By most accounts, the biggest barrier is the cost of the technology and disputes about who should pay for it.

Many health care payers, including CMS (Centers for Medicaid and Medicare), are set up to reimburse physicians for procedures, not the monthly fees charged by disease management companies.

Ehrman's study and many others pay for the services through grant money, but that will stop once his study concludes.

Many health care payers are wary.

In a controversial report on the subject last year, the Congressional Budget Office concluded that while disease management programs might improve patients' health, there was no clear evidence that the programs saved money.

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However, as Medicare costs skyrocket, CMS is exploring ways to keep down expensive hospital and nursing home care.

The bulk of Medicare costs come from chronic diseases, according to CMS.

Forty-three percent of Medicare spending goes for the 14 percent of Medicare beneficiaries with congestive heart failure; 32 percent goes for the 18 percent of beneficiaries with diabetes.

"Helping people before they get to a crisis is really the hottest field in Medicare right now," said Health Hero's Brown.

But CMS doesn't want to pay for new services unless they prove their worth.

Late last year, CMS began a groundbreaking experiment.

It is set to cover some 180,000 chronically ill patients in 10 regions chosen for their high enrollment of patients with chronic diseases.

In each region, some patients will be enrolled in a so-called chronic care improvement programs, which monitor patients and encourage them to follow health guidelines and get necessary preventive care; they may or may not use remote monitoring devices.

Companies that manage these patients will not be paid unless they can demonstrate at least a 5 percent cost savings over a randomly matched control population in the same region.

The savings are expected to come mainly from fewer hospitalizations and emergency room visits.

The most effective companies will have first crack at disease management contracts for millions of Medicare patients.

Key to the effective use of the remote monitoring devices is knowing exactly when patients benefit from having the costly devices at home.

Stegall said American Healthways, which has received contracts in two of the 10 CMS pilot regions, has evaluated patients with stable condition after equipment was removed from their homes.

"People have retained for more than six months the habit of weighing themselves and keeping their blood pressure under control," she said.

Ehrman of the Henry Ford Heart and Vascular Institute said his study is currently addressing the question of how long patients should have remote monitoring devices at their home.

"These patients will always have heart failure and always have the chance of hospitalization. What we don't know yet is how we can identify people who have learned well enough, either from the HB or via other means, that we can trust them to recognize when they are starting to get into trouble and act upon it."

Stegall said that the average length of time patients keep the devices varies, but that she tries to wean patients off the devices in six to nine months.

The ultimate goal, after all, is to help patients take care of themselves.

"It helps patients manage their own information. It's not a watchdog."

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