Archive for the ‘Telehealth & Telemedicine’ Category

Infographic: Telehealth Index

January 28th, 2015 by Melanie Matthews

Sixty-four percent of Americans would be willing to have a physician visit over a video platform, according to a new survey conducted by Harris on behalf of American Well.

An infographic by American Well drills down into the survey results, including details on consumer perceptions of telehealth.

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care ManagementReal-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels.

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14 Protocols to Enhance Healthcare Home Visits

January 20th, 2015 by Cheryl Miller

Use of telemonitoring equipment, electronic medical records (EMRs), a staff dedicated to monitoring home visits and engaged caregivers are just some of the protocols used to enhance home visits, according to 155 respondents to the Healthcare Intelligence Network’s most recent industry survey on home visits.

Following are 10 more protocols used to improve the home visit process:

  • Inclusion of home visiting physician in hospital rounds; and the collaboration of home visit physician with primary care physician (PCP) and complex case managers.
  • Using our medication management machines with skilled nursing follow-up to increase medication compliance.
  • Proactive phone calls to determine if a patient's condition is worsening and in need of home visits.
  • Daily workflow management algorithms with prioritization and mobile access to electronic case management records.
  • Using teach-back to assure comprehension.
  • Easy to use/wear multimodal, advanced diagnostics telemonitoring allowing patients total mobility and continuous real-time monitoring.
  • Medication reconciliation is crucial in eliminating confusion for the patient, and our electronic medical record (EMR) accurately reflects what the patient is taking, including over-the-counter (OTC) and supplements.
  • Hospital coach gathers information and prepares the patient for discharge, coordinates with home visit staff, home visit team (coach and mobile physician) and completes home visit.
  • Portable EMR to document and review medical information on the spot.
  • EHR-generated lists, community-based team, community Web-based tracking tool, telehome monitoring devices, preferred provider network with skilled nursing facility/long-term acute care (SNF/LTAC), home health and infusion therapy.

Source: 2013 Healthcare Benchmarks: Home Visits

http://hin.3dcartstores.com/2013-Healthcare-Benchmarks-Home-Visits_p_4713.html

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions.

Remote Diabetes Monitoring: Magic is in the Phone Call, Not the Technology

January 8th, 2015 by Patricia Donovan

Using a blend of telehealth, access to electronic medical records, electronic communication with providers and direct communication with patients, nurse care managers with the New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program significantly improved patient clinical outcomes and impacted healthcare costs for enrollees with diabetes. Here, Susan Lehrer, RN, BSN, CDE, associate executive director of the telehealth office for NYCHHC, shares some lessons learned from the eight-year-old program.

We can achieve really significant clinical and financial outcomes with available simple technology. I want to say 'simple' because this is not rocket science. It’s a glucometer that transmits over a modem, a blood pressure cuff that transmits the information of blood pressure via Bluetooth® to us that we see on a Web site within seconds.

That information is the first step, but providing the case management and communication back to providers is where the magic happens. Conducting effective patient interactions utilizing motivational interviewing can be done over the phone. We were all disbelievers in the beginning. “How can I do the same thing that I did face-to-face over the phone?” we asked ourselves.

You can’t do the same thing, but over time, you can achieve the same outcomes, as long as you have providers seeing the patients and patients keeping their appointments.

Technology enables us to give the feedback at the moment that the patient needs it. If somebody’s blood sugar is 58, and they don’t feel very well, calling them at that moment, which we do every day, prevents them from overcorrecting. Eventually, they learn how to treat their hypoglycemia. Giving that immediate feedback to a patient is where the dramatic clinical outcomes occur. Patients can learn self-management with very targeted interventions and support.

To recap, it’s not about the technology, because the data comes to us every day, but it’s the magic that happens in the phone call back to the patient.

remote diabetes management
Susan Lehrer RN, BSN, CDE is the Associate Executive Director for the House Calls Telehealth program for the New York City Health and Hospitals Corporation. Ms. Lehrer joined HHC in 2006 to design and implement the Telehealth program to provide expert care management for Diabetics with poor control.

Source: Diabetic Telehealth Monitoring: The Impact of Real-Time Data on High-Risk Patients (webinar available for replay)

The Year in Healthcare Intelligence: Reimbursement, Value-Based Results Resonate with Readers

December 29th, 2014 by Patricia Donovan

Newswise, fee-for-value healthcare initiatives eclipsed fee-for-service models.

When survival of healthcare providers hinges on payment for services rendered, it's not surprising our 2014 readers closely tracked news of emerging payment models and results from patient-centered, quality-based initiatives.

