Archive for the ‘Avoidable ER Use’ Category

Guest Post: Analytics-Backed Wearables Provide Value Through Actionable Health Insights

July 18th, 2017 by John Valiton, CEO of Reemo Health

wearables for seniors

Analytics-enabled wearables offer opportunities for chronic disease management and delivery of value-based care.

The wearable market has experienced a growth rate of more than 20 percent and is estimated to reach over 213 million units shipped worldwide by 2020, according to IDC. These numbers likely don’t come as a surprise, as wearables have become an everyday tech accessory for nearly every generation — children, Millennials, Gen X, and even seniors. In fact, research by Accenture found that 17 percent of Americans over the age of 65 use wearables to track fitness — a percentage right on track with the 20 percent of those under the age of 65 that use wearables similarly.

But, while the value of utilizing wearables to track health has been tapped for the everyday consumer, it has yet to reach its full potential. Wearables can go far beyond heart rate monitoring and counting steps — especially for seniors. These devices, when connected with a data analytics platform, can provide the valuable insights needed to not only track health in real time, but predict potential threats and optimize care according to need. And the analytic insights, integrated with previous health records, not only benefit the senior, but give professional and family caregivers a deeper look into the behavior that can improve long-term health, streamlining delivery of care by mitigating the need for trial-and-error treatment planning.

With over 50 million seniors in the U.S., this offers a huge opportunity for care facilities to provide real value to the patients they serve, whether in a senior care facility where residents are monitored on an hourly basis, or still living independently where facilities provide data insights at scheduled check-ins. But, as more facilities adopt wearable and analytic solutions, they must acknowledge the importance of using the wearable-enabled analytics platform to keep users engaged by providing value through actionable insights, rather than simply mining data and pushing it out. If there are not real benefits for both the senior and care provider, that wearable device is likely to end up in a drawer in a matter of months.

As caregivers dive into these valuable insights, they can be applied to assist with everything from chronic disease management and health event recovery to reduce the chance of post-acute readmission, to predicting potential threats based on irregularities in activity levels and vitals — allowing providers to truly delivery value-based care. For example, through the analysis of activity data, caregivers can follow the pathway to a potential fall for a senior, and proactively take steps to avoid this often traumatic event. Additionally, urinary tract infections (UTIs) are a large risk for seniors, and often occur after a 72-hour period where light activity such as walking becomes increasingly painful and trips to the restroom increase. By tracking a senior’s activity levels through a wearable device, caregivers can strategically treat those with potential UTI issues.

Through these kind of applications, truly actionable wearable data can provide immense value for both seniors and the caregivers tasked with keeping them on the pathway to a positive aging experience. And for those still living independently, the integration of response systems — such as push-of-a-button 911 dialing — within the wearable devices can provide additional value in their daily life by providing peace of mind to the senior and their loved ones, and functionality in the case of an emergency.

The use of wearables in everyday life doesn’t have to be limited to tracking a morning walk or getting reminders to stand up when you’ve been sitting for too long. If used alongside a powerful analytics platform, these devices can truly improve seniors’ quality of life, while strengthening connections with caregivers through increased visibility into seniors’ daily activities and peace of mind for loved ones. And while the wearable revolution is sweeping the nation, it truly should be about more than wearables for seniors. Wearables, backed by powerful data analytics, can become invaluable for our aging generation while providing unmatched insights for both personal and professional caregivers.

John Valiton, CEO, Reemo Health

John Valiton, CEO, Reemo Health

About the Author: John Valiton is CEO of Reemo Health, a senior health technology solution designed to empower caregivers with actionable insights to improve the aging experience. As a 20-year business development veteran and entrepreneur, Valiton has developed partnerships with many national and international companies. He has been an avid technology enthusiast since an early age, and applied his interest in all things tech at the intersection of IoT, wearable technology, healthcare and data science through his position as a strategic advisor, chief revenue officer and now chief executive officer for Reemo.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Reducing SNF Readmissions: Clinical Targets, Quality Scorecards Elevate Performance

May 23rd, 2017 by Patricia Donovan

reducing SNF readmissions

Michigan’s Tri-County Collaborative holds the line on hospital readmissions from 130 participating SNFs.

Three geographically close Michigan health systems shared more than a concern over escalating readmissions from skilled nursing facilities (SNFs).

As Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System ultimately discovered from Michigan Quality Improvement Organization (MPRO) data in 2013, they also shared about 30 percent of their patient population.

