In new payment models that eventually involve risk contracting, patients with complex and varied conditions will present a special challenge. Likewise, accountable care organizations (ACOs), which are growing here and nationwide, require more patient follow up to reduce readmissions and visits to the emergency department (ED).
As you care for patients with chronic diseases like COPD, CHF and diabetes, you’ll need to not only monitor patients, but also engage them in their own health management. A program at one Indiana health facility is demonstrating how – led by an ISMA physician.
Under a $16 million Beacon Community Program grant awarded to the Indiana Health Information Exchange (IHIE), St. Vincent Health in Indianapolis subcontracted with IHIE and invited multiple hospitals in central Indiana to participate in a clinical trial to reduce hospital readmissions using home monitoring and videoconferencing by nurses.
|Alan Snell, M.D.
chief informatics officer
St. Vincent Health
Their results showed a reduction of 4 percent in the 30-day readmission rate compared to national averages for heart failure of around 20 percent. Now interventions that were part of the grant activity will be utilized to scale a Remote Care Management program to monitor 400-500 discharged patients for 60 days or longer over the next year.
“Always, it is the top 3 to 5 percent in any given population who account for 50 percent or more of total health care costs,” said ISMA member Alan Snell, M.D., chief medical informatics officer for St. Vincent. “That’s where the return on investment is found. Cost avoidance – not reimbursement – becomes the focus.”
The Indiana hospital is serving as the pilot site for this remote monitoring program. If results are successful, Ascension Health, the nation’s largest Catholic and non-profit health system and parent organization for St. Vincent locally, plans to expand the program to its hospitals nationwide.
More home care, less inpatient care
“It’s important in these new payment models to design appropriate care for patients who are not in a facility,” said Dr. Snell, who leads the program. “With newer technologies and using the mobile platform, we can do more now with remote monitoring and videoconferencing, to provide high quality virtual care in the home.”
Patients in the program whose conditions begin to deteriorate can be connected back to the medical practice for prompt follow-up to avoid an ED visit and/or another stay in the hospital.
Since the Beacon grant project began in 2010, more monitoring technologies are available and costs are decreasing. Technology will now allow patients to submit test results, measure vital signs and participate in videoconferencing with nurses or coordinators on the care team – all from their own homes. Dr. Snell is also interested in introducing virtual therapies in the home through mobile devices and even the television.
“This is about increasing patient education and improving their health literacy, which is difficult to cover in a 10-minute office visit,” Dr. Snell said. His program involves electronic education and engagement tools to help patients better manage their chronic diseases – and accomplishing it virtually.
“Technology is an enabler,” said Dr. Snell. “It allows us to develop customized treatment plans with the patient, the family and the health care team – the physicians, nurses, transition care specialists and others.”
The unanswered question is how effective the interventions are long-term. That’s the next area Dr. Snell and St. Vincent want to research. In the meantime, their results from the Beacon grant project have captured national attention and will be published soon.