Home Health Agency Turns to Telemonitoring to Reduce Readmission Rates and Decrease Costs
Ascension at Home Wisconsin, a network of agencies that support patients’ transition from acute care facilities to their homes, is determined to provide the best care possible. The market for telemonitoring and home health services is growing quickly as hospitals seek to improve the patient experience and decrease readmission rates. However, meeting this growing demand means agencies like Ascension at Home must serve more patients despite an industry-wide talent shortage, beef up educational resources and proactively intervene before patients are readmitted to the hospital. In the past, patients either overwhelmed staff with questions and requests for unscheduled visits, or they didn’t communicate enough and let their health deteriorate between weekly nurse visits. To improve patient care, Ascension at Home needed a robust remote care solution.
Ascension at Home chose a solution that uses Vivify Health’s remote care management platform, and includes Samsung Galaxy tablets and clinical monitoring services from Evolution Health. Key patient health data is captured via the Samsung devices, and then transmitted to the Medical Command Center at Evolution Health. When problems arise, Evolution contacts the patient and loops in the Ascension team. This enables Ascension at Home to provide better care to more patients, without taxing the field staff, and to ensure troubling symptoms are quickly addressed to improve patient outcomes.
Readmission rate for Ascension at Home telemonitoring patients is 8 percent, compared to 24 percent nationally.
Ascension at Home has used its telemonitoring program to improve patient care, education and engagement — and thus deliver better health outcomes for patients and referring healthcare organizations. Readmission rates for patients are now at 8 percent, about a third of the national average. Ascension at Home has grown the business by 300 customers in one year, created new lines of business and earned a reputation as a top home health provider.
“With telemonitoring, we can spot the negative trend in a couple days, rather than waiting until the next nurse visit.”
Nathan Agen, Ascension at Home’s director of clinical services
Ascension at Home Wisconsin is a network of four home health agencies that support patients as they transition from hospitals back to their homes. It’s part of the larger Ascension at Home network and a direct subsidiary of Ascension — the largest nonprofit health system in the U.S.
A four-star-rated agency, Ascension at Home Wisconsin serves approximately 1,150 patients each year, from all over the state. Along with providing in-home care services for patients discharged from Ascension hospitals, the organization also offers a remote care program for insurance payers.
To learn more, visit Ascension.org.
The Customer Need
Connecting Roving Workers and Dispersed Patients
Hospitals have long relied on home health agencies to get recently discharged patients back on their feet. But as new healthcare legislation puts pressure on hospitals to improve the patient experience and decrease readmission rates, care providers are increasingly tapping home health agencies to provide the post-acute care and disease management education that patients need to stay healthy at home.
Spending for home health agencies increased 6.3 percent to $88.8 billion in 2015, according to the Centers for Medicare and Medicaid Services, and home health now accounts for roughly 3 percent of all healthcare spending.
This is good news for agencies like Ascension at Home Wisconsin. But meeting this growing demand also means seeing more patients despite an industry-wide talent shortage, beefing up educational resources and proactively intervening before patients end up back in the hospital. That’s a tall order, considering Ascension at Home serves patients suffering from congestive heart failure, COPD, cancer, pneumonia and other serious health conditions that can degenerate quickly.
Such sick patients, especially those with new diagnoses, have copious questions and complex needs. In the past, many patients overwhelmed Ascension at Home staff with questions, concerns and requests for unscheduled visits. Meanwhile, other patients didn’t communicate enough, and if their conditions deteriorated between weekly visits, home health workers might not catch the problem before patients ended up in the emergency room.
Ascension at Home had used another remote monitoring solution for high-risk patients, but the previous vendor didn’t offer the advanced functionality needed to optimize communications or integrate telehealth data into clinician workflows. “It was like telemonitoring and home health were two separate programs,” says Nathan Agen, Ascension at Home’s director of clinical services.
Agen knew that to improve patient care, boost clinician productivity and grow the business, Ascension at Home would need a more robust telemedicine solution, such as Vivify Health.
Providing Collaborative Care
Ascension at Home chose a solution utilizing Vivify Health’s remote care management platform, and including a kit with Samsung Galaxy tablets and integrated medical devices, and clinical monitoring services from Evolution Health.
High-risk patients who qualify for the new solution — about 10 percent of patients — receive a Vivify kit, which includes a Galaxy tablet loaded with Vivify software, Samsung Knox security and Bluetooth biometric devices such as a weight scale, blood pressure cuff and oximeter. Patients use these devices each day to capture and transmit key health data through Vivify’s Care Team portal to the Medical Command Center (MCC) at Evolution Health. Patients also complete daily questionnaires about how they’re feeling.
