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Telehealth: A Vital Tool in the Home Healthcare Space

Health systems are using digital health tools and telehealth platforms to better care for patients after they leave the hospital, as well as those most at risk of returning. The platform adds critical value to a struggling home healthcare service line.

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- A North Carolina-based health system is one of several using telehealth to improve its home healthcare services – a critical move in light of expected cuts in home health reimbursements from Medicare.

FirstHealth of the Carolinas, a five-hospital health system based in Pinehurst, N.C., reportedly saved almost $2 million by using telehealth to care for high-risk patients who don’t qualify for Medicare-funded home health services. The health system used a grant from the Duke Endowment to create a care management program for selected patients in its Medicare Advantage plan.

Under the pilot program, launched in late 2015, the patients were visited by a home health nurse within 48 hours of discharge, then given an mHealth enabled tablet that allows them to track their own vital signs and send that data to FirstHealth. The digital health platform also enabled patients to access personalized health and wellness information and collaborate with FirstHealth on an ongoing care plan.

According to health system officials, while the telehealth platform cost roughly $700 per patient for a 60-day care plan, rehospitalizations would have cost the health system more than $8,000 for each patient – none of which is covered by Medicare, and some of which could have cost the health system even more in penalties.

“We looked at - for all the patients we managed - the data six months prior to the complex care intervention and six months after,” Patty Upham, the health system’s director of care transitions, told Home Health Care News. “In terms of cost to the payer, it was almost $2 million [in savings] to the payer.”

FirstHealth is one of a growing number of health systems using telehealth and mHealth platforms to continue and reinforce care management after hospital discharge, especially for patients at a high risk of returning to the hospital. The effort is, in part, driven by the Centers for Medicare & Medicaid Services (CMS), whose Medicare reform mandates under the Affordable Care Act include reduced reimbursements for home healthcare.

In 2015, Medicare paid $17.8 billion to almost 11,400 home health agencies that served approximately 3.4 million beneficiaries. In efforts