The first part of this breakout was a panel discussion. Alzheimer's disease was discussed as a key need where HU solutions can help those patients remain independent longer, delaying the inevitable transition to institutional care. Assisted living and congregant homes can make better solutions than home care, for seniors who would otherwise be isolated.

Health plans have a number of incentives for adopting HU solutions. The payer's key motivation is to provide the best care at the best cost. Payers look for evidence of cost savings and improved quality of life. Insurers are motivated when they are at risk. In capitated environments, payers and providers look for cost savings and/or improved outcomes. One speaker noted that HU solutions are not new, they've been around for more than 10 years. The challenge is to scale up to broad industry adoption. There are also different motivations between payers who see high turnover, and self insured employers who have longer term relationships with employees and retirees. For new studies, randomized controlled studies are the gold standard.

How can providers be encouraged to recommend or order telehealth solutions. The disruptive issue for providers is the transition from patient encounters measured in months, to data that is provided daily or round the clock. This interaction with data between office visits is something that's new for providers. This change requires a big shift in how physicians think and practice medicine. (I've seen ICD implantable vendors sow fear, uncertainty and doubt by telling physicians looking at a competitor's wireless ICD remote monitoring solution by suggesting that the additional data will increase the physician's malpractice risk.) This is a huge barrier to adoption, with no "best" solution.

A barrier to adoption for home health providers is the different protocols required by payors. Medicare reimbursement is a problem, a third of home care agencies lose money on Medicare patients. Changes required to effectively utilize HU solutions for nursing is as significant as it is for physicians. Many home health agencies won't invest in cost saving technology unless it is reimbursed.

On the political front, members of congress still are not interested in changing the status quo in health care by supporting HU solutions. MedPac has a huge impact on Congress' perception of health care issues. MedPac's position is that "there is not conclusive evidence" that HU solutions lower costs and improve outcomes. There also seems to be an absence of constituent issues revolving around HU solutions. The federal level is slower than movement at the state levels - Colorado has adopted HU solutions to lower Medicaid costs (so has Indiana). There exists a lot of data showing the efficacy of HU solutions, but the industry needs to do a better job of packaging and publicizing these data. Data must also look "academic" - a study with bold "Research Paid For By XZY, Inc." is a turn-off for politicians and staffers. Vendor data is assumed to be biased, the NIH or NSF are the premier sources regarding credibility. The need for mult-site randomized controlled studies is a challenge for NIH and NSF, a partnership with industry would be beneficial - could this be a role for Continua?

Visit reduction protocols is knowledge that is not widely available. This is another area needing education and research. Other barriers include things as mundane as union contracts that stipulate hospital admissions in situations that could be avoided using HU solutions. The flip side of avoided hospital admissions include an increase in ambulatory visits and additional communications between patient and caregivers.

The "production" cycle between doing research and product development was also noted. It can take a year or more to write a grant, get funding and complete the research - even longer to get published (which many pubs won't take if the content has been publicized). In this time products can be eclipsed by next generation products. Keeping research and products in synch is an important yet difficult task. This is an important consideration because payors look at not just the application, like telehealth, but also the technology required for the implementation - is video conferencing required, would simple telephone interaction be sufficient - payors want data on the minimum technology required.

Pictured right is one of ViTel Net's home monitoring solutions.