Posts Tagged ‘Remote Monitoring’

Remote Patient Monitoring Fosters a New Generation of Care Management and Preventive and Value-Based Care

April 5th, 2018 by Melanie Matthews

Remote Patient Monitoring

Moving healthcare out of the brick-and-mortar traditional setting into remote patient monitoring.

As healthcare moves out of the brick-and-mortar traditional setting into patients’ homes and their workplaces, and becomes much more proactive, the University of Pittsburgh Medical Center (UPMC) has been expanding its remote patient monitoring program to foster a new generation of care management, preventive care and value-based care, according to Dr. Ravi Ramani, director of UPMC’s Integrative Heart Failure Program.

The remote patient monitoring program at UPMC has its roots in the heart failure program but has since expanded to additional disease states across the integrated delivery system’s continuum of care.

After achieving reductions in all-cause readmission rates from its remote monitoring of heart failure patients, UPMC knew that the clinical processes were effective and, therefore, was ready to scale the program, said Dr. Ramani during Remote Patient Monitoring at UPMC: Creating Early Warning Systems To Reduce Unplanned Healthcare Utilization, a March 2018 webinar now available for replay.

“To really scale the program and get into the population level management,” said Dr. Ramani, “we really need a vastly reduced cost per unit. The only way to really do this is to leverage what the patients already have, which is ‘Bring Your Own Device.'”

UPMC also focused on refining their operational model so that they select the right patients, put them through an appropriate care pathway, and then integrate all of its other resources to work together, including analytics, operations and finances.

During the webinar, Dr. Ramani shared how UPMC: aligned its various stakeholders for remote patient monitoring success; assessed its hardware needs as patients transitioned through high-risk and low-risk stratifications; leveraged its Enterprise Master Patient Index for remote patient monitoring; and developed its clinical process for bringing new disease states into remote patient monitoring. Dr. Ramani also shared the impact of the program on unplanned care, including ED visits and admissions, and patient satisfaction.

Listen to Dr. Ramani share UPMC’s nine-point vision for a sustainable, scalable remote patient monitoring program.

8 Things to Know about Telehealth and Telemedicine

April 28th, 2015 by Cheryl Miller

From early detection of impending heart failure from as far as 3,000 miles away, to the latest wearable wrapped around wrists or bodies, or simply sitting in pockets, telehealth is having a radical impact on the healthcare industry.

The range of telehealth and telemedicine services has expanded in the two years since the Healthcare Intelligence Network (HIN) last conducted its telehealth survey. While the majority of organizations had telehealth programs in place in both 2013 and 2015, of those that didn’t, the number of respondents who said they would launch a service in the next 12 months nearly tripled over two years (64 percent in 2015 versus 26 percent in 2013), according to new market metrics from the Healthcare Intelligence Network’s (HIN) Telehealth & Telemedicine in 2015: Remote Monitoring, Wearable Devices Upgrade Burgeoning Industry survey, conducted in April of 116 healthcare organizations.

To address expanding population targets for telehealth services, the 2015 survey documented telehealth use for homebound, severe behavioral, at-risk for falls, and high-utilizers for the first time. Following are seven more facts about the burgeoning telehealth industry.

  • Three fourths of respondents (74 percent) said they expect Medicare to add remote patient monitoring to its list of covered telehealth services in the next 12 months;
  • Of clinical applications for telehealth, remote monitoring jumped from 57 percent to 63 percent;
  • Self-care/self-management tools and e-mail reminders remained among top telehealth tools for patients and health plan members;
  • The use of telephonic advice lines decreased from 55 percent in 2013 to 26 percent in 2015;
  • The nurse case manager has primary responsibility for telehealth, according to 32 percent of respondents;
  • Thirty-five percent of respondents said that bed days was the utilization metric most impacted by telehealth programs; and
  • Nearly 60 percent of respondents said they are reimbursed for telehealth from private payors.

