Using Telehealth to Improve Continuity of Care
As our global population grows older with a higher incidence of chronic conditions, we have an imperative to truly improve quality of care both within and beyond the walls of the hospital while reducing costs. Continuity of care plays a key role in patient management by ensuring that patients experience a smooth transition from the hospital back to the home, and new models of care that utilize telehealth technologies will be important to support this process and reduce rehospitalizations.
In the context of post-discharge care, telehealth technologies can enable healthcare providers to bridge care between the hospital and home, encouraging earlier interventions and thus reducing the need for rehospitalizations (Wakefield, n.d.). This advanced level of connectivity is necessary to overcome the traditional “black hole” of care that occurs in the period between initial hospital discharge and a patient’s first follow-up appointment. During this time, physician transitions, medication adjustments, and other changes to the care routine that were made in the hospital often fall by the wayside and are not adequately transitioned when the patient goes back to his or her primary provider.
However, the advanced level of care offered by telehealth technology ensures that the healthcare professional can intervene early when a change in health is noted, thereby improving the quality of care, reducing the chance for readmission, and ensuring cost-efficiency for both the hospital and the patient. By extending their reach beyond the traditional confines of the hospital walls, clinicians can offer a connection of care between the hospital and the home that results in better overall outcomes and lower costs (Schlachta-Fairchild et al., 2008). When using the newest generation of remote health management (RHM) systems, clinicians can communicate with patients on a regular basis while having access to timely actionable and accurate data from the patients in their homes.
As the role of RHM expands in post-discharge care and other healthcare services, there is great potential for future growth of this market. A recent analysis from Frost & Sullivan (2008) expects the telehealth market to reach $428.6 million in 2015, more than quadrupling from the $98.2 million it generated in 2008. Further, according to a recent survey of American government and health leaders, 90% of U.S. health leaders and 84% of global health leaders believe that the merging of information technology and healthcare will be critical for changing healthcare delivery (PR Newswire, 2010).
New Models of Care
New models of care that incorporate RHM offer numerous benefits to providers, payors, and patients alike. One key advantage of RHM is the notable improvement to patient care and safety. According to the Joint Commission 2010 National Patient Safety Goals for both hospital and home care, correct identification of patients, approved use of medications, and careful review of patient safety risks are all important ways to improve overall patient safety in hospitals and homes (Joint Commission, 2010). To meet these goals, hospitals may implement telehealth systems to help manage high-risk patients and ensure that the correct medications are being taken at the right times. As a result of the recently-passed Patient Protection and Affordable Care Act, starting in October 2012, Medicare will penalize hospitals whose readmission rates within a 30-day period are higher than expected (Kentucky Coalition, 2010); therefore, hospitals will have even more financial incentive to help transition patients home and keep them there.
Adoption of RHM also decreases costs for both hospitals and patients across a variety of chronic disease categories, especially through the reduction of rehospitalizations (Seto, 2008). Today’s healthcare landscape is seeing a renewed interest in the economic costs of rehospitalizations: according to a 2010 report by the Center for Technology and Aging, 17.6% of all Medicare hospital admissions are readmissions, a majority of which are avoidable. In total, readmissions cost $15 billion annually; however, if successfully prevented, Medicare could save $12 billion of the $15 billion in readmission costs, equaling 80% of this expenditure and decreasing costs for hospitals, payors, and patients.
Telehealth has the potential to dramatically reduce this number, minimizing unnecessary costs, and improving quality of care. According to a trial sponsored by the University of Illinois at Chicago (UIC) Institutional Review Board and the West Side Veterans Administration (WSVA) Research and Development Committee, home healthcare provided by nurse telemanagement reduced the rate of readmissions by more than 25%, resulting in savings of at least $136,000 when compared to patients who had nurse home visits without the adjunct of telehealth. The projected national cost of chronic heart failure hospital visits could be reduced from $8 billion to $4.2 billion annually, based on hospital days per patient per year with and without intervention and the cost of intervention by telehealth (Seto, 2008).
