Well, I missed a couple sessions due to internet access issues - Hyatt is too cheap to provide free and easy Wi-Fi coverage (one reason I stayed at a different hotel).

Joe Ternullo, telemedicine guru at Partners Healthcare, opened the closing session. After the obligatory overview of needs and market trends, Joe launched into the agenda.

The first question was, is there a shift to wellness management? The CMS response was they're all about quality and cost effectiveness. The potential for patients to seek out providers with EMRs and a focus on wellness was proposed a s a key factor in the shift to wellness management - no data was provided. There's been a leap of faith that the government will drive EHR adoption and standardization, and that the result will be higher quality and lower cost. The home health care industry's financial decisions are driven by reimbursement. Remote monitoring was adopted when changes in reimbursement created the incentives. The importance of buyer's internal change agents or HU champions is currently critical to adoption in early innovator accounts. There was recognition of the resistance of providers (especially non-acute care providers) to invest capital to reduce operating costs and improve quality. Reimbursement seems to drive a disparate extent. It was suggested that publicly available quality data for physicians, home health agencies and hospitals will shift investment decisions to look at more than reimbursement - an example of this is the current push by CMS on prevention and transparency in quality outcomes.

Eric Handler, of CMS regional office in Boston, spoke about a new provider reporting program that started last January. Participants submit procedure and outcomes data to CMS who calculates quality measures, providing feed back on how the provider compares with their peers. This program will be expanded into a full pay for performance program. The quality results will be available to the public. Eric reinforced that this is happening now, and will become pervasive.

Dire predictions were made that early innovators adopting HU solutions will be in a position to buy up technology laggards. Companies that are in Leap Frog Group could be valuable HU adoption drivers. Bridges to Exellence is another program driving quality improvements in health care delivery.

The closing comments included predictions and exhortations. Looking at a consumer or retail model there are huge opportunities for consumer paid HU solutions. Five to ten years was the range noted as the horizon for real HU adoption. Informaiton tech adoption, remote monitoring connectivity, and changes in health insurance design will help consumers vote with their feet. Lastly the quality movement will be an accellerator to HU adoption. For the foreseeable Americans will continue to eat fast food, watch TV and smoke cigarettes. There is a need for behavior modification and education. Most home health agencies first bought their first IBM PC was when Medicare refused to accept paper claims. Interoperability will provide the flexibility and affordability (along with private pay) to drive HU adoption. It was also suggested that elder care benefits (like remote monitoring) would be attractive to large self insured employers. Research must be timed to ocur when technology is sufficiently mature. One panelist challenged the group to use HU solutions to delivery needed care to the uninsured, and those who can't afford HU themselves. Don't forget Medicaid as a source for HU adoption - quality measures are coming to bear in this market as well.

Pictured right, the plenary panel holding forth.