Source: 2015 Healthcare Benchmarks: Telehealth & Telemedicine

Telehealth & Telemedicine

2015 Healthcare Benchmarks: Telehealth & Telemedicine delivers actionable new telehealth metrics on technologies, program components, successes and ROI from 115 healthcare organizations. This 60-page report, now in its fourth year, documents benchmarks on current and planned telehealth and telemedicine initiatives, with historical perspective from 2009 to present.

10 Tools to Complement Chronic Care Management

April 23rd, 2015 by Cheryl Miller

Despite new CMS payments to physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal chronic care management program, leaving critical reimbursement dollars on the table, according to new market metrics from the Healthcare Intelligence Network (HIN). Almost 45 percent of 119 respondents to HIN’s 2015 Chronic Care Management survey, conducted in January 2015, have yet to launch a CCM initiative, the survey determined. However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt comparable quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

How to best capitalize on these reimbursement opportunities? Follow-up with patients immediately following hospital discharge is the most common component of CCM initiatives, according to 81 percent of respondents. Following are nine more tools to complement chronic care management, in respondents’ own words:

  • Holding care manager, primary care provider (PCP) and clinical team reviews;
  • Any patient over a certain risk score gets a phone call from the physician or advanced practitioner registered nurse (APRN) for a follow up with the patient.
  • Utilizing a structured assessment tool in the electronic health record (EHR);
  • Coaching the patient to wellness and holding them accountable;
  • Addressing psychosocial issues with care coordination strategies;
  • Having a life planning agenda; knowing what to do if symptoms worsen, and what end-of-life agreements are in place;
  • Conducting motivational interviewing to support lifestyle changes;
  • Coordinating with nurse practitioners; and
  • Using remote monitoring devices for heart failure patients.

Source: 2015 Healthcare Benchmarks: Chronic Care Management

Chronic Care

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN’s industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

Countering 5 Remote Monitoring Cautions in Face of mHealth Uncertainty

March 24th, 2015 by Cheryl Miller

remote_patient_monitoring

Physician champions and legislative advocates can spur remote patient monitoring success.

Physician skepticism about mHealth is a frequently cited barrier to implementing remote monitoring. But once physicians understand they can allot in-person visits for those who truly need them, then use their other time remotely monitoring other patients to wellness, they might be more willing to buy in to mHealth.

It’s all about educating the physician, advises Dr. Luke Webster, vice president, chief medical information officer, CHRISTUS Health, who shared how CHRISTUS responded to these challenges during its remote patient monitoring pilot.

  • Unclear ROI: There are always questions around ROI. We look at pre-implementation costs and pre-enrollment costs versus post-costs, including all project costs. What does that ROI mean for your organization?
  • Limited Resources: With care transitions, we took remote patient monitoring and put it on top of the care transitions program. That added additional responsibilities to the already busy workflow process. Whether you’re looking at an E-Hub model or expanding these programs into other areas of your organization, it’s important to review that budget up front. What’s expected of your outcome goals? How will you do that from a day-to-day process and biweekly performance outcomes and measures so you meet that targeted overall outcome, whether it’s reducing length of stay, cost of care, or 30-day readmissions?

    You want all of that to match. Your resources have to be identified upfront. We have been very fortunate to have our providers as champions. They buy into it; they understand it. They didn’t buy into it initially because the nurse coach thought it necessary to make that patient home visit. Sometimes it is. But she has found, with these tools, that she can better do that from her office and manage more patients.

  • Physician Skepticism: It is important to understand your champions, your available resources, backup, etc., when issues come up and you need those resources. We’re finding — and statistics state this — that physicians are still more comfortable doing face-to-face visits. Keeping those patients healthier and at home means we’re keeping them out of the facilities. The physicians and primary care providers may have some skepticism regarding that as well. They have less hands-on training with the equipment so perhaps don’t fully understand the opportunity for them to fill clinic days with patients that are truly in need of an appointment that day versus monitoring others who can be coached to wellness at home.

    It’s about educating physicians, finding those champions and engaging them in the overall process and direction of our health system.

