ACCA: Tech innovations key to value-based care
CHICAGO—On the road to value-based care, consumer electronics and technological innovations may be the key, Eric Louie, MD, chief medical officer at Sg2 in Skokie, Ill., said during a morning keynote March 23 at the American College of Cardiology Administrators (ACCA) meeting.

Looking at the Dartmouth Atlas Study, Louie said that it’s hard to believe that the disparities within the healthcare system are due to geography. He said that value must be demonstrated in the expenditures exhausted by the U.S. healthcare system.

Therefore, the question becomes: “How do you more efficiently deliver care?” Louie said that two major strategies will be by linking outpatient care to inpatient care and delivering value over the entire continuum of care.

Louie said that there needs to be balance between volume and value. In the future, incentives and the right tools to make the transition to value-based care will be imperative.

Consumer electronics will be a large piece of the puzzle that will help to drive care. The introduction of the 3D HDTV, tablet computers and the cross-breeding of Skype to review images will be major players in the move toward impacting and improving quality-based care.

“Cardiology is a great example of how consumer products, especially for imaging, have driven our ability to extend beyond the stethoscope for the physical examine and really understand what is happening to the patient,” Louie offered. “Imaging is believing and it will have a big impact on patient care.”

He added that consumer electronics can help spread contextually relevant information and therefore ultimately increase access to care.

He added that Siri on Apple’s iPhone can “read your mind,” and help provide relevant resources and information to help answer clinical question. In addition, GE Healthcare’s Vscan echo allows an echo interpretation to be performed through the iPhone with the same quality as doing that by the bedside. And while he noted that the iPhone may be too small for this interpretation, he added that it’s “amazing we can even consider this.”

While not approved yet by the FDA, he outlined another technological advance using the iPad and iPhone that can help cardiologists remotely read ECGs. The real-time monitor (Alive ECG) is an iPad app that allows the device with a single lead ECG on the patient’s chest to have the ECG information transmitted for remote interpretation to the physician’s iPhone for instantaneous decision making.

He also mentioned a pill-sized leadless pacemaker with sensing and pacing capability that is in the works; it is implanted in the patient’s myocardium and synced up to a physician’s iPhone for monitoring. 

On the other hand, Louie said that making improvements to clinical care, like using the radial PCI approach, can help save money and improve patient satisfaction by decreasing length of stay, discharging the patient on the same day.

Louie offered that cardiovascular imaging should focus on finding which patient to send for a procedure, and he questioned whether these types of new technologies will be cost-effective.

For instance, a University of Texas, Southwestern study found that using a combination of hybrid OR for aortic debranching and elephant trunk with endoscopic aneurysm exclusion was not cost-effective. In fact, the reimbursement was $61,194 for the procedure compared with $82,000 for the cost of the system.

“We are on the road to value-based care and there are many ways we can work better together, harder together with better tools to provide value to our patients,” Louie summed.