The insurer sponsors a daily monitoring program for CHF patients in which they call into an automatic recording and answer
questions related to shortness of breath, weight gain and appetite. The responses are entered into a software logic system
analyzed by nurses, who then respond accordingly. "We try to encourage these patients to take advantage of the monitoring
program by emphasizing how different problems can lead to readmission," Girolami says. When patients end up in a skilled nursing facility, Geisinger case managers keep tabs on their patients by checking on medication
compliance, indications of exacerbated problems connected to CHF and blood sugar levels. The Center for Connected Health, a subsidiary of Partners HealthCare System, also emphasized CHF in a recent pilot similar
to what Geisinger is doing. In conjunction with Partners Home Care, the Center for Connected Health developed a telemonitoring
system for home-bound patients with CHF who had recently been discharged from the hospital. They transmitted their weight, blood pressure and oxygen saturation to a nurse daily. In addition, the patients answered a
set of 10 questions about their daily activities via a touch screen. Nurses, alerted by any unusual measures, evaluated each
patient and contacted them by phone when necessary. The telemonitoring program resulted in 40% fewer nursing visits and a
25% reduction in re-hospitalization rates. Joseph Kvedar, MD, director of the center located in Boston, points out that telemonitoring also can be cost-effective—a patient
visit by a nurse costs one-tenth of a visit to the emergency room. KEEPING THE BRAIN FIT Humana has adopted a program to support its older members' independence—especially in maintaining a healthy mental status—as
gleaned through member surveys. The computer-based Brain Fitness Program is said to help strengthen brain function in adults
aged 60 or older. Developed by San Francisco-based Posit Science, it helps improve one's attention span, increases the power
of listening, enhances mental acuity and increases memory retention. The program is designed to be completed during 40, one-hour
sessions and is tailored to individuals' capability levels. Based on research appearing in the Proceedings of the National Academy, there was an average improvement in memory of 10 years
using the program. Humana offers the Brain Fitness Program free-of-charge to its Medicare Advantage members and for $100 to its prescription
drug plan (PDP) members. The product retails for $495. Although it is computer-based, Scott Latimer, market president for
central and northern Florida for Humana, does not foresee that as a barrier. The larger problem may be members who don't own
a computer; thus, Humana has arranged for sessions at community facilities. He says the program will improve quality of life—stimulate
older adults to remain mentally acute—while most likely having little impact on healthcare costs. Mari Edlin is a frequent contributor to MANAGED HEALTHCARE EXECUTIVE She is based in Sonoma, Calif. Exclusive content ONLINE For more on DM for seniors, visit http://www.managedhealthcareexecutive.com/
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