  • Reimbursement Regulations: You need an advocate who can speak for you, represent what you’re doing, and prove the value both at a state and federal level. That should be an ongoing process and on your calendar monthly: identifying and calling your state or federal representative.
  • Rising Technology Costs: This is a booming area; vendors can’t get their products out fast enough. When you set up a budget for a program like this and look to initiate a pilot or expansion, you must look at all technology costs—not only for hardware but for software, upgrades and required support. Do you go through a third party vendor, and do you lease or purchase your equipment? When do you purchase the equipment? Just from our original pilot in late 2012 to today, we’ve seen some changes in technology. If your kits are organized to fit that original technology, how will that change 18 months later, and what will be the cost of adjusting the kits (for example, Styrofoam, boxes, etc.)?

    All of that will change. Look at those technology costs and related issues as you move forward and have a plan to how best recycle that kit.

    Remote Monitoring
    Luke Webster, MD, is vice president and chief medical information officer of CHRISTUS Health. Dr. Webster has over 20 years of clinical and health informatics experience. He specializes in health informatics and physician leadership, clinician adoption and change leadership, clinical transformation, evidence-based medicine, clinical analytics and process improvement.

    Source: Remote Patient Monitoring for Chronic Condition Management

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)

Remote Care Management Improvements As Close As Telephone

June 3rd, 2014 by Patricia Donovan

Telephonic care management leads the list of remote patient monitoring strategies.

Remote patient monitoring in all its embodiments is here to stay, as results from our 2014 survey validate, with everything from interactive voice response (IVR) to video visits to home sensors driving results in population health management, particularly for the frail elderly.

Even CMS shows signs of softening its stance toward telemedicine. A key provision of a May 2014 rule issued by the Centers for Medicare and Medicaid services removed some barriers surrounding the umbrella issue of telehealth. In particular, this rule reduced the burden on very small critical access hospitals, rural health clinics and federally qualified health centers (FQHCs) by no longer holding physicians hostage to a prescriptive onsite schedule. This provision addresses the geographic barriers and remoteness of many rural facilities, and recognizes telemedicine improvements and expansions that allow physicians to provide many types of care at lower costs, while maintaining high-quality care.

More of these concessions are likely to come as the industry embraces value-based care and the market for devices to track home-based biometrics and activity continues to explode.

But sometimes, it’s not the clinical emergency averted by the use of remote monitoring but the assurance provided by a simple phone call. Analytics by naviHealth, a convener in the CMS Bundled Payments pilot, identified healthcare utilization patterns by the elderly that might benefit from telephonic care management.

“Often we found that some of our beneficiaries re-admit [to the hospital] because they simply want social interaction with someone else. A telephone call can sometimes be gratifying enough for that beneficiary so that they’re not seeking social engagement back at the hospital again,” notes Kelsey Mellard, vice president of partnership marketing and policy with naviHealth.

“If you think about how you target your population, you have high risk, low risk and maybe medium risk, depending on your analytics and clinical team. This is not rocket science,” Ms. Mellard continues. “It is a lot of work. It’s a lot of use of analytics against a target, but once you’ve identified that target population, it’s a question of how to turn up the engagement or turn down the engagement based on where that patient is. ”

“It can be very simple telephonic care management in the form of brief conversations,” she concludes.

Excerpted from 2014 Healthcare Benchmarks: Remote Patient Monitoring

6 Criteria for Evaluating Vendor Partners for Remote Patient Monitoring

April 22nd, 2014 by Patricia Donovan

Just as there are guidelines for identifying individuals most likely to benefit from remote monitoring, healthcare organizations must also choose remote monitoring vendor partners with care, advises Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge, who shared lessons gleaned from vendor selection for Humana’s nine separate pilots of remote patient monitoring.

I want to share how Humana chose the partners that we work with in these programs, because there are so many potential vendors to work with in the remote monitoring space. We had been evaluating companies off and on for about a year. We ended up doing a request for information (RFI) process with the top 25 we had identified internally. They weren’t necessarily the biggest vendors or the companies with the strongest balance sheet, but rather those that met the different capability criteria we were looking for and possessed the flexibility and creativity to work with us.

