Expanding a Telehealth Program to Serve More Patients
By Mitch Work, MPA, FHIMSS
The 30-day readmission rate for heart failure patients who participated in one health system’s telemonitoring program went from 16% in 2014 to 5.1% in 2015 to just 3% in 2016. Results like this simply cannot be ignored. They must be celebrated—and, more importantly, replicated.
That is the mission for MultiCare Health System, a nonprofit integrated healthcare system based in Tacoma, Washington. Its leaders are now looking to expand upon the success that they have experienced since implementing telemonitoring and video conferencing capabilities from Honeywell LifeStream Solutions in 2015. Since starting the program, heart failure and chronic obstructive pulmonary disease (COPD) home health patients have used tablets to collect and wirelessly transmit biometric data to LifeStream, Honeywell’s clinical monitoring software. LifeStream provides a single consolidated view of patient information that enables care providers to make informed, data-driven decisions. In addition, nurses and doctors are using tablets to conduct video visits with patients in their homes.
“There is an increasing emphasis on improving outcomes and reducing costs by finding more innovative ways to deliver care. Early on we realized that this program allowed us to do just that: deliver great outcomes while reducing costs. And patients love it; they really do,” says Lynnell Hornbeck, manager of home health at MultiCare. “To be frank, it’s truly been a very successful program. We feel strongly that we could achieve similar outcomes with other populations, so that has been a key driver for us in moving forward.”
More is sometimes better
To that end, MultiCare is now undertaking a major initiative that promises to expand its telehealth program from serving about 100 patients to more than 500.
“We’re getting ready to launch a major change in our healthcare delivery model, which takes the successes that we have had with our telehealth program and expands it to all of our medical management patients in our home health department,” Hornbeck explains. “Up until now, it’s been really focused on heart failure patients and COPD. We’re now going to take and expand that to basically all medical diagnoses. So, we are in the process of adding patients with diabetes, cancer, and stroke to our telehealth population.”
Through its telehealth expansion, MultiCare is looking to reduce costs by offering high-quality care in a more efficient manner, letting virtual visits take the place of in-home appointments. In fact, with this model in place, MultiCare expects to enable home health case managers to double their daily average caseload, moving from 30 to about 70 patients. In addition, MultiCare is looking to improve care outcomes through telemonitoring, which will promote personalized clinician-patient collaboration on clinical care issues.
Growth requires strategy
To achieve these goals, however, the program must be developed in a purposeful manner. MultiCare leaders are embracing the following strategies as they expand the initiative:
Latching on to structure. To meet the needs of a large number of patients, MultiCare is offering a two-tiered telehealth program. “Tier one will be a full-blown program. These patients will have the telehealth monitor with all the peripheral devices in the home. They will get all of the intensive interventions that we can provide. We expect about 300 to 350 of the 500 patients will be enrolled in this tier one program,” says Kelly Gariando, RN, telehealth specialist at MultiCare.
When enrolled in the second tier or “coaching model,” patients will use their own devices to transmit vital information to the nursing staff, rather than using the tablets supplied by MultiCare. “For most patients, they will have three to four months of full-blown monitoring with the video visits and then move to the second tier when their vitals are more stable,” Gariando says. When participating in tier two, nurses will continue to track the medical data that patients transmit with an emphasis on “coaching the patients toward the self-management of their disease.”
Customizing the tools. As the program expands, MultiCare is doing whatever it takes to ensure that its technology is capable of supporting a broad range of patients. “The challenge is getting all the disease management templates hardwired into the system,” Hornbeck says. To do so, program leaders are leveraging the Honeywell LifeStream Disease Management Question and Assessment model to build out specific disease management templates. With this tool, they plan to build templates to accommodate an array of diseases, including cancer, diabetes, and stroke.
Optimizing the end results. While MultiCare is focusing on a variety of diseases, leaders are looking to zero in on the specific interventions that will bring the greatest returns in terms of improved care quality and reduced costs.
“We are focusing a tremendous amount of attention on medication management because we expect to get significant results. The medical management literature says that about 1 to 3 billion dollars a year in healthcare costs can be attributed to noncompliance, and 10% of all hospitalizations are due to noncompliance. And, unfortunately, patients simply don’t always take their medications,” Gariando points out.
Ensuring a successful launch. Medication management is a key component baked into all of MultiCare’s disease management programs. Even though the Honeywell monitors are simple to use, the patients using them are often elderly and need assistance. Therefore, MultiCare technicians always work directly with patients when setting up equipment in the home. During this process, they also engage the patients in a medication reconciliation exercise.
“The tech helps the patient as they gather all of their medications and then shows them how to use the camera to go over the medications with the nurse,” Gariando says. “The nurse has the hospital records and goes through the medication list in detail. At the same time, the tech helps as the patient holds up each pill bottle and shows it to the nurse, and they go through each medication one by one. About half the time, the patients don’t know what medications they are supposed to be taking, and this helps them get on the right track from the beginning.”