Part 2 of a series
In the first post of this series, we looked at the big picture of how technology-based remote patient monitoring (RPM) can help improve outcomes and lower the cost of managing high-risk patients – especially those with multiple chronic conditions.
Without a doubt, it all sounds good in theory, as many healthcare innovations do. But how does it work in actual practice? That’s where the real value will be determined.
The Trinity Health At Home experience
One organization that has been using RPM with great success is Trinity Health, one of the largest non-profit, multi-institutional Catholic healthcare delivery systems in the nation. Trinity serves patients in 22 states from coast-to-coast through 94 hospitals and 109 continuing care locations that include home care, hospice, Program of All-Inclusive Care for the Elderly (PACE), and senior living facilities.
One of Trinity’s most important goals is to move 75% of its revenue to value-based reimbursement by 2020. They understand that keeping patients out of the hospital and the emergency department (ED) by helping them stay healthier at home is critical to achieving this objective. They knew RPM technology could help, but they also understood that technology alone wasn’t the solution.
The average age of the patients who eventually became part of the Trinity Health At Home program is 75. Those patients didn’t grow up using our modern technology, so Trinity needed to find a high-technology program that could effectively monitor the health status of high-risk patients at their homes. The program especially needed to be easy for the patients and their caregivers to understand and use. Among the many RPM programs on the market, Trinity selected to partner with Vivify because it best met all the desired criteria.
Trinity had some very clear goals for the Trinity Health At Home program as well. One was to reduce preventable hospital readmissions. At the start of the program, readmissions were in the 13-15% range. They wanted to take that number down to the single digits, both to take advantage of re-admission reduction incentives from Centers for Medicare and Medicaid Services (CMS) in the present and to better position themselves to reduce their costs under value-based reimbursement arrangements in the future.
They also saw reducing readmissions as the right thing to do. Entering the hospital, or even going to the ED, is tremendously disruptive to the lives of patients. If they could head off events that lead to hospital readmissions and ED visits, it would improve the quality of life for the patients and their families.
Finally, Trinity wanted to reduce the number of PRN (when necessary/unplanned) visits to the home by nurses. PRN visits are relatively expensive and they are time-consuming. In an era where there are already nursing shortages in many areas, the total time required for an in-home visit to address issues that could have been avoided by RPM, is time taken away from helping other patients.
Initially, Trinity started with a pilot program for proof of concept. Its success – only one patient out of the 55 participants had a readmission within the 60-day timeframe – led to expansion of the program. Today, Trinity Health At Home encompasses 12 home health agencies, with plans to add two more in the coming months.
Designed for ease of implementation
The Home Care Coordinator identifies potential patients for the Trinity Health At Home program while the patients are still in the hospital. Trinity has been very aggressive in this pursuit, with the program being applied to more than 80% of Medicare episodic discharges that meet the criteria. Trinity sets the initial time period for use of the RPM technology is 60 days, although it can be extended where there is demonstrated need to continue.
Once eligibility has been confirmed, a nurse visits the patient prior to discharge to explain the program, provide a demonstration, and obtain signature consent. A logistics coordinator at Vivify then assigns a health kit and sets up an appointment for a Trinity Health At Home nurse to visit the patient at home, bring out and set up the health kit, and teach patients and/or caregivers how to use it.
This initial in-home visit has been critical to the success of the program. Rather than simply sending the technology to the home with instructions, the nurse is able to not only explain the technical workings but also deliver a level of comfort in working with it. The first personal visit begins building a working relationship of trust which, in turn, increases compliance.
Included in this initial meeting is showing patients and caregivers how to use the “call” button to make a video call. Encouraging patients to use video instead of voice-only calls has been highly successful in driving better health outcomes as well as saving time. For the nurses, being able to see what is going on with patients means they don’t have to rely as much on patient descriptions for information, and patients can’t hide certain conditions as easily because they’re simply afraid of hearing bad news.
Nurses also use this visit to determine if any changes or improvements need to be made in the home, such as adding or beefing-up a wi-fi connection or adding a video camera to a tablet that doesn’t have one. They then arrange for the changes to be made.
Each day, patients take readings, such as blood pressure and weight, and submit them through the tablet. They also answer a series of questions (such as, ”How are you feeling compared to yesterday?”) The questions are designed to obtain a more complete understanding of the patient’s health that might not show up in only the factual numbers.
All of the information goes to the appropriate Trinity Health At Home nurse. Each nurse works from home, making more time available to monitor patient data. If a patient hasn’t submitted data by 10 a.m. local time, the tablet provides gentle reminders to do so. If the information hasn’t been received by 10:30, the nurse will proactively make a video call to the patient to ensure everything is alright and remind him or her to get the data in.
Obtaining the data is rarely a problem, however. Trinity Health At Home reports a better than 90% compliance rate among patients participating in the program.
Video calls a difference-maker
The use of video calls that are available 24-hours-a-day has been especially instrumental in helping Trinity Health At Home reduce PRN nurse visits. Prior to the start of the RPM program, Trinity Health At Home was averaging 6 PRN visits per 60-day period. That number has already been reduced to 5, with a goal of reducing it further to 4.
One way that has played out was with a patient who made a video call saying his catheter had stopped dripping. Normally, a nurse would have to drive to the patient’s home and check the catheter for problems. In the meantime, the nurse would be unavailable to help others for anywhere from 1-2 hours, depending on the distance.
With the video call, the nurse instructed the patient to move the tablet to his side, where she could see that the stopcock was closed. She explained how to open it and the problem was solved in a few minutes.
The Trinity Health At Home RPM program has also led to two other significant measurements of success. The first was in 60-day readmissions, which have been reduced from 13-15% to roughly 8%. This alone has enabled Trinity to improve revenue by taking advantage of CMS incentives while reducing its costs.
The second success is in patient satisfaction with the program, which is currently in the 90%+ range. Patients are getting answers faster, staying healthier, and avoiding more disruptive trips to the ED or inpatient stays. They are very appreciative, and Trinity expects this high level of satisfaction will be reflected in its The Healthcare Effectiveness Data and Information Set (HEDIS) scores and Medicare Star ratings.
In Part 3 of this series, we will cover the reactions of patients, caregivers, and clinicians and how the Vivify RPM sets up Trinity Health At Home for additional future success.