Some think that it’s a good idea to warn people when you’re going to be working with a large entity like Humana, so that the companies we choose are prepared to deal with our procurement and legal processes, and understand it will take some resources on their side. Since the change to the HIPAA rule in 2013 there iss more downstream liability, so we require additional business liability insurance, and our business information agreements are quite stiff. All of those things must be worked through before we can work with a vendor.

We were also looking for companies that could be easily scalable. You could have a great piece of equipment, but if it’s going to take ten months or a year to procure another thousand, that’s not going to work for us because we have to be thinking on a national basis. We also were looking for vendors willing to work with members with various home situations. We did not want to exclude anybody from our pilot.

For example, some of the equipment we looked at would only run if there were broadband in the home. We needed someone to put some type of device that they could plug in, that would help boost them or create a 4G or 3G network wherever they were. We needed to adapt to the different home situations that our individuals lived in.

Then, the equipment had to be senior friendly. We learned a lesson from a great study with Intel about three years ago. The results had some positives and some negatives, but one thing we learned was that the size of the equipment was important. At that time, the piece of equipment we were using weighed about 37 pounds. Because of the frail nature of some of our members, we had to hire an intermediary to do setup and delivery and then package it up and send it back afterward. It created a lot of extra cost and a little more confusion trying to arrange those deliveries and pickups.

One thing that we are dedicated to doing this time is making sure that whatever equipment we had in the home that we could manage it easily, and that hopefully the senior themselves or their caregiver would be able to set it up.

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

9 Remote Monitoring Technologies Enhance Telephonic Care Management

April 2nd, 2014 by Cheryl Miller

From home sensors that monitor daily motion and sleep abnormalities, to video visits using teleconferencing, Humana is doing its best to ensure that the frail elderly can remain at home as long as possible.

When integrated with a telephonic care management program, these remote monitoring technologies have helped Humana to avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges, says Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge. The pilots are part of a continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

Most Americans are living longer, and suffering fewer deaths from acute illness, Miller said in a recent Healthcare Intelligence Network webinar, Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results. But they are also developing more chronic illnesses and functional limitations, which are often the costliest to manage.

Despite their growing frailty, however, nine out of 10 Americans prefer to age at home, she continues. To help them live independently and age gracefully at home, Humana, which has over 30 years experience in the Medicare program, and over two and a half million Medicare advantage members, launched the Humana Chronic Care Program (HCCP). Targeting the members most in need, or the sickest 20 percent, which drive 75 percent of the company’s costs, the company implemented a series of nine healthcare remote monitoring pilots for individuals with congestive heart failure (CHF) and diabetes as well those with medication adherence problems. The pilots also target those with functional challenges that make activities of daily living (ADL) challenging.

“There is a clear need to look beyond disease and address functional limitations,” Miller says.

One of the pilots includes strategically placed home-based sensors that monitor ADL levels of those with functional impairment. Algorithms detect abnormalities in the patients’ activities, i.e. erratic sleeping behaviors or toileting patterns that can signal infections, which then generate alerts for recommended interventions.

Video visits include two way audio-video communications so that care managers can interact with their sickest members as an adjunct to home visits. Members are given tablets to use for face-to-face contact with their care manager, or to go over any educational materials their care managers or physician provides them.

Ranging from passive to active monitoring, all of the technologies are senior-friendly, and designed to help members manage their conditions, reduce hospitalizations and improve the patient/member experience, Miller says.

A mobile Personal Emergency Response System (PERS), for those that live alone or have limited caregiver support, has been the most popular, Miller says. Members are mailed a cellular device that can be activated manually by a button, or automatically via an accelerometer. Once turned on, the PERS device connects the member to clinically trained emergency support. Many patients have asked if they could extend their use of this particular device once the pilot was over, Miller says. She explains why:

Besides being a health issue, I think the device also speaks to the level of safety concerns that a lot of seniors who have multiple chronic conditions, and who live alone, have. They don’t want to necessarily reach out to their neighbors all the time. This provides them some peace of mind, which is the ultimate goal of the program.