This revelation, combined with the pinch of new hospital readmission penalties from the Centers for Medicare and Medicaid Services (CMS), prompted the three to set aside competition and siloed strategies and forge a coordinated approach to reducing readmissions from SNFs.

Today, the resulting Tri-County SNF Collaborative operates with a set of clinical and quality targets and metrics created in tandem with more than 130 member SNFs. Tri-County’s dozen participation requirements for SNFs range from regular reporting through a dedicated SNF portal to achievement of specified performance metrics.

“We developed collaborative relationships,” explained Susan Craft, director of care coordination for the family caregiver program in HFHS’s Office of Clinical Quality & Safety. “We wanted to have very open, honest conversations to review issues that were identified and find ways to resolve those.”

Ms. Craft shared the roots, framework and results of the SNF collaborative, which launched in the first quarter of 2015, during Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a May 2017 webcast now available for replay.

Once admitted to the collaborative, member SNFs must report on 14 metrics in four key areas: acuity, care transitions, quality and readmissions. In return, SNFs receive a 13-point unblinded quarterly scorecard with metrics on readmissions and patient acceptance response times, among many others.

A multidisciplinary team within Tri-County Collaborative reviews all SNF metrics bi-annually to determine each facility’s continued participation.

As for the collaborative’s impact since its launch, Henry Ford Health System achieved a nearly 20 percent drop in Medicare SNF readmissions as well as a 28 percent reduction in SNF lengths of stay. The initiative also identified opportunities for improvement, resulting in enhanced outpatient scheduling and nurse-to-nurse handoffs and interventions focused on SNF-specific issues like sepsis, Ms. Craft explained.

Despite these advancements, the collaborative still faces the inherent challenges of competition and transparency, as well as SNFs’ hesitancy to adopt value-based practices. “Our SNFs are still entirely dependent on fee for service [payment models],” said Craft. “They haven’t been impacted by penalties and value-based purchasing, although that is coming for them next year.”

Although not yet referring to participating SNFs as “preferred providers,” the collaboratives hopes to one day equip patients with complete data pictures to guide them in SNF selection. Also on Tri-County Collaborative’s radar are home care agencies, concluded Ms. Craft.

“We know there needs to be a lot of coordination across all post-acute care settings.”

Listen to Susan Craft describe how Michigan’s SNF Collaborative set aside competition to improve quality and readmission rates.

3 Priority Populations for Home Visits and 10 More House Calls Benchmarks

February 14th, 2017 by Patricia Donovan

More than half of home visits include screening for social determinants of health.

More than half of home visits include screening for social determinants of health.

Which patients should healthcare providers visit at home? A new survey on home visits identified three key populations that should receive home-based care management: the frail elderly and homebound (69 percent); the medically complex (69 percent); and individuals recently discharged from the hospital (68 percent).

In stratifying patients for these home visits, 62 percent rely on care manager referrals.

These were just two findings from the 2017 Home Visits survey conducted by the Healthcare Intelligence Network. Nearly three quarters of the survey’s 107 respondents visit targeted patients at home, an intervention that can illuminate health-related, socioeconomic or safety determinants that might go undetected during an office visit.

Who’s conducting these home visits? In more than half of responding programs, a registered nurse handles the visit, although on rare occasions, patients may open their door to a primary care physician (4 percent), pharmacist (4 percent) or community paramedic (3 percent).

Once inside the home, the visit is first and foremost about patient and caregiver education, say 81 percent of respondents, with an emphasis on medication reconciliation (80 percent). Fifty-nine percent also screen at-home patients for social and economic determinants of health, factors that can have a huge impact on an individual’s health status.

Patient engagement, including obtaining consent for home visits, tied with funding and reimbursement issues tied as the top challenges associated with in-home patient visits.

How to know if home visits are working? The most telling success indicator is a reduction in 30-day hospital readmission rates, say 83 percent of survey respondents, followed by a drop in hospital and ER utilization (64 percent). Seventy percent of survey respondents reported either a drop in readmissions or in ER visits.

Here are a few more metrics derived from HIN’s 2017 Home Visits survey:

  • Eighty-five percent of respondents believe that the use of in-home technology enhances home visit outcomes.
  • Fifteen percent report home visits ROI of between 2:1 and 3:1.
  • Eighty percent have seen clients’ self-management skills improve as a result of home visits.

Download an executive summary of results from HIN’s 2017 Home Visits Survey.

