Telehealth for
chronic care
management:
developments
and challenges

Chronic disease is one of the leading drivers of America's $3.8 trillion annual spend on healthcare costs. In fact, 90% of United States spending on healthcare falls under the chronic disease and mental health umbrella. One of the bright spots in the fight has been the use of technology like remote patient monitoring devices and telehealth for chronic care management to support hospitals and health systems as they reduce the cost of chronic disease.

Some of these diseases are preventable and many are manageable—if detected early and addressed with diet, exercise, treatment compliance and/or medication adherence; but challenges remain. The sheer scope of chronic disease in the US is staggering, with roughly 60% of Americans suffering from some sort of ongoing or incurable condition such as asthma, diabetes, cancer or heart disease. This creates a dynamic where technology is needed at a large, easily accessible scale—a scale that's only recently becoming feasible thanks to advancements in communication and data transmission.

The Centers for Medicare & Medicaid Services began reimbursing for some chronic care management services in 2015, contributing to the expanded adoption of technology that falls under the chronic care category.

In recent years, we've seen a proliferation of wearables, remote patient monitoring devices, apps and telehealth technology. Even simple activity trackers have gotten more attention as useful tools in the fight against chronic disease. A study by Cedars-Sinai Medical Center and UCLA, for example, found that the use of activity trackers contributed to the self-reported general health, physical function and fatigue levels of patients with ischemic heart disease through what appears to be improved adherence.

To support effective use of and innovation around remote patient monitoring devices, the Agency for Healthcare Research and Quality has continually funded a range of research projects aimed at improving care for patients with chronic disease. These projects encourage the implementation of technology solutions, health information technology adoption and change management, usability and system design, and the sustainability of health IT efforts in chronic disease management.

The results have been promising. Technology has fostered earlier detection, increased access, and patient empowerment across a range of diseases. Take a chronic obstructive pulmonary disease diagnosis, for example. New entrants such as portable COPD testing devices allow testing to occur at the point of care with diffusion capacity testing, spirometry and full lung volumes evaluated in just 20 minutes. Other examples of improved outcomes thanks to technology include reliable fall detection systems, enhanced and successful weight management.

While innovations in telehealth for chronic care management have improved patient care, other technological challenges remain. Studies show that big data is highly effective in risk prediction, cost reduction, improving diagnostic accuracy and informing treatment guidance in various phases of chronic disease management. On the artificial intelligence (AI) side, AI has been used to get in front of conditions like chronic kidney disease, which often goes undetected until major damage is done.

But with chronic disease management now involving the communication of large amounts of structured and unstructured data between disparate organizations and systems, it brings with it questions around the patient journey, accessibility, and interoperability.

The chronic disease patient journey is complex. Visits with multiple providers, intricate medication management and shifting insurance coverage all create a path that's challenging to manage. Tech solutions like AI, big data and even wearable remote patient monitoring devices are being incorporated to improve visibility, clean up outcomes and smooth the patient experience, but true interoperability between organizations that support improved patient engagement is still an aspiration.

With chronic disease, access to care regardless of the financial status of a patient, can make a difference. For example, patients with Medicaid have been found to exhibit increased awareness of hypertension and being overweight. This is an area of almost unlimited potential as novel tech solutions for common conditions like type 1 diabetes often remain largely concentrated in expensive, inaccessible devices.