▸ Acne. Electronic follow-up visits for mild to moderate acne were a hit with patients and dermatologists in preliminary results from the first 60 patients of an ongoing study. Patients received digital cameras and uploaded facial photos for evaluation, trimming the average time spent by patients to about 20 minutes instead of over 2 hours for travel and clinic time. Blue Cross/Blue Shield reimbursed dermatologists for e-visits at the same rate as a follow-up visit in the clinic. "We see it extending to psoriasis and other skin conditions that don't vary too much between visits," Dr. Kvedar said.
▸ Hypertension. To increase adherence to hypertension therapy, 70 patients are being given "smart" pill bottles that transmit a signal when a scheduled medication dose has been taken or missed. They'll also get a palm-size globe that glows red when a dose is overdue and green when the medication is taken.
A separate study brings the center together for the first time with employees of a large company, EMC Corp. of Hopkinton, Mass. The company recruited 400 employees with high blood pressure to be randomized to usual care or to a group that is asked to measure their blood pressures at least twice weekly with special home blood pressure cuffs that transmit readings to a central computer. Patients will get individualized feedback and advice weekly on a Web site; those whose blood pressure readings climb particularly high will be contacted via e-mail or phone by a clinician.
If these technological self-management strategies succeed in keeping blood pressures down, it's a win for patients, the company, and clinicians. Trends toward basing clinician reimbursements on quality care through "pay for performance" and similar strategies will help push demand for better, more efficient care, Dr. Kvedar said.
When physicians in a system don't get a bonus unless they keep the average hemoglobin A1c levels of diabetic patients under a certain level, a Center for Connected Health program to help them attain one is "music to people's ears," he said. "Things are starting to line up in a very exciting way on the reimbursement side. You'll see that in the next few years."