Engage a Pharmacist and 12 More Prescriptions for Medication Management

October 20th, 2016 by Patricia Donovan

Half of medication management programs engage retail or community pharmacists in 2016.

When should a pharmacist be brought in for a medication management consultation?

When the patient requests a consult, experiences general medication adherence issues, or suffers complications from medications, say respondents to the 2016 Medication Management survey by the Healthcare Intelligence Network.

The 101 respondents to the August 2016 survey also indicated that as a general medication management guideline, and with or without a pharmacist’s involvement, polypharmacy patients, individuals taking high-risk medications, those registering frequent ER or inpatient stays and those transitioning between care sites should receive priority.

Drilling down to clinical red flags for medication management, a diagnosis of diabetes is a key indicator, say 84 percent, followed by congestive heart failure or hypertension, say 81 percent of respondents.

Despite the inclusion of pharmacists in 90 percent of medication management programs, 42 percent of respondents say pharmacists are not currently reimbursed for medication management-related tasks.

Other medication management metrics documented by the survey include the following:

  • The three most common components of medication management programs are education and health coaching (71 percent), a medication needs assessment (69 percent) and pharmacist counseling (68 percent).
  • A pharmacist-driven clinical assessment is the most reliable standard for measuring medication management, say 63 percent of respondents.
  • E-prescribing and aids such as medication event monitoring system (MEMS) caps, pillboxes and calendars are the most common medication management tools, according to 49 percent of participants.
  • Patient-reported medication data is the information most commonly assessed for medication management, say 78 percent, closely followed by medication refill patterns (75 percent) and claims data (53 percent).
  • Half of responding medication management programs engage a retail or community pharmacist.
  • Fifty-eight percent of respondents not currently engaged in medication management plan to launch a program in the coming year.
  • Forty-four percent of respondents share electronic health records for medication management purposes.
  • Beyond a pharmacist-driven assessment, the Medication Possession Ratio (MPR) is the key measure of medication management for 31 percent of respondents.

Click here to download an executive summary of survey results: Medication Management in 2016: Polypharmacy, Diabetes Patients Priorities for Pharmacist-Led Interventions.

UPMC: INTERACT Tools Boost Provider Communication in RAVEN Project to Reduce Long-Term Care Hospitalizations

September 6th, 2016 by Patricia Donovan
UPMC reduces long-term care hospitalizations

Even custodial or housekeeping staff can use the INTERACT Stop and Watch tool to record subtle changes in a patient.

The RAVEN (Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents) project by the University of Pittsburgh Medical Center (UPMC), aimed at improving quality of care for people residing in long-term care (LTC) facilities by reducing avoidable hospitalizations, is set to enter phase two in October 2016. Here, April Kane, UPMC’s RAVEN project co-director, describes a pair of key resources that have enhanced communication between providers, particularly those at the eighteen nursing homes collaborating with UPMC on the RAVEN project.

Currently INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement project and has been funded through Medicare. It is designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities (SNFs). The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. These tools are free online.

INTERACT is used in multiple settings, but in our long-term care setting, we’ve been primarily encouraging the use of two INTERACT tools. There are a wealth of others. First is the Stop and Watch tool. This is a very easy early detection tool that would be used by members of your nursing home staff, such as nurses aides, custodial or housekeeping staff, and other workers who have a lot of one-on-one engagement with residents.

Using this tool, they may notice subtle changes, such as a patient who isn’t as well engaged, who has been eating or drinking a little less, or is not as communicative as they had been before. It’s a very easy one-page tool. Sometimes it’s a card where they can circle if they’re seeing something different, for example, “The resident seems a little different,” or “They ate less.”

The goal would be to take that tool to either the LPN or the RN in charge of the unit they’re working on and say, “You know, I was with Mrs. Smith today. This is what I’ve been seeing that’s a little different with her.” That nurse should take that tool, validate its usage and then from there, go in and assess the patient.

If appropriate, they should utilize a second INTERACT tool, SBAR (Situation, Background, Assessment, Recommendation), to provide a more thorough assessment of what is going on and determine if this is a true changing condition. The SBAR allows the nurse to provide feedback to physicians in the very structured format physicians are used to reviewing. This allows them to place all the vitals and information in one place.

When they do make that call to the physician, they’re well prepared to update them with what is going on with a particular resident. The physician then feels comfortable in deciding whether to provide further treatment on site or if appropriate, to transfer out to the hospital, depending on that resident’s need.

Click here for an interview with April Kane on the value of UPMC’s onsite enhanced care coordinators in the RAVEN project.