Here is a retrospective of stories that dominated our readers' news feeds over the last 12 months:

  • We reported on results from many accountable care organizations (ACO) over the last year, but few generated interest like the Anthem Blue Cross-Healthcare Partners accountable care collaboration that saved more than $4 million. The program succeeded by sharpening its focus to those with two or more chronic diseases—the population that research shows can most effectively be helped by coordinated care, officials state. A dedicated staff of care managers and care coordinators identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible.

  • Heads also turned when the Centers for Medicare and Medicaid Services (CMS) proposed updated penalties and incentives for its Medicare Shared Savings Program (MSSP), an accountable care initiative for Medicare beneficiaries. The proposed rules are designed to strengthen MSSP by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is also suggesting a third ACO model," track 3," which integrates some elements from the Pioneer ACO model.

  • The patient-centered medical home (PCMH) model, a stepping stone to an ACO, garnered its share of readership, especially when the National Committee for Quality Assurance (NCQA) added five measures to its medical home criteria, the gold standard for patient-centered measurement.

    In its third iteration of PCMH standards since 2008, the NCQA added behavioral health integration and care management for high-need populations, among other new criteria.

  • The patient-centered model suffered a setback, however, when one of the first, largest, and longest-running multipayor trials of PCMHs in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department (ED), or ambulatory care services or total costs of care over three years. Research by Rand Corporation and colleagues centered on patient-centered activities in the Southeastern Pennsylvania Chronic Care Initiative.

  • There was good news on the medical home front, however: A study published in September, 2014 attributed reductions in emergency room visits, principally by patients with chronic illness, to the PCMH approach. Research by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI), and published by Health Services Research, found that transitions to a medical home were associated with a 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more ED visits in any given year. These reductions were most evident among patients with diabetes.

  • Readers also paid attention when Geisinger Health System, an early adoptor of care coordination for chronic illness, announced that its all-or-none or “bundled” approach to primary care for patients with diabetes produced better health outcomes, and the benefits happened quickly for the more than 4,000 patients in the study. The system-wide approach was not easy, warned Geisinger: the model requires constant evaluation, and must be scalable across a variety of practice settings.

  • Also raising the bar for physician practices was Highmark, which shared six requirements for the "best practices" element of its successful pay-for-performance initiative. Physician practices can earn additional rewards for completion of an office-based best practice project, essentially a small pilot, that involves measurement and reporting.

  • On the flip side, reporting of some questionable hospital pricing strategies rated some page views as well. Data released early in 2014 by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP) found that some U.S. hospitals charge more than 10 times their cost, or nearly $1200 for every $100 of their total costs. Public oversight or regulation seems to help constrain excessive pricing, researchers found; Maryland, probably the most regulated state in the United States, has the lowest average charges of all the states among its 10 most expensive hospitals.

  • Cost savings aside, readers seemed especially attuned to new approaches or technologies designed to streamline healthcare delivery and enhance the patient experience, such as an uptick in remote monitoring.

    One hundred percent of respondents to the Telehealth in 2013 Survey by the Healthcare Intelligence Network monitor weight and vital signs, up from a respective 79 and 77 percent in 2010. The health conditions monitored remotely remain the same from 2010, the top three being heart failure, COPD and diabetes.

  • And finally, as all eyes focus on care management interventions that span the healthcare continuum, many readers responded to a story on a CMS pilot that would give hospice patients more options in the type of care they wish to receive at the end of life. Under the Medicare Care Choices Model, individuals who meet Medicare hospice eligibility requirements could receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

Were these stories on your news radar in 2014? Stay up-to-date in 2015 with the latest healthcare news, trends and benchmarks with a free subscription to the Healthcare Business Weekly Update.

11 Statistics About Remote Patient Monitoring

December 23rd, 2014 by Cheryl Miller

Remote monitoring of individuals with multiple chronic conditions reduced hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted disease self-management for nearly all of these monitored patients, according to the 119 respondents who participated in the Healthcare Intelligence Network's inaugural survey on Remote Patient Monitoring in March 2014. Other targets of a remote monitoring strategy included frequent utilizers of hospitals and emergency rooms (ERs) (62 percent) and the recently discharged (52 percent).

Following are seven more statistics from the Remote Patient Monitoring survey:

  • Fifty percent of respondents rely on specific diagnoses sets to identify candidates for remote monitoring.
  • More than a quarter of respondents (27 percent) target the frail and/or home-bound with remote monitoring programs.
  • Reimbursement for remote monitoring, followed by the education of patients in this technology, were identified by respondents as the chief challenges of these remote care management efforts.
  • Two-thirds of respondents said remote monitoring reduced bed days.
  • Telephonic case management is a component of remote monitoring efforts for 71 percent of 2014 respondents.
  • About a third of respondents report the use of either a Web interface or a dedicated mHealth app to supplement remote monitoring.
  • A patient-centered touch, such as a follow-up phone reminder to use a monitoring device or a personal coaching session, was frequently cited as a noteworthy supplement to remote monitoring technology.

Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Remote-Patient-Monitoring_p_4868.html

2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

Humana Remote Monitoring Tools Assess Frail Elderly with Functional Limitations

November 18th, 2014 by Patricia Donovan

In nine separate pilots of remote patient monitoring, Humana is testing technologies to keep the frail elderly safe and healthy within their homes for as long as possible. Here, Gail Miller, vice president of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge, reviews some of the tools and challenges of remote care management of individuals experiencing difficulties with activities of daily living (ADL).

Question: What assessment tools do you use to measure functional limitations and ADLs?

(Gail Miller): Besides the Charleston Frailty Index, we have a proprietarily developed tool that was started with Green Ribbon Health that manages all of the functional capabilities. That is the one that we use to help scale people. We also use the PH12 and the Subjective Global Assessment (SGA), as well as a couple of other assessment tools. It will often depend on how the person is presenting, but our primary assessment tool for functionality is the mDAT, which we developed internally.

Question: How does Humana define ‘frail’?

(Gail Miller): We use the clinical definition of frail — people more likely to fall, unable to keep their balance, on various medications, etc.

Question: How do you coordinate care for the functionally challenged?

(Gail Miller): If someone is having problems falling in their home, we will send our care managers into the home to do a fall and safety assessment, and then we will work with that member to complete the actions on the plan and to try and make their home safer for them to be able to move around in. If the person is having issues with their balance for example, and it isn’t due to the construction of their home or the way items are placed there, then we will get them to the appropriate provider so that they can be assessed, and see if there are things that we can do to improve on that.

In that case, we would not only be taking them to one of our providers, but also getting them enrolled in one of our Silver Sneakers classes, which is a class we offer that focuses specifically on balance and core strengths.

remote patient monitoring
Gail Miller is vice president of clinical telephonic operations for Humana Cares, the complex care and chronic management arm of Humana, Inc. Her responsibilities include the oversight of the complex and chronic care programs provided telephonically to members of Humana.

Source: Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population

Infographic: Telemedicine Enhances Health Care Delivery

October 27th, 2014 by Melanie Matthews

Telemedicine is becoming a mainstay in the healthcare delivery system, according to a new infographic by Accenture. While in its early stages, telemedicine is expected to grow rapidly and could provide alternatives for some physician office visits and urgent care and ER visits.

Accenture released an infographic on the topic that looks at the potential of telemedicine, the role of employers in telemedicine adoption and where telemedicine fits into the telehealth spectrum.

Telemedicine Enhances Health Care Delivery

2013 Healthcare Benchmarks: Telehealth & Telemedicine More than 10 million Americans directly benefited from a telemedicine service during the past year, according to American Telemedicine Association estimates. Telehealth's broad reach encompasses telemedicine -- the use of telecommunications technology to deliver clinical diagnosis, services and patient consultations -- as well as the exploding field of mobile health.

2013 Healthcare Benchmarks: Telehealth & Telemedicine is packed with actionable new information from more than 125 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page report, now in its third year, documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to present.

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Multi-Specialty Telehealth Collaborative Offers One-Stop Healthcare for Underserved, Remote Patients

October 24th, 2014 by Cheryl Miller

It’s all about the patient.

That’s what prompted Blue Shield of California and Adventist Health, both not-for-profit organizations, to collaborate on a telehealth program that could afford quality care to all Californians, when and where they need it, says Lisa Williams, senior director of strategic integration and execution, healthcare quality and affordability, Blue Shield of California, during Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth Collaborative, an October 15th webinar, now available for replay.

The presentation also featured Robert Marchuk, vice president of ancillary services at Adventist Health, and Christine Martin, director of operations, Adventist Health; all three shared the inside details on the collaboration and the shared mission and values that has led to the program's success.

Located in largely rural markets, access to specialists is especially critical for the program’s success, Ms. Williams says. The nine-site program, which launched in March, includes 11 specialties, ranging from cardiology to dermatology to orthopedics and rheumatology, which account for the majority of volume in pre-op and post-op care. Specialists are all board-certified and credentialed. The program will expand to an additional 16 sites by the end of this year, with plans to add telepsychiatry, she says.

Central to the program is its care coordination center, a full-service, virtual, multi-specialty physician practice with robust patient and provider supporting services, says Mr. Marchuk. Similarly to a one-stop shopping site, when patients enter a site, clinicians make one phone call regarding that patient to the center, which coordinates all aspects of that patient’s care, from scheduling an appointment with the provider and the clinic itself, ensuring all patient records are available and uploaded to their electronic medical record (EMR), to scheduling follow-up ancillary services and physician appointments and billing. “It’s been very successful,” says Mr. Marchuk, “and really sets us apart from other programs.”

