2 Responses

1. Matt Handley MD

   May 20th, 2008 at 2:36 pm

   1

   Ted

   Great to bring the satellite up like this. A few points:

   1. When you get to societal perspectives, the ability to mold the model to your biases is large. Once the costs of driving to daycare can be included, the key variable in cost effectiveness is the bias of the modeler…
   2. Still, this is a great demonstration of the Willie Sutton story - the bank robber, who when asked shy he robbed back, replied “because that is where the money is” - Heart disease is the big Kahuna. HTN is a bit more nebulous, as the cost effectiveness of treating hypertension is related to the overall cardiovascular risk rather than the BP (a young person with elevated BP has a very low rate of CVD event in 5 years, while a patient who is 75 with DM has a very high risk of CVD in 5 years - and since a 30% decrease of a big number is bigger than a 30% decrease in a small number, that is where the money is). CVD is a bigger driver of outcomes and costs than the common cancers, but receives less attention
   3. Patient engagement and empowerment are likely the key to CVD risk reduction, but we would benefit from more studies of the use of eHealth strategies to lower CVD risk. as you know, at Group health we are not waiting for the studies to exploit the benefits of eHealth for BP control (or other conditions). I do most of my BP follow up virtually, with patients having a clear understanding of their target BP, and have them visit only for confirmatory BP checks.

2. Ted Eytan

   May 20th, 2008 at 2:52 pm

   2

   Hey Matt,

   I could not ask for better than to have a national expert in CVD prevention help this along :).

   1. Agreed. This data is societal perspective, medical costs only, so Inpt, Outpt, Rx, ER. The indirect costs issue will come up in the next post. Welcome your input.

   2. The question is, if you are a philanthropy serving all of a State’s residents, and you want to bring stakeholders (beyond health system - employer, plan, provider, patient, family, community, Web2.0) together to support patient engagement in chronic illness care, what’s a good first condition to get partners together - one that has visible care gaps, affects a lot of people, has costs spread across stakeholders, and could benefit from deployment of Health2/Web2 tools (as you yourself do now)?

   Heart Disease is $6 bil in total expenditure (California). Hypertension is $3 bil (again, California) - not terribly far behind, and the data shows that most uncontrolled hypertensive patients are seeing doctors and insured, hence the “under the watchful eye of the health care system” quote.

   3. BP represents a great way to change thinking about visit and non-visit based care, as you illustrate so well!

   Keep following along if you would, next post is indirect costs, then the A3 is coming,

   Ted