Guest Post: Reimbursement Policy Needs to Join the 21st Century

Imagine a banker making a loan without knowing the precise interest rate.  Imagine a drone flyer dropping a bomb without knowing the exact coordinates.  Imagine a doctor prescribing hypertension medication based on one data point – the blood pressure score recorded in the office after the patient fought through rush hour traffic, in a panic, fearing being late for the appointment.

Of those three scenarios, one happens hundreds of times a day in America, and the others almost NEVER happen.

Wouldn’t it be great if your primary care physician could look at your last 30 blood pressure scores, recorded over the last 2 months?  Well…it is happening today, but it doesn’t happen with nearly enough frequency because the old, tired, inaccurate “one data point” process gets reimbursed; whereas, contextual, longitudinal trends on blood pressure don’t.

At Healthrageous, we witnessed the positive benefits of empowering people with hypertension through the use of wireless blood pressure cuffs.  In a random controlled trial conducted in 2008 with 404 employees of the EMC Corporation in Eastern Massachusetts, those in the intervention group who used their wireless cuffs ended up receiving twice as many medication consults as the control group – leading to more precise titration of their blood pressure medications.

We are talking about a disease that is called the “silent killer” and which affects one in three adults in our country.  Yet, reimbursement policy for wireless devices that yield meaningful clinical biometrics remains stuck in the 1950s.  Back then, a farmer with high blood pressure paid for his doctor’s visit with a dozen eggs and a quart of milk.  Surely health care reform can include accountable, self-managing consumers sharing their BP scores with their doctors.  Yet, we don’t allow reimbursement for wireless blood pressure cuffs.  We don’t reimburse physicians for interpreting treasure troves of accurate hypertension data collected over time.  We simply shrug when patients find it too difficult and disruptive to visit their doctors in order to get medication for the silent killer.  Hence, they don’t see the doctor and are “silently” being killed by our stuck-in-time reimbursement policies.

And hypertension is but one example of wireless biometrics better informing overworked doctors and giving them the necessary information to effectively prescribe for our growing, mobile population.

Rick Lee is the CEO of Healthrageous, a CCA member.  He has made a career in the creation and sales of specialty health care applications and companies.  Prior to founding Healthrageous in 2009, he ran the largest EAP in the country for Magellan, was a founder of Quality Oncology, a disease management company, and was on the founding team of Value Health, with his specialization mostly in behavioral health.

Guest Blog Post Disclaimer

 CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health.

The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

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