Identifying gaps in their markets, and then finding the right specialty and specialist for that market are big parts of the process, Mr. Marchuk continues. "There are physicians out there that can be wonderful on a face-to-face visit and very, very good clinically, but don't necessarily lend themselves well to a video interaction, so we screen very carefully."

Clinician engagement, extensive training, and communication at all points of contact are also important, says Ms. Martin. “You can never over-communicate,” she says. Patients, staff, local providers and specialty providers all need to know what’s going on, so the experience can be as seamless as possible.

Reimbursement for telehealth is still on the negotiation table, Mr. Marchuk adds. But ultimately, it pays to invest in the technology now for the future.

“It’s one of the fastest growing growing fields. It’s affordable, accessible, and cost-effective. Telehealth really can enhance the physician and patient relationship.”

Listen to interviews with Robert Marchuk and Lisa Williams.

Infographic: Is the Average Patient Ready for Telehealth?

October 15th, 2014 by Melanie Matthews

The telehealth industry is poised for significant growth, with some 350,000 users today expected to grow to 7 million by the year 2018, according to a new infographic by iTriage.

The iTriage infographic looks at who's likely to use telehealth -- by gender and by age group; the average cost for a telehealth visit and some predictions for the future of telehealth.

Are Patients Ready for Telehealth

Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth CollaborativeA collaboration between Adventist Health and Blue Shield of California is improving access to specialist care and reducing inefficiencies through virtual telehealth visits. The nine-site program, which launched in March and includes 13 specialties, will expand to an additional 16 sites by the end of this year.

During Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth Collaborative, an October 15th webinar at 1:00 p.m. Eastern, Robert Marchuk, vice president of ancillary services, Adventist Health, Christine Martin, director of operations, Adventist Health, and Lisa Williams, senior director of strategic integration and execution, healthcare quality and affordability, Blue Shield of California, will share the inside details on the collaboration and the shared mission and values of the organizations that is leading to the program's success.

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

Yale Online Forum Helps Teens with Diabetes “Not Look Like a Jerk”

August 14th, 2014 by Cheryl Miller

Being a teenager is hard enough; when it’s complicated by a chronic disease like type 1 diabetes, it’s even harder.

Enter telehealth, in the form of a monitored discussion board for teens with the disease.

Margaret Grey, DrPH, RN, FAAN, Dean and Annie Goodrich Professor at the Yale School of Nursing, has spent the majority of her career helping patients and families manage chronic conditions, and helping kids — teenagers in particular — manage their diabetes through their teen years so they can reduce their risk of long-term complications.

“I’ve been studying these kids for 30 years,” says the pediatric nurse practitioner, who, prior to assuming the deanship in 2005, served as associate dean for scholarly affairs and was the founding director of the school's doctoral program and the NIH-funded Center for Self and Family Management and a related pre- and post-doctoral training program. “Kids have black and white thinking — and have to manage how to 'not look like a jerk' by being given the skills to manage their disease, to think about it in a different way.”

Grey and other researchers conducted several clinical trials: an advanced diabetic education project and a life skills program, which showed that teens with diabetes' overall health and quality of life were better after going through both programs. Results showed that intensive therapy and better metabolic control reduced the incidence and progression of microvascular and neuropathic complications from diabetes from 27 percent to 76 percent.

But how to maintain those results? According to researchers, "Metabolic control tends to deteriorate as a combined result of insulin resistance that accompanies the hormonal changes of adolescence and lower adherence to the treatment regimen often associated with the desire for autonomy.”

“So we took those interventions and developed an online program kids could do at their leisure," Grey says. It incorporated a monitored discussion board that allowed kids to communicate with others like them. Teens with diabetes overcome their fear of being stigmatized by logging onto the Web site,­ called TeenCope, ­with other teens with diabetes and engaging in self-management exercises. The online program simulates situations teenagers with diabetes might encounter by using graphic novel animations that illustrate coping skills lessons from the animated characters. “As kids transition to adolescence, they require more effort and thought,” Grey says.

Peer support is an important component of maintaining a healthy lifestyle, as adolescents face pressures such as not wanting to reveal medical equipment in a social setting, or reveal their medical conditions in a social situation.

In addition, the program will also integrate an online educational program aimed at problem-solving for teens with diabetes. Adolescence is a time when patients neglect self-monitoring, dietary recommendations, and pharmacologic treatments — not because of a lack of knowledge, but due to the decision-making difficulties characteristic of this life stage. Studies show that poor metabolic control in the teen years correlates to reduced self-management in adulthood, making adolescence a key period for developing healthy behaviors. And once teenagers can get a handle on their diabetes, they improve not only their own health, but their families’ quality of life.

“This is a way to give them the skills to think about their condition in a different way,” Grey says.