Infographic: 18 Million Non-Urgent ED Visits

June 3rd, 2016 by Melanie Matthews

Many states are moving toward co-payments for Medicaid patients who visit emergency departments for reasons classified as “non-urgent,” according to a new infographic by Policy Prescriptions.

The infographic examines key characteristics of these non-urgent ED visits.

Industry reforms, expanded coverage under insurance exchanges, Medicaid expansion, and shifting healthcare delivery models continue to influence emergency room utilization. In response, healthcare organizations employ a variety of strategies to reduce avoidable ER use.

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital emergency departments.

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Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Alternatives for Potentially Preventable ER Visits

April 15th, 2016 by Melanie Matthews

Ten common conditions represented more than 2 million annual emergency room visits in New York at an estimated cost of about $1.3 billion, and nine out of 10 of them could have been avoided or treated elsewhere, according to research issued by Excellus BlueCross BlueShield.

A new infographic by Excellus BlueCross BlueShield highlights key findings from the study, including the impact of preventable visits and the geographic regions with higher rates of preventable visits.

Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Can Digital Health Drive Down Diabetes Costs?

April 14th, 2016 by Patricia Donovan

The majority of organizations engage in digital health to enhance patient satisfaction with their healthcare experience, according to March 2016 HIN market metrics.

New metrics from the Healthcare Intelligence Network (HIN) have determined that 58 percent of digital health initiatives target patients with diabetes, the global cost of which is now $825 billion per year, according to a new report from the Harvard T.H. Chan School of Public Health.

Harvard, the World Health Organization and nearly 500 researchers around the globe recently conducted the largest-ever worldwide study of diabetes levels.

Respondents to the February 2016 Digital Health Survey by the Healthcare Intelligence Network report that, along with the diabetes population, individuals with congestive heart failure and hypertension are also closely monitored by digital health programs.

Weight and vital signs, key indicators that can signal complications with diabetes and other chronic conditions, are the health activities most frequently monitored by digital health, said 63 percent of survey respondents, a trend Melanie Matthews, HIN executive vice president and chief operating officer, would like to see expanded.

“In our device-driven era, many individuals already use at least one electronic tool for health-related reasons. Coaching people to use digital health to monitor vital signs like weight and blood pressure will foster self-management.” And with chronic conditions held in check, the industry should see a drop in hospital utilization and associated cost, Ms. Matthews predicted.

Digital health, also called ‘connected health,’ leverages technology to identify, track and manage patients’ health problems.

The survey also identified these digital health trends:

  • Individuals at moderate risk for hospitalization are the most engaged in digital health, said one-quarter of respondents.
  • Seventy percent said the principal goal of digital health is to elevate patient satisfaction with the healthcare experience.
  • Individuals at risk of a health crisis or hospital admission are the most heavily invested in digital health, according to one-quarter of respondents.
  • Mobile and tablet apps are the front-running digital health platforms, say 78 percent of these respondents, with online health education the principal digital health activity for 58 percent.
  • Overall, patient engagement proves the biggest digital health hurdle to overcome, say 23 percent of respondents.

For more 2016 digital health metrics, download the Digital Health Survey executive summary.

Novant Health Pharmacists Dispense Healthcare Value in the Discharge Space

February 25th, 2016 by Patricia Donovan

Novant Health's team of 12 clinical pharmacists supports medication management across the care continuum.

It’s a statistic healthcare organizations know well: 20 percent of Medicare beneficiaries are readmitted to the hospital within 30 days.

Factor adverse drug events (ADEs) into this trend, and the picture becomes more dire.

Enlisting pharmacists to reduce the number of ADEs in the Medicare population is just one goal in a five-point program by Novant Health to deliver healthcare value through medication management services.

“We’ve focused on adverse drug events because we feel they are an opportunity,” explained Rebecca Bean, Novant Health’s director of population health pharmacy. “Many ADEs are potentially preventable, and we know they are a contributor to hospitalizations. We believe pharmacists have a role in reducing risk for ADEs.”

The list of ADE risks is extensive. By the end of Ms. Bean’s February 2016 presentation on Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients, now available for replay, she had identified more than 25 different factors that can complicate medication management— everything from a patient’s affordability issues, even among the insured, to fear of a drug’s side effects to potential dangers from high-risk medications or health conditions.

In the Novant Health model, an RN care coordinator risk-stratifies the newly discharged, combing real-time hospital discharge notifications for red flags, such as patients taking high-risk medications or having high-risk conditions, signaling the need for a pharmacist referral.

