By Matt Phillion
Transitions of care went through a massive transformation during the COVID-19 pandemic. Ensuring patients moved safely between environments while remaining in-network became more complex with the needs and challenges of a mid-pandemic world, and avoiding readmissions and patient leakage became paramount. How has the industry risen to these growing changes, and what lies before us as the world strives to find a post-pandemic reality?
Maryann Lauletta, MD, FACHE, is chief medical officer of Chicago-based Dina, which develops an AI-powered at-home care platform that orchestrates care logistics to help get patients home and drive down avoidable days in hospitals. Lauletta says that COVID-19 safety has driven much of the healthcare transformation that we’ve seen—essentially forcing the industry’s hand.
“Patients were afraid to go to the hospital and risk exposure to COVID and become sicker, so a lot of care was moved into the home,” she says. “For those patients who did end up in the hospital, even those who would have traditionally been discharged to something like a SNF, they may have ended up going home instead. This resulted in a higher acuity of patients being cared for in the home.”
Change in healthcare is slow compared to other industries, whether related to payments or reliance on older technology. The pandemic saw adoption of new technologies increase. But beyond that, providers were in many ways forced to see “the person behind the patient,” says Lauletta.
“It is eye-opening for many caregivers to really understand what it’s like for a patient in the home,” she says. “We’ve often planned around the patient [rather than collaborated with them]. We create a care plan and give it to the patient expecting them to comply.”
Barriers for patients as well as providers
With a greater focus on health equity and social determinants of health, the reasons why patients may not cooperate with care become crystal clear. New technology to assist with home monitoring and transitions of care thus becomes even more valuable.
“The monitoring devices [that rose to prevalence] have been wonderful,” says Lauletta. “They help identify a lot of gaps.”
But this added technology is not without its own challenges. Organizations may deal with as many as a dozen vendors whose devices and services don’t communicate well with each other. “This was a new challenge for providers,” says Lauletta. “It really highlighted the fact that you need to partner with a solution that enables you to navigate and easily plug those different types of vendors into one solution for true visibility and transparency.”
Healthcare’s focus is on what’s best for the patient. But in terms of social determinants of health, new technology isn’t always simple for the patients to adopt.
“Maybe the patients [aren’t] as tech savvy to participate,” says Lauletta. “We often don’t talk about connectivity in the home. Do they have Wi-Fi? Are they in a remote area? Are they trying to connect using a device with spotty coverage?”
According to Lauletta, providers and organizations need to make it easy for the patient to participate in their care plan through technology. That means anticipating and providing solutions for their tech-related challenges. An older population might struggle to read a small screen, for example, or their hands may not be adept enough to interface with it.
“One workaround we’ve found is providing them with a tablet with bigger fonts and bigger buttons. We’re asking them questions, so we want them to be able to see the buttons without the risk of error,” says Lauletta.
Patient portals are becoming more and more common, but again, not every patient is technologically adept at navigating them. HIPAA-compliant texting platforms, Lauletta notes, enable these patients to access their care without a complex login system. With the right platform, they don’t even need a smartphone—instead, they can use an older device simply capable of basic texting.
“It’s about pushing information to them so they’re not forced to search for it,” she says. “Everyone is fixated on engagement, satisfaction, safety, and quality of care. You need a platform that is able to demonstrate improved outcomes. It’s not just throwing tech at people.”
While it indeed takes a village to care for a patient, Lauletta says, that village also needs to be technologically connected. “We need to be connected, share information in real time, communicate in real time, so that insights can happen and we’re not always reacting,” she says.
The patient’s care journey at home has traditionally been managed through a series of intermittent visits, but changes in health often occur in the gaps between those visits. “Maybe they’re not feeling well, or not able to eat or drink and feel weaker,” says Lauletta. “We need a way to gather that information between visits from the patient so we can understand what’s happening at home and deploy the right kind of help, whether it’s telemedicine or in person.”
It’s about staying connected with the patient, not just monitoring. “We need to pay attention to the person behind the patient,” says Lauletta. “COVID highlighted the damage of isolation and loneliness, its impact on recovery and illness—especially with older populations who may not already have a community of people online. We need to find ways to keep the person behind the patient connected so we can tend to their medical needs.”
The effects of lack of access
Newer monitoring and engagement technologies can help address loneliness and isolation for patients in the home, but they can also contribute to personal safety.
“It’s not something we hear a lot about, but housing, food, and personal safety—there are ways to address those issues, in ways that don’t take a lot of time,” says Lauletta.
Some platforms enable providers to ask questions of patients, allowing a case to be escalated if a patient gives an outlier or unexpected response. When such a response comes up, the patient can be connected to a care manager who then triages the patient’s needs, akin to traffic control. Does the patient need a phone call, an in-person visit, or something else? The care manager’s decision will be informed by the severity of the response and its associated indicators.
This broaches another topic: expanding the capacity of the workforce. “We’re facing a staffing shortage and burnout,” says Lauletta. “It’s colliding with aging baby boomers and is really reaching a critical point. Triaging is a way to extend our staff and our capabilities without having them feel like they’re overextended. We manage by exception, which is a huge benefit as you can focus your attention on the patients who really need it—the critical few.”
The right technology for the right job
It’s one thing to strive for keeping a better eye on how your patients are doing; it’s another to have the right tools for the job.
When shopping for technology, healthcare organizations need to ask the right questions of their vendors. Can the technology be plugged into the organization’s master platform? Is it interoperable? Buyers need to be savvy and interrogate vendors to understand the limits of their capabilities, Lauletta says.
“Organizations need to investigate carefully before they commit. People tend to put a Band-Aid on a problem and realize the bleeding hasn’t stopped,” she says.
When looking at technology to partner with, Lauletta advises, know where the vendor’s long-term plans are headed. Also, ask about the touchpoints with patients. Does the technology simply facilitate moving a patient from point A to B, or are you maintaining connectivity? Are you involved when moving from B to C as well, or is your organization’s role done by that point? Do you want the patient or caregiver involved in communication with the organization?
“Also, what kind of data are you looking for?” says Lauletta. “There’s tons of data in healthcare, but is it meaningful and actionable? You face a barrage of information, but if you can’t collate it and process it to help influence outcomes, it’s just noise.”
Improving access to the patient at home enables organizations to track or even predict readmissions, secondary complications, and other issues that impact the cost of care.
“It truly takes a connected village. Providers can’t do it solely on their own, and healthcare systems can’t do it on their own either. We need to provide more funding to support caregivers in the home and involve them. They know the patient best,” says Lauletta. “We need to get those kinds of providers linked into a platform so they can share their insights and access more information from the home.”
Collecting information from non-emergency or even non-healthcare-related services can help providers see the bigger picture, informing them whether those services are being delivered satisfactorily and with an eye to patient health.
Lauletta tells a story about a patient who had presented to the ED multiple times with back pain. “A social worker felt there was more to the story and advocated for someone to visit the patient at home,” says Lauletta.
They discovered the patient had no bed, which had been thrown away due to a bedbug infestation. The patient had other pest issues and was sleeping on a kitchen table to stay off the floor. “Hence the source of the back pain,” says Lauletta. “We never would have discovered this if a sympathetic provider hadn’t looked further into the environment.”
Instead of costly medical treatments, providers sent pest control to the home and found the patient a new bed. This non-medical intervention resolved the back pain and stopped the need for visits to the ED.
“We have to find ways to extract information from patients in a non-threatening way,” says Lauletta. “Screening questionnaires might not be the full solution, but they help tell the story. The right platform can bring real structure to this and provide insights for the care team before emergencies come about.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at email@example.com.