With the implementation of RHM comes the potential to accommodate a decreasing labor force as well. By limiting the time spent traveling to remote areas and the length of basic check-up appointments, telehealth technology allows for improved productivity of hospital staff, especially in the post-discharge care setting (Schlachta-Fairchild, L., 2008). Telehealth-enabled care models can help clinicians—whether hospital-based, home-based, or remotely-based—better manage the risk associated with chronic care patients, enabling them to move beyond simple data collection toward more interactive interventions. Driving educational information to the patient at the time of an identified teachable moment, providing regular reminders, and supporting virtual visits with video conferencing technology are a few ways that the new generation of telehealth technologies differs from simple vital sign collection modalities. Using these technologies, healthcare providers have greater availability and the opportunity to reach more patients and spend additional time addressing the needs of each individual.
Finally, RHM ensures that the patient has an increased involvement in the management of personal health. In a recent survey by PriceWaterhouseCoopers (2010), 97% of government and health leaders in 20 countries agreed that patients should have some responsibility for managing their health and chronic conditions, such as obesity, diabetes, and heart disease. This accountability is especially important in post-discharge care: when released from the hospital, patients and their caregivers must be engaged in managing medications and staying true to care plans. Contrary to the traditional belief that fragile elders are unable or unwilling to use technology, older people are very engaged in telehealth systems, especially those that allow them to stay more independent while aging in place in their homes.
According to a recent study, elderly patients using a video-enabled RHM device reported high satisfaction and improved perception about the quality of care that they received (Little & Meyers, 2010). Another study found that telehealth patients report a higher sense of patient satisfaction; users feel more connected to their care team, which reduces the stress of managing chronic illness and enhances the sense of control of their own health (Noel et al., 2004).
Further supporting this shift in focus, the Patient Protection and Affordable Care Act has created a groundswell of interest in new and more affordable models of care. The next phase of health reform will “reflect a concerted effort to keep people well, out of the hospital and more actively engaged in managing their own health” (Pricewaterhouse Coopers, 2010)—all areas in which RHM has a track record of improving outcomes. The current shift from quantity to quality in payment of care will also help support the growth of the telehealth industry and solutions marketplace by enabling clinicians to manage by exception and offer more personalized care to their patients.
Accountable Care Organizations (ACOs) are another hot button-issue as a result of the Patient Protection and Affordable Care Act. Built upon the goal of rewarding high quality care and encouraging providers to work together to deliver superior results, ACOs will also need the support of telehealth to both implement and measure improved care. RHM encourages this unified structure of care by connecting the full team of healthcare providers to the patient and ensuring a high level of attention is paid to the patient’s health post-discharge. According to the law, ACOs require a coordinated care team to “define processes to promote evidence-based medicine, report on quality and cost measures, and coordinate care.” Using a RHM model is a promising solution as many telehealth systems have the capabilities to support these initiatives to help meet new requirements and track progress.
The question for many continues to be reimbursement, and a variety of organizations and companies are advocating for a system where clinicians are compensated for “virtual visits” by the Centers for Medicare and Medicaid Services and other payers (American Telemedicine Association). However, healthcare organizations do not need to wait for reimbursement, as the financial incentives for implementing telehealth are already clear. Hospitals in particular will see lower financial penalizations if they can successfully extend their care into the homes and prevent readmissions, and payers will reap the benefits of a healthier patient population with chronic disease under control.
As the number of patients with multiple chronic conditions continues to rise, so will the number of inappropriate and costly hospitalizations (Robert Wood Johnson Foundation, 2010), and our hospital-centric system simply cannot afford this influx of patients and acute incidents. With this growing market and the undeniable demographic need, RHM solutions are necessary to ensure that clinicians remain connected to their patients with up-to-date medical recommendations and proactive engagement. Our spiraling costs and commitment to patient care are forcing us to start now to change the way that patients and clinicians interact tomorrow. Telehealth solutions such as RHM have already been proven as cost-effective systems that improve quality of life for patients and clinicians alike—now is the time to start implementing them throughout post-discharge care and beyond.
Julie Cherry is an advanced practice nurse with a specialty in gerontology. Her area of expertise is in chronic illness management. She has worked diligently throughout her career to influence the adoption of care models designed specifically to meet the needs of the chronically ill. Cherry is currently the director of professional services for the Digital Health Group at Intel Corporation. Previously, she helped pioneer the first home telehealth solution for remote patient monitoring and more recently was instrumental in the design and development of the Intel Health Guide system. She has published extensively, focusing on the care of the chronically ill, and has written several publications and position papers on the impact of technology for remote patient monitoring and chronic illness management. Cherry holds both a BS and an MS in nursing from San Jose State University.