Once referred, pharmacists conduct a comprehensive drug therapy review, keeping an eye out for adverse effects, newly prescribed medications and polypharmacy as well as general medication adherence issues.

“There could be financial barriers to getting their medications. There could be health literacy issues. Those are the sorts of things we want to make sure we’re directing pharmacist resources toward,” noted Ms. Bean.

Aware its providers have limited time to spend with patients, the integrated health system layers its pharmacists as an additional resource to improve quality performance, to incorporate protocols and evidence-based guidelines such as the all-important medication reconciliation. In an era of electronic health record use, the medication list has become dynamic, with many providers editing the list, Ms. Bean notes.

“We’re also utilizing our pharmacy team both on the inpatient and outpatient sides to gather that best possible medication history, and then teach other clinical team members how to best reconcile medications.”

Ms. Bean shared seven ways Novant Health pharmacists impact comprehensive medication management services, including the dozen benefits of incorporating these clinicians into its patient-centered medical homes (PCMH).

Encouraged by early financial gains from pharmacist interventions, particularly in the areas of medication reconciliation, therapeutic monitoring and warfarin review, Novant Health is committed to staff development to further its medication management program, exploring certification programs and even pharmacy resident programs.

“We feel it’s really valuable in the discharge space to be able to get a pharmacist involved with taking care of patients,” Ms. Bean concluded.

Listen to an interview with Rebecca Bean in which she offers ideas to improve the accuracy of medication lists.

Intermountain Healthcare Determined to Diminish Patient Disengagement Divide

November 5th, 2015 by Patricia Donovan

One in three healthcare consumers are disengaged from self-care, prevention and health IT, explained Intermountain Healthcare's Tammy Richards, corporate director of patient and clinical engagement.

Dismayed by national dips in patient engagement, satisfaction and health literacy, among other industry currents, Intermountain Healthcare convened a patient engagement steering committee composed of its highest level leaders.

What emerged was a strategic six-point patient engagement framework that not only has transformed patient care by the Salt Lake City-based organization but also has fostered a climate of shared accountability throughout the not-for-profit health system.

In a dramatic example of the framework’s potential, Tammy Richards, corporate director of patient and clinical engagement at Intermountain Healthcare, described how one Intermountain ER nurse, using newly acquired engagement skills, emotionally and personally connected with Harold, an alcoholic, disenfranchised frequent ER utilizer who previously had only reacted in an angry, abusive fashion.

“We changed, and Harold changed, and this is really what patient engagement is about: genuinely connecting with individuals, understanding their story and then providing them with the tools, electronic or personal, to heal or hopefully stay healthy,” Ms. Richards said during A Patient Engagement Framework: Intermountain Healthcare’s Approach for a Value-Based System, an October 2015 webinar now available for replay.

In presenting the six key program tenets, Ms. Richards underscored how her organization’s multilayered approach supports the mission of Intermountain Healthcare: Helping people live the healthiest lives possible.

Intermountain was particularly disturbed by Deloitte’s finding that one in three healthcare consumers are disengaged, Ms. Richard explained. “[The disengaged] are reporting less desire for care, less commitment to preventive action, less interest in technology and other solutions, and they are less financially prepared,” she said.

That critical data point ignited Intermountain’s efforts to reengage and engage its consumers, she added.

She shared highlights from the six-point engagement framework, including the following:

  • Incorporation of patient and family perspectives into the planning, delivery and evaluation of healthcare;
  • Designation of a staff member as the system’s health literacy coordinator;
  • Application of meaningful technology that spans the engagement framework;
  • Formation of workgroups and work streams dedicated to health literacy, engagement technology and patient experience that report to the steering committee; and
  • Better-timed offering of care decision aids to patients.

Although technology is often touted as the answer to patient engagement, Ms. Richards cautioned against the employment of too many tools to engage patients. “Historically, we’ve created chaos with systems and programs that have no interoperability. This is certainly an issue from an industry perspective; it’s also an issue within a hospital or within a system.”

With its engagement framework in place, Intermountain will continue to explore new methods of creating a seamless, integrated care experience for its patients, so that it may better serve its Harolds, its chronically ill, and even its pediatric populations, Ms. Richards concluded.

“We know that we’re going to fulfill our mission and it will be a constant journey. We know that our mission of helping people live the healthiest lives possible is within our grasp.”

Click here for an interview with Tammy Richards.