Vijay Velu has specialized in developing some of the most advanced home monitoring devices on the market. Using wireless technology, a central computer hub captures data on weight, blood pressure, cholesterol and more and transmits it to a command and control center where the data can be analyzed and checked for any medical response that might be needed. But aside from some trial telehealth projects that are either under way or on the drawing board, Velu is acutely aware that his company – MediBeam Health Monitors – has only a small market to go after right now. While the technology is there to gather vital statistics and prevent medical emergencies, the money to pay for it all has been lagging. To make it a daily reality for America's seniors, says Velu, the elderly will need to leverage all of their power at the polls to "make it an election issue. This is going to take five to seven years to become mainstream." Right now, most support for home monitoring devices is coming from Medicare, but the agency will only routinely pay for the first six weeks of home monitoring. "To get better embracement, there needs to be some sort of reimbursement," says Gregg Malkary, founder and manager of Spyglass Consulting Group. Spyglass recently conducted some 100 in-depth interviews with a range of healthcare providers to gain a better understanding of the field. "CMS is looking at this," adds Malkary, "and there are trials with Veterans Affairs to see which patients and solutions would work best. " One of those trials is just now being rolled out by the Center for Health Services Research in Primary Care at the Durham VA Medical Center, which will distribute 450 wireless blood pressure units from Carematix to hypertensive veterans. Their blood pressure readings, taken daily, will be transmitted automatically to a centralized database. Depending on blood pressure results, select patients will receive behavioral-lifestyle intervention, medical medication management or a combination of the two. "This study is one of the first to compare three interventions designed to improve blood pressure control," says Hayden Bosworth, PhD, a Duke University professor and the principal investigator of the study. Bosworth and his colleagues expect the ease of use of Carematix's units will deliver some real benefits and demonstrable savings for the VA. The problem with other types of monitoring device, says Carematix founder and president Sukhwant Khanuja, PhD, is that they were not only expensive but also hard to use. People had to sit at a fixed station to get their blood pressure readings. Not surprisingly, the more difficult it was to use, the lower the compliance levels. Khanuja is clearly hopeful that positive results from the VA study will help spread the word of his product and the returns that can be gained by lowering healthcare costs. "At the end of the day, the system has to save money," says Khanuja. For now, that's an argument that seems effective primarily with self-insured employers, who can see hard returns as they drop to their bottom line. So far, though, most third party insurers "see this as just another thing they might need to provide reimbursement for," adds Khanuja. And CMS is confronting the simple fact that is has only so much money available to spend. That lack of financial flexibility has translated into a lack of support that has created a major obstacle for monitoring advocates, especially if you consider that a full home monitoring system can cost from $3,000 to $5,000. For home monitoring to really catch on, says Malkary, costs will need to come down. But there is real hope that lower costs can happen soon. Dell Computers, which established its dominant position in the PC business by rapidly discounting the cost of technology, has been busy on the monitoring technology front. If Dell can get the cost of these monitoring systems down to around $500, adds Malkary, payers are much more likely to start examining the kind of savings they can gain from rolling them out. Advocates like Velu, though, say time … and numbers … are on their side. The United States is quickly headed to a point where 10-to-15 million of the country's elderly will need home monitoring services. This is coupled with a time when more and more doctors are aging as well … a trend that will significantly add to the pressure for more home monitoring and fewer office visits.