the physicians’ office on Monday and provide them some video feedback that says, ‘How about trying some different techniques while you’re doing things over the weekend so that we can monitor and manage you better, rather than waiting for that diabetic to crash and bringing you into the emergency room?”

Williams:            On the Continua Health Alliance website, in the description of your activities, one of the things that I have to ask about is “plugfests.”  What’s that about?

Parker:            Plugfests are opportunities where companies get together to test their devices individually in a safe testing environment.  What it means is that we can bring these companies together in a safe, behind-the-scenes way for them to do pre-market testing of their devices.  These may be barebones, literally circuit boards that they are testing to make sure that their devices can connect in the appropriate ways and it’s doing the expected things to meet the Continua requirements for certification.

Williams:            I’ve been speaking today with Chuck Parker, Executive Director of the Continua Health Alliance.  We’ve been talking about connected health.  Chuck, thanks for your time today.

Parker:            Thank you.  I appreciate it.

March 23, 2011

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