Care coordination in a business-to-business and a business-to-consumer model for telemonitoring patients with chronic diseases

Introduction For telemonitoring to support care coordination, a sound business model is conditional. The aim of this study is to explore the systemic and economic differences in care coordination via business-to-business and business-to-consumer models for telemonitoring patients with chronic diseases. Methods We performed a literature search in order to design the business-to-business and business-to-consumer telemonitoring models, and to assess the design elements and themes by applying the activity system theory, and describe the transaction costs in each model. The design elements are content, structure, and governance, while the design themes are novelty, lock-in, complementarities, and efficiency. In the transaction cost analysis, we looked into all the elements of a transaction in both models. Results Care coordination in the business-to-business model is designed to be organized between the places of activity, rather than the participants in the activity. The design of the business-to-business model creates a firm lock-in but for a limited time. In the business-to-consumer model, the interdependencies are to be found between the persons in the care process and not between the places of care. The differences between the models were found in both the design elements and the design themes. Discussion Care coordination in the business-to-business and business-to-consumer models for telemonitoring chronic diseases differs in principle in terms of design elements and design themes. Based on the theoretical models, the transaction costs could potentially be lower in the business-to-consumer model than in the business-to-business, which could be a promoting economic principle for the implementation of telemonitoring

Extending the Business-to-Business (B2B) model towards a Business-to-Consumer (B2C) model for Telemonitoring Patients with Chronic Heart Failure

Purpose: We describe and perform an initial evaluation of the extension of the Business-to-Business model to a Business-to-Consumer model for telemonitoring of patients with chronic heart failure. Design/methodology/approach: We explored the problems in implementation of telemonitoring via the B2B model by means of a root cause analysis, including the 5-whys method to help us understand the shortcomings of the B2B approach, and then the 5W1H method to explore whether the B2C is a better strategy. The extension of the model was executed in the Business Model Generation framework. By using qualitative content analysis techniques, we supported our argumentation with findings from other studies. Findings: The B2C model is based on the interplay of agents – healthcare provider, equipment manufacturer, payer/regulator and distributor/promotor – all working together to improve patient outcomes. In our opinion, the success of the extended model in telemonitoring CHF patients hinges on two entities – the Telemonitoring center and Telehealth nurses – being repositioned in the out-of-the hospital setting. Social implications: Penetration of mobile telehealth via B2C model will allow for greater availability, access and equity in healthcare. Originality/value: We introduced a fourth pillar to the existing B2B model (i.e. distributors and/or promotors). The B2C model we propose might allow for scalability, generalizability and transferability of telemonitoring currently unattained with the B2B model. &nbsp

Replication Data for: VOI in Telehealth for CHF Management

This data underline the study on Value of Information (VOI) in telehealth for Chronic Heart Failure (CHF) management. The data in this set pertain to the Expected Value of Partially Perfect Information (EVPPI) for patients in all New York Heart Association (NYHA) classes of disease severity, and class IV

Value of information analysis in telehealth for chronic heart failure management.

ObjectivesValue of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands.MethodsThe expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands-patients in all NYHA classes of severity, and patients in NYHA IV class only.ResultsThe population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses.ConclusionsResults of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities

Cost-Effectiveness Analysis in Telehealth: A Comparison between Home Telemonitoring, Nurse Telephone Support, and Usual Care in Chronic Heart Failure Management

Objectives: To assess the cost effectiveness of home telemonitoring (HTM) and nurse telephone support (NTS) compared with usual care (UC) in the management of patients with chronic heart failure, from a third-party payer's perspective. Methods: We developed a Markov model with a 20-year time horizon to analyze the cost effectiveness using the original study (Trans-European Network-Home-Care Management System) and various data sources. A probabilistic sensitivity analysis was performed to assess the decision uncertainty in our model. Results: In the original scenario (which concerned the cost inputs at the time of the original study), HTM and NTS interventions yielded a difference in quality-adjusted life-years (QALYs) gained compared with UC: 2.93 and 3.07, respectively, versus 1.91. An incremental net monetary benefit analysis showed (sic)7,697 and (sic)13,589 in HTM and NTS versus UC at a willingness-to-pay (WTP) threshold of (sic)20,000, and (sic)69,100 and (sic)83,100 at a WTP threshold of (sic)80,000, respectively. The incremental cost-effectiveness ratios were (sic)12,479 for HTM versus UC and (sic)8,270 for NTS versus UC. The current scenario (including telenurse cost inputs in NTS) yielded results that were slightly different from those for the original scenario, when comparing all New York Heart Association (NYHA) classes of severity. NTS dominated HTM, compared with UC, in all NYHA classes except NYHA IV. Conclusions: This modeling study demonstrated that HTM and NTS are viable solutions to support patients with chronic heart failure. NTS is cost-effective in comparison with UC at a WTP of (sic)9000/QALY or higher. Like NTS, HTM improves the survival of patients in all NYHA classes and is cost-effective in comparison with UC at a WTP of (sic)14,000/QALY or higher