Posts Tagged ‘remote care management’

CHRISTUS Remote Patient Monitoring Challenge: Balancing Mission and Margin in Fee-Based World

March 5th, 2015 by Patricia Donovan

CHRISTUS Health recently expanded its remote patient monitoring program from 24 to 170 participants.

In its initial months of coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health nearly halved participants’ average cost of care, experienced no 30-day readmissions, and realized a 100 percent patient satisfaction rating.

Now, having expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients, the challenge for the multi-state and international integrated delivery network is scaling up RPM technology while balancing its mission of keeping patients healthy and in their homes with the financial fallout of keeping reimbursed patients out of the hospital in a largely fee-for-service environment.

“As a faith-based system, we are very passionate about keeping patients healthy and keeping them at the less restrictive, least risk environment. However, we also have to make sure our revenue stream is sufficient so that we keep our doors open,” noted Dr. Luke Webster, chief medical information officer for CHRISTUS Health during Remote Patient Monitoring for Chronic Condition Management, a February 24, 2015 webinar now available for replay.

Dr. Webster was joined by Shannon Clifton, director of connected care for CHRISTUS Health, who described the daily RPM program’s eligibility criteria and clinical workflow process as well as its clinical, financial and quality benefits.

Constructed around a Bluetooth®-enabled monitored kit sent home at hospital discharge, the RPM initiative is now supported by a team of six care transition nurses, up from a single nurse at the program’s outset, Ms. Clifton explained.

Other program elements include in-hospital kit delivery and patient education, as well as nurse coach monitoring following the patient’s return home.

Participants, who are identified via CHRISTUS’s care transition program, self-monitor key biometrics. A nurse coach responds to any alerts, coaching the patient back within wellness parameters and alerting the primary care physician if necessary to further engage the patient.

Patients remain in the program for up to 60 days. There are now 100 RPM kits in circulation, up from the initial ten in the program’s first phase.

While patient satisfaction remains high—98 percent currently in the expanded phase—CHRISTUS must also contend with the uncertainty of mobile health and a degree of provider skepticism and resistance. Another RPM-related hurdle is the additional workload it creates for care transition nurses.

With the support of its CFO, CHRISTUS Health is exploring options to optimize its RPM investment, including advocacy for expanded telehealth reimbursement; RPM subscription options for ‘the worried well’ who would pay for the monitoring; and development of a centralized e-hub, among other ideas.

Listen to Shannon Clifton describe the critical stage of the 60-day program that strives to keep high-risk patients within wellness parameters.

6 Health Plan Trends in Remote Patient Monitoring

February 12th, 2015 by Patricia Donovan

CHF and COPD are the health conditions most frequently targeted by health plan remote monitoring programs.

Frequent emergency room users, individuals with chronic comorbidities and members recently discharged from the hospital are the populations most often monitored remotely by health plans, according to 2014 market data.

Payors comprised 16 percent of respondents to the Healthcare Intelligence Network’s 2014 survey on remote patient monitoring.

The survey identified the following payor trends in remote care management:

  • Forty percent of health plans said they had a remote monitoring program in place, versus a high of 64 percent for case management and a low of 24 percent for hospital/health systems.
  • Health plans principally rely on case management assessments to identify remote monitoring candidates (80 percent) a fraction more than case management organizations themselves (78 percent). They were also most likely to depend upon direct member/patient referrals—a high of 44 percent versus a low of 0 percent for health plans and a median of 25 percent for hospital/health systems.
  • Health plans were most likely to monitor frequent hospital/ER utilizers remotely (100 percent) versus a low of 55 percent for case management and a median of 75 percent for hospital/health systems. They were also most likely to monitor those patients recently discharged (80 percent) versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
  • Of the top five chronic diseases monitored by remote technologies (CHF, COPD, asthma, hypertension, and stroke), health plans were most likely to monitor CHF (100 percent versus a low of 25 percent for hospital/health systems and a median of 89 percent for case management); COPD (100 percent versus a low of 50 percent for hospital/health systems and a median of 67 percent for case management); and asthma (80 percent versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
  • In terms of payor challenges associated with remote monitoring, patient education was a strong concern (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 56 percent for case management, as was reliability of self-reported data (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 44 percent for case management.
  • Across the board, all three sectors (100 percent) said telephonic case management was key to remote monitoring.

Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

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)

6 Criteria for Remote Patient Monitoring Applications in Managed Care

July 10th, 2014 by Cheryl Miller

Among the six criteria that Humana uses to evaluate vendors for remote patient monitoring applications are reducing medical costs and generating a positive ROI at a program level, says Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge. Applicants have a tough bar to pass, because programs not only have to work, they have to work better on those already being care managed.

First, we put together criteria for what we wanted to do in a managed care application. We were looking at reducing medical cost and generating positive return on investments (ROIs) at a program level. Our studies are more difficult to set up because all these people are under care management. Whenever anyone is going to work with us, they have to understand that they have a tough bar to pass, because not only does the program have to work, it also has to work better on someone who is already being care managed. We are looking for that incremental lift that we could get from remote monitoring.

Everything has to be customer friendly and easily adaptable to our members’ lifestyles. We want our members to feel rewarded by their efforts to monitor their health. We want to involve the members, physicians, caregivers and families so that everybody in the care circle is included, and we want to test with little disruption to our large organization.

We have more than 2,000 nurses and social workers on the telephone. This is something that you have to consider to introduce new pieces of technology, in addition to considering how you are going to put it into your operational stream. We have been able to do that. We decided to move forward with this new care management model using all of the tools that we had and to extend our reach by using remote monitoring.

We were specifically looking for remote monitoring technology to help our members manage their conditions, to reduce hospitalizations, and to improve their consumer experience. We have nine remote monitoring care management pilots underway. We have a tenth pilot that is in development. People have to consent to both care management for Humana Cares as well participation for the pilot.

The member selection for our remote monitoring program was based on complex clinical analysis. There was no additional cost to our members to participate in these pilots, and the equipment that we use is considered a loan to the member for the duration of the pilot or as long as they are members of Humana if that pilot is rolled out.

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

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