Effective care coordination for heart patients is the aim of a new mandatory cardiac bundled payment plan from the Centers for Medicare & Medicaid Services (CMS) for heart attacks and bypass surgeries. According to CMS, the five-year plan – scheduled to go into effect July 1, 2017 – will be mandatory for hospitals in 98 metropolitan statistical areas (MSAs). About 1,220 hospitals will participate.

Reviewing the model

“This program holds hospitals financially accountable for episodes of care that last 90 days after inpatient discharge – including all related care covered by Medicare Parts A and B,” says Will Pettinger, Vice President of Customer Development at Vivify Health, a fast-growing international digital health company. The model includes payments for acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) procedures.

Also, Pettinger explains, Medicare is implementing this cardiac rehabilitation incentive payment model to improve patient outcomes after AMI or CABG in select MSAs, adding to the current bundled payment plan for surgical hip and femur fracture treatment already on the accountability list for hospitals currently participating in the agency’s initial bundled payment model, Comprehensive Care for Joint Replacement.

Reshaping processes

Healthcare providers receiving these bundled payments will need to stretch their capabilities and improve their performance in several areas, Pettinger says:

  • Pinpointing sources of costs during the 90-day episode
  • Engaging physicians in improving clinical standards and minimizing care variations
  • Establishing new metrics and systems for gauging and reporting outcomes
  • Building viable relationships with post-acute care partners, such as skilled nursing facilities, rehabilitation centers, and home health providers
  • Understanding patterns of readmissions

At the same time, they will need to pursue solutions, including technology innovations, to reduce the risk of a return to the hospital.

Realizing results with remote patient monitoring

Remote patient monitoring solutions such as Vivify’s fully managed, “instant-on” health kit can be the key to success in bundled payment programs, Pettinger notes. “With daily insight into how patients are feeling, and how they’re performing on a range of biometric markers, providers can intervene as needed before these patients re-present to the emergency room. Preventive care, especially after an acute episode, is an essential component of keeping patients healthy and producing better clinical and financial outcomes overall.”

The Vivify managed kit includes a tablet and integrated Bluetooth wireless health devices; patient-guided care plans, health surveys, educational videos, and coaching content; and one-touch videoconferencing for virtual visits. “It serves as an electronic nurse, alerting the patient every day – persistently and in a positive, reinforcing way – with essentially the same message, ‘It’s time to take care of yourself.’”

Reining in costs

Caring for patients at home as opposed to in a rehabilitation or skilled nursing facility can save significant dollars, Pettinger points out. “As we look at the numbers, the average post-acute stay at a rehab facility costs roughly three times as much as a home health stay for the same patients.”  With sophisticated but cost-effective remote monitoring, patients can not only be engaged in their own care, but also be contacted by care managers at any time, on demand, he says.  “Clearly these technology solutions can rein in costs by reducing the human resources needed for patient care, cutting down unnecessary doctor’s appointments, and curtailing expensive emergency room visits and hospital admissions/readmissions.”

Reinforcing patient compliance

A vital factor in helping patients comply with treatment plans after an acute-care episode is making it easy for them to do so. Vivify’s managed kit has yielded an exceptionally high patient compliance rate, primarily because it’s easy to use, Pettinger notes – an important feature, as the average age of patients who use it is 77 years old.

“Our compliance rate ranges between 90 and 94 percent – compliance meaning patients who answer all questions and take their biometric readings every day for an entire month. In an industry where the success rate in getting patients to engage in their care is typically about 20 percent, our results are – in a word – phenomenal.”

Vivify surveys indicate that kit users have more confidence in their self-care and in interactions with health care providers, another contributor to the high compliance rates.

Regrouping with the family

Families, friends, and other loved ones are essential participants in patient recovery, and the managed kit solution readily facilitates their involvement. “Our platform enables caregivers to include multiple people on a virtual visit,” Pettinger explains. “It offers not only the clinical component, where medical information is securely exchanged, but a separate, social support component. Videoconferencing can wrap in the patient’s core community as appropriate, providing a huge psychological benefit for all involved and accelerating the healing process.”

Responding to the tidal shift

The cardiac bundled payment is another sign of what the future holds for healthcare, Pettinger predicts. “Over the last 10 years, we’ve seen a profound tidal shift in the monetary responsibility for caring for patients – taking the onus away from insurance companies and putting it squarely on the shoulders of the provider community. As this paradigm shift in payments continues, providers will necessarily shift their focus from fee-for-service revenues to fee-for-value payments. Taking into account clinical and financial patient outcomes requires a fresh look at the continuity of care. With these insights, it’s more important than ever to keep close track of patients inside the bundled payment system.”

Remote care monitoring solutions provide the tools for achieving these goals, he explains, by enabling providers to effectively extend care beyond the hospital’s four walls, significantly reduce the cost of care, and dramatically improve patient satisfaction.

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