Telemonitoring Reduced Costs and Inpatient Visitation Rates for Patients with Advanced Cardiovascular Disease: A Matched Cohort Study Telemonitoring Reduced Costs and in-Patient Visitation Rates for Patients with Advanced Cardiovascularddisease

Introduction: Reducing the cost of care of patients with cardiovascular disease is an important target for integrated health systems. Managing these patients is difficult and costly, with commensurately high rates of inpatient (IP) visitation.

Hypothesis: Medical costs and IP visitation rates of patients receiving remote telemonitoring (TM) will decrease, relative to what they would have otherwise been.

Methods: We performed a concurrent matched cohort study, comparing patients receiving TM to those who did not. Our treatment cohort includes all members of Priority Health, Grand Rapids, MI (PH) that received TM between January 2012 and September 2013. Members of the treatment cohort were matched 1:1 against non-TM members of PH, indexed on the month of TM enrollment. Matching criteria includes age and sex; chronic morbidity status (heart failure, COPD, HTN, diabetes); observed medical costs 12 and 6 months prior to initiation of TM; and IP utilization within 12 months prior to initiation of TM. Members were excluded from treatment and putative control cohorts if they did not have continuous enrollment for 12 months prior and 24 months post initiation of TM. Endpoints include 24 month cumulative medical cost and IP visitations.

Results: We provide population-level metrics (Table) with 80% confidence intervals for endpoint differences and average cumulative cost and inpatient visitation curves (Figure) for our treatment and matched control cohorts.

Conclusions: Remote telemonitoring of patients with advanced cardiovascular disease can reduce inpatientvisitation rates, driving a reduction in medical costs. In this study, we estimate a visitation rate reduction of 4.9%, and a medical cost reduction of $13,608 over 24 months.