Chronic conditions such as diabetes are among the main cost drivers in the German health care sector. As a result, an increasing number of health insurance companies and health care providers are setting up health care management initiatives in an attempt to lower these costs. Peter Ewig is a product manager for AnyCare, a Stuttgartbased health care company. As part of his MBA studies with the School of International Business and Entrepreneurship at Steinbeis University Berlin, he launched and managed a project entitled “Using telemedicine in health care management for diabetics”.
Diabetes, especially Type 2 (adult-onset) diabetes, is a lifestyle disease. Alongside a suspected genetic predisposition, the main causes of this condition are poor diet and insufficient exercise. Current estimates indicate that 8–10 % of Germans have diabetes, mostly Type 2. Projections suggest that diabetes and resultant comorbid conditions are responsible for annual costs of € 22–30 billion in Germany alone – a figure which is set to grow.
Diabetes is just one of a number of chronic conditions that are creating ever-increasing costs in the health care sector as they become more widespread in the population. The introduction of the 2009 German Health Care Fund established a new basis for the financing of statutory health insurance. Instead of simply bearing medical costs, health insurance companies are now supposed to play a role in managing the health of their customers. One way to do this is by setting up (or buying) health care management systems. “Health care management” refers to approaches that attempt to provide patients with the appropriate level of health care resources, or to inform them of these resources, based on economic considerations.
Technological progress has had a positive impact on health care management initiatives, especially telemedicine. It is now possible to provide telemetric services to a largenumber of patients using relatively simple telemetric applications. For instance, in patients with heart failure, weight gain caused by increased water retention indicates a deterioration in the patient’s condition. But with daily weight monitoring using a set of telemetric scales, it is now possible to detect this at an early stage, thus avoiding expensive hospital stays. Telemetric monitoring and response is normally carried out by a medical services center on behalf of the insurance company, or by a health care provider.
Chronic conditions like diabetes are ideal candidates for telemonitoring. With this in mind, AnyCare assigned Peter Ewig a project entitled “Using telemedicine in health care management for diabetics”, to be completed as part of his MBA at Steinbeis University Berlin. The aim of the project was to develop a framework and potential products which would allow telemetric monitoring of diabetes patients to be integrated into new or existing health care management initiatives at AnyCare.
Once the condition has progressed to a certain stage, diabetes patients have to measure and record their blood sugar level regularly. Telemetric care is based on providing these patients with devices that also transmit this data to their doctor or medical service center. All companies developing telemetric methods of this nature are currently facing the same problem: in Germany and elsewhere, there is a lack of scientific evidence pointing to the most effective method for different subgroups of diabetics (both economically and in terms of the patient’s health). This unknown factor makes it very difficult for companies to develop telemetric monitoring methods for diabetics. Yet telemetric monitoring holds tremendous potential to save money in the health care sector.
The biggest savings are expected among groups of diabetics currently responsible for major costs in the health care sector, or those groups likely to cause high costs due to a combination of factors – such as the medications they need and the stage their condition has reached. Companies who want to tap into this market segment and benefit from these potential savings should make use of a set of tools, to ensure they are able to address different aims and situations. For telemetric monitoring of diabetics, this set of tools comprises a variety of telemedical devices, diabetes training materials, digital medical records, access to a medical service center, and a network of doctors involved in the patient’s monitoring. With all of this in place, it is possible to set up a six-month training program (for example) for patients with Type 2 diabetes and resultant comorbid conditions which would include telemonitoring. During the program, patients would learn about diabetes and its consequences via telephone, and a medical service center would record their blood sugar values via telemonitoring and discuss them with the patient.
If the patient’s doctor is involved, the transmitted blood sugar values could confirm two things: a) that the patient is adhering to the treatment, and b) that the treatment is working. This approach aims to stop the condition from progressing to a more advanced stage – thus preventing costs from ballooning – by improving the patient’s ability to manage their condition. Round-robin methods involving the patient, their doctor and the medical service center can be especially effective.
Due to the amount of technology involved, the cost-benefit ratio should always be kept in mind when it comes to telemetric monitoring of diabetics. Ultimately, monitoring programs will only become an established part of the statutory health insurance market if they pay for themselves (by compensating for the cost of monitoring through savings). Despite this, it is also important to ensure that as well as saving costs, telemedicine does not lead to a deterioration in the level of care provided to patients. It is important that patients do not feel that they are being discriminated against or even “checked up on”. As a result, programs of this kind need to be assessed not just in economic terms, but also from the patient’s perspective. The main recommendation in Peter Ewig’s MBA project is that AnyCare should try to gain as much experience as possible in telemetric monitoring of diabetics, as quickly as possible. In fact, AnyCare has already taken its first steps: AnyCare TeleMed Diabetes, the first system for telemetric monitoring of diabetics, was launched at the end of 2009.