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Congressionally Mandated Study of Telemedicine Indicates No Savings to Medicare
Contact: Cheryl Pedersen, (609) 275-2258
PRINCETON, N.J. (July 2, 2009)—Home telemedicine holds promise for cost-effective delivery of monitoring, educational, and therapeutic services to people with chronic illnesses. However, findings from Mathematica’s congressionally mandated evaluation of the Informatics for Diabetes Education and Telemedicine (IDEATel) demonstration, reported in the July issue of Diabetes Care, showed no overall cost savings for Medicare.
The demonstration was designed to provide telemedicine services to Medicare beneficiaries older than 65 who had diabetes and who lived in medically underserved areas of New York City and upstate New York. The demonstration sought to improve the health of Medicare beneficiaries with diabetes and to reduce the complications they faced by improving access to care and conformance with physician guidelines. A consortium led by Columbia University designed and implemented IDEATel in two four-year phases.
In the first phase, beneficiaries received a desktop personal computer with a monitor, mouse, and keyboard; a video camera; speakers; microphone; and glucose and blood pressure meters. They used the equipment to measure and monitor their blood sugar and blood pressure, interact with an IDEATel nurse case manager through scheduled video conferences, and access web-based educational materials. In the second phase, beneficiaries recruited in the first phase, and a new refresher cohort of eligible beneficiaries, received a newer, smaller, and easier-to-use home telemedicine unit to replace the computer.
The demonstration was neither as intensive nor as technologically sophisticated as originally designed. IDEATel was clinically effective at only one site and had no cost-reducing effect on Medicare total, Part A, or Part B expenditures or on the use of expensive services, such as hospital care. Furthermore, the intervention’s costs were high—more than $8,000 per person per year—when compared with costs for programs with similar-sized clinical impacts.
In addition, the demonstration’s specific type of home telemedicine intervention was not generalizable to other telemedicine interventions. As a result, findings from the evaluation do not imply that home-based telemedicine cannot increase value for the Medicare program.
“With adjustments, a Medicare program such as this might provide real benefits to beneficiaries,” said Lorenzo Moreno, lead author of the article and a senior researcher at Mathematica. “Increased home-based televisits from nurses and self-tracking of progress could improve patients’ self-care behaviors. These improvements could help participants avoid long-term health complications, which in turn would reduce use of acute care services, hospitalizations, and Medicare costs.”
“Costs to Medicare of the IDEATel Home Telemedicine Demonstration: Findings from an Independent Evaluation,” by Moreno, Stacy B. Dale, Arnold Y. Chen, and Carol A. Magee appears in the July edition of Diabetes Care. This study was funded by the Centers for Medicare & Medicaid Services. A final report to Congress was released early this year.
Mathematica, a nonpartisan research firm, conducts high-quality, objective policy research and surveys to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, education, family support, employment, nutrition, and early childhood policies and programs.