Listen to an interview with Gail Miller of Humana Cares/SeniorBridge here.

What are your organization’s efforts in remote patient monitoring? Participate in our e-survey, 10 Questions on Remote Patient Monitoring, by April 22, 2014 and you will receive a free summary of survey results once it is compiled.

5 Population Health Tactics That Open the Door to Care Access

March 18th, 2014 by Patricia Donovan

remote patient monitoring

Remote patient monitoring is a phone call away.


Remote monitoring of patients, one of five Adventist Health approaches to improve access to care, can be as basic as a follow-up phone call or as high-tech as sensors placed around the home to monitor activities of daily living (ADL). Here, Elizabeth Miller, VP of care management at White Memorial Medical Center (part of Adventist Health), offers a set of population-based ideas to improve access to care.

First, consider embedding care professionals into the patient-centered medical home (PCMH). We do that for our highest risk patients. We embedded a nurse practitioner/social worker so that as the patients were on site, we talked to the primary care in the medical foundation to schedule their high-risk patients, the ones that we are going to population health-manage. We will embed our staff and come to you two days a week.

Second, consider home visits for homebound patients, although those are very intensive. I’ve done home visits; it takes about an hour and a half per patient.

Another option to consider is group settings; you may be able to reach out in your community and have group settings for the purpose of population health management. Also, consider going to a physician’s office for group settings.

There is also telehealth and monitoring from a distance. I can tell you that it doesn’t always go as well as face-to-face visits because sometimes some things are lost without the face-to-face. It is my personal preference to meet face-to-face, but we do monitor from a distance. A lot of this is just telephone calling to follow up.

We also send reminders. We phone to remind them of appointments; you can also send them letters or employ text messaging. It depends on your population and how savvy they are with social media and tools.

Excerpted from Population Health Framework: 27 Strategies to Drive Engagement, Access and Risk Stratification.

Readers, what do you think? Could remote monitoring extend care for the population you serve? Share your comments here, or Tweet questions @H_I_N and we’ll try to get them answered during this week’s webinar on Humana’s remote patient monitoring with telephonic case management to improve care coordination.

Funding Shortfall Short-Circuits Telehealth Use

September 19th, 2013 by Patricia Donovan

Despite numerous claims that telehealth boosts healthcare’s efficiency and reach, significant financial hurdles still remain, with cost still the most formidable barrier to implementation for more than a quarter of respondents to the 2013 Telehealth and Telemecine survey.

Reimbursement for these technologies remains an issue for one-fifth of the population surveyed for the third annual telehealth assessment.

Even so, where technologies such as videoconferencing for remote diagnostics are deployed, adopters report impressive gains in medication adherence and care of remote and rural patients, as well as a decrease in health complications. Take, for example, the numerous initiatives in the area of remote monitoring, the top clinical telehealth application reported by this year’s respondents. More than half — 57 percent — monitor patients or members remotely; fully 100 percent of those employing this technology track vital signs and weight in monitored individuals, two critical red flags in treatment of individuals with chronic illness.

Active users of telehealth and telemedicine also experience fewer hospitalizations, hospital readmissions, emergency room visits and bed days within served populations, respondents reported. More studies are needed to tie telehealth and telemedicine interventions to these metrics, as researchers at UC Davis Children’s Hospital did recently. They found that telemedicine consultations with pediatric critical-care medicine physicians significantly improved the quality of care for seriously ill and injured children treated in remote rural ERs, where pediatricians and pediatric specialists are scarce.

The study also found that rural ER physicians are more likely to adjust their pediatric patients’ diagnoses and course of treatment after a live, interactive videoconference with a specialist. Parents’ satisfaction and perception of the quality of their child’s care also are significantly improved when consultations are provided using telemedicine, rather than telephone, and aid ER treatment, the study found.

In a related development, UC Davis researchers have been awarded a $2.5 million grant to study telepsychiatry by the Agency for Healthcare Research and Quality (AHRQ) of the U. S. Department of Health and Human Services.