Microsoft Implements Chronic Condition Management Platform at Denver Health

19 April 2011 | Jack Hersey, General Manager, U.S. Public Sector Health and Human Services, Microsoft

With an aging population, the incidence of chronic disease is skyrocketing with worrying implications for the health of patients and the U.S. healthcare system.

• According to an article in Health Affairs, chronic illness accounts for 83% of all health spending in the U.S.
Diabetes alone costs the U.S. $83 billion a year in hospital fees, nearly one-quarter of total hospital spending, according to the Agency for Healthcare Research and Quality.
• Today, diabetes affects 25 million Americans, or just over 8% of the population, and the Centers for Disease Control and Prevention (CDC) predict that if current trends continue, as many as one in three U.S. adults could have diabetes by 2050.

At the same time, changes in reimbursement policies are forcing providers to find ways to reduce readmission rates for patients with chronic illnesses – according to the Agency for Healthcare Research and Quality, potentially preventable chronic conditions accounted for 6.2% of all hospital stays in 2008. Additionally, the cost of health is impacting the long term viability of our state budgets and service. Medicaid, at an average of 22%, is the single largest expense category in state fiscal budgets and this number is growing significantly. Almost every state is looking at how they can reduce the overall cost of delivering care while improving quality and outcomes. And effectively managing chronic diseases is essential to reduce the cost to taxpayers.
Denver Health is a model for states given the current challenges. The hospital network and health plan, which predominantly serves the uninsured, has a disproportionate number of patients with chronic diseases such as diabetes. Recognizing the need to improve diabetic patient care and prevent readmission, Denver Health and EMC Corporation worked with Microsoft to develop a technology-based platform to enable physicians and diabetic patients to interact via text messaging.
Denver Health designed the program with the understanding that many of their patients do not have regular access to computers or smartphones. Their Chronic Condition Management platform (CCM), which is built on Microsoft Office SharePoint Server 2007, Microsoft Dynamics CRM and SQL Server 2008, helps doctors and diabetics communicate via text message in between regular office visits. Medical staff establish appropriate reminders in the CCM system, which then automatically sends text message reminders to patients. These reminders prompt patients about their upcoming appointments and remind patients to text in their daily blood glucose readings. This allows Denver Health case managers to track patients’ blood glucose control in between visits. If a patient’s blood glucose levels are too low or too high, clinicians can intervene by directing patients to schedule an office visit to review their health status.
The hope is that this in-between visit communication will help patients better manage their condition, reduce readmission rates and ultimately, improve health and reduce costs.
Patients in the first phase of the pilot responded to the text messages and improved glucose control through self-management. Denver Health reports that not only are patients more engaged in the management of their disease, but doctors are able to quickly identify patients suffering from dangerously high/low blood sugar readings.
Denver Health is considering expanding the program to support the management of other chronic conditions. It’s a powerful example of the potential of technology to improve health outcomes and control healthcare costs. Not only do solutions such as Denver Health’s Chronic Care Management platform have the potential to immediately impact readmission rates, they also are easily replicated and implemented as part of any hospital or clinic’s at-home chronic condition management program.
Indeed, today most states already own the majority of technology to implement such systems. The growing health and economic burden of chronic disease poses numerous challenges. But the good news is there are easy to use technologies, such as text messaging, voice reminders and in-home monitoring using Microsoft HealthVault, that give patients the tools to better manage their own health, improve patient outcomes and reduce costly hospital readmissions.
Is your organization using Microsoft technology to improve the way physicians care for and interact with patients? Tell us how you are using Microsoft’s technology in an innovative way, and we’ll hopefully be profiling you on the Microsoft in Health blog in the near future.
Jack Hersey
General Manager, U.S. Public Sector Health and Human Services, Microsoft