The Indiana health system has fine-tuned a remote patient monitoring program to treat specific chronic care patients and those with COVID-19, and is showing a significant decrease in hospitalizations and total costs of care.
Remote patient programs don’t just automatically work out. They have to be carefully planned and developed in order to gain traction and produce results. Most importantly, they have to target the right patients.
At Deaconess Health, early efforts to apply telehealth to home monitoring were slow and clunky, particularly in the manual collection of data, so that the effort put into the program outweighed what little results they were getting. Roughly three years ago, administrators at the Indiana-based health system decided to narrow their focus.
“This wasn’t going to work unless we found the right patient,” says Amanda Bohleber, MD, the health system’s chief transformation officer. “This was really about finding the right patient who would benefit from this and using the right tools.”
Bohleber and Allison Flowers, RN, Deaconess Health’s telehealth clinical manager, replaced the legacy RPM platform with Vivify technology and integrated with the health system’s Epic EMR platform. They used a tool within Epic to evaluate patients based on their readmission risk, then created a new RPM program targeting those with chronic conditions like COPD and congestive heart failure who had at least a 20 percent chance of returning to the hospital after being discharged.
“The patient has to be sick enough to benefit from this program,” says Bohleber.
The 20 percent readmission rate is a key number. For health systems like Deaconess, that’s a costly percentage of patients coming back for care, affecting not only the quality of life for those patients but the hospital’s bottom line. Telehealth and RPM programs that push care out of the hospital and into the home need to attack those statistics, changing the outcomes at home.
Therein lies the challenge for health systems who’ve jumped onto the RPM bandwagon over the past year to handle patients affected by COVID-19. Many have found that telemedicine and mHealth tools are great for tracking patients at home and giving providers insight into how to manage their care from a distance.
But in many cases the effort put into the platform isn’t equaling the results at the other end, and the health system isn’t seeing a significant decrease in cost, an improvement in caregiver workloads or an uptick in clinical outcomes. They’re shifting care around, not improving it.
For Bohleber and Flowers, the goal was to not only create a program to manage care at home, but to use it on patients who were spending a significant amount of time receiving care, costing the health system a lot of time and effort and reducing their enjoyment of life. The program would, first and foremost, allow these patients to receive care at home, where they would be more comfortable, while allowing providers to track key benchmarks and observe daily activities that directly affect care management.
“They’re getting care when they need it, and at home,” says Flowers. “They like knowing that someone is always watching out for them … and along the way we’re giving them education (and access to other resources) that helps them to manage their own disease.”
While designing an RPM platform that caters specifically to patient with certain chronic conditions – in this case COPD and CHF – Bohleber and Flowers also had to make sure that process was comfortable for the care providers, beginning with the nurses who would be checking up on patients every day and gathering the data from the platform. On this end, nurses manage care from one dashboard, receiving alerts whenever the data indicates a patient in need of help.
The technology itself is simple. The health system has 50 kits for the program, containing wireless mHealth devices that track patient vitals and a tablet that allows patient and provider to connect via virtual visit whenever necessary to collaborate on care. What goes into that kit is dependent upon the type of patient being treated, so it’s important that the health system choose the right devices and platform that meets specific needs.
That, too, is getting both easier and more confusing. The RPM market is growing quickly, particularly in light of the coronavirus pandemic, giving providers many options for home-based care management and coordination. A number of telehealth companies are marketing these kits in coordination with programs run through hospitals and clinics, but there are also consumer-facing devices available in retail locations that pledge to offer the same services.
For Bohleber and Flowers, the technology comes through a contract with Vivify. They’re working together with the company to make sure each kit has what that patient needs to receive care from home, and what Deaconess Health needs to care for that patient at home.
That will be important as the program scales up and outwards. Last October, Deaconess expanded it to handle COVID-19 patients, and has used it to treat roughly 400 people. Moving onwards, Bohleber sees the platform addressing patients with other chronic conditions, including diabetes, hypertension and other conditions.
So far, through the program, Deaconess has seen its 30-day readmission rate cut in half, from 14 percent to just below 7 percent. That translates into a savings of $500,000 in costs associated with readmission, including penalties. More broadly, the health system estimates it has saved about $6.5 million in total costs associated with care, as measured by charges captured in the electronic health record (they’re measuring up to 180 days before and after hospitalization).
And according to surveys, 93 percent of the patients in the program are satisfied with its ease of use, and 94 percent are happy with the care they’re getting at home. Those number aren’t at high when the patient is in the hospital or shuttling back and forth for appointments.
“We made our case financially,” says Bohleber, who notes that the expansion to help patients with COVID-19 “showed that there is a really good space for care at home,” including for patients with less complex care needs and those needing rehabilitation and therapy.
“We are seeing a significant difference” in care outcomes, she says, pointing to the 30-day readmission rate and total cost of care. “We’re seeing changes.”