When the Vivify data shows signs of health decline and generates the appropriate alert, MCC contacts the patient and the Ascension team. “It’s a collaborative effort,” explains Agen. “MCC nurses place video calls with patients using the tablets and do some minimal triaging. That face-to-face connection helps them assess what’s going on. Then MCC notifies our team so we can follow up.”
This enables Ascension at Home to provide better care to more patients, without taxing the field staff. “Ascension has around 120 telemonitoring patients at any given time, and they’re spread across the state,” says Dr. Jeffrey Beeson, emergency medicine physician and senior vice president of Evolution Health. “They can’t possibly have nurses in all those locations around the clock. But MCC can do virtual patient visits to answer questions and address concerns. And using the data, we can help Ascension identify and prevent patient decompensation.”
For example, patients with congestive heart failure who gain two or more pounds per day might be retaining fluid. “With telemonitoring, we can spot the negative trend in a couple days, rather than waiting until the next nurse visit, when the patient has gained 15 pounds and can’t breathe.”
Ascension at Home has also enhanced its ongoing disease management education by matching up weekly nurse teaching modules with relevant content from Vivify’s video library. “Home health is that short-term gap to get patients stabilized in their own homes,” says Agen. “A big part of our job is education and encouraging the patient to be engaged in their disease process.”
Ascension at Home has grown its patient population by about 300 people over the past year and has opened up new lines of business.
Samsung Galaxy Tablets
Multi-purpose device designed to improve productivity and workflow efficiencies.
Premium device that provides increased performance for collaboration and creativity.
Boosting Productivity and the Bottom Line
After two years of using the Vivify/Samsung solution and a year and a half partnering with Evolution Health, Ascension at Home has verified several key benefits:
- Increased productivity: With the solution now integrated into field nurses’ workflows, they can deliver top-notch care more efficiently. For example, in November 2016, Ascension at Home’s 113 high-risk telemonitoring patients generated 7,200 biometric and subjective alerts. Evolution managed 81% of these alerts and narrowed down the number of patients requiring escalation to 19%.
- Decreased operational costs:Thanks to the videoconferencing capabilities on the Samsung tablets, home health nurses don’t have to respond to alerts in person. “Field nurses often get calls from MCC about patients they’re not scheduled to see that day. In the past, they would have to reroute and go assess the patient. Now they can do a video call to evaluate whether a visit is actually needed.” Ascension at Home has decreased the “average visit per episode” for telemonitoring patients from 15 to 10.
- Reduced readmissions: In 2015, national all-cause readmission rates were at 24 percent, according to Strategic Healthcare Program (SHP). Ascension at Home had an 8 percent readmission rate for telehealth patients. “The hospitals had less penalty dollars at stake, insurers avoided expensive hospital bills and patients got to stay at home,” says Agen.
- Scalability: Able to serve more patients with fewer dedicated resources, Ascension at Home has grown its patient population by about 300 people over the past year and has opened up new lines of business. The organization now provides remote monitoring services for several insurance companies, and has proposed a remote wellness program to the Ascension Healthcare System for high-risk patients who don’t qualify for home health.
- Better patient engagement: Ascension at Home has a 70- to 80-percent kit utilization rate and high patient satisfaction in the telehealth program. Dr. Beeson attributes this to the comfort patients feel when someone is watching out for them. “They like knowing that if they have a question or if something is wrong, they can hit a button and talk to a nurse. They like seeing the nurses’ faces. That sense of comfort increases their activation measures.”
- Reliable technology: When building kits for customers, Vivify works exclusively with Samsung tablets. “For customers who choose to rent kits rather than buy their own, Vivify extends the warranty on the Samsung tablets to three years, because we’re that confident in their durability,” says Bill Paschall, vice president of business development at Vivify. “The tablets hold up during the recycling process between patients. We don’t use protective cases, yet we’ve had extremely low breakage rates. The screen resolution is great for videoconferencing, which really makes patients feel connected to their caregivers. And we’re now implementing Samsung Knox to boost device security.”
Between smart healthcare solutions, Vivify’s innovative software platform and Evolution’s clinical support, Ascension at Home has been able to grow its business, improve patient care, achieve better health outcomes for patients and referring clients, and earn a reputation as a top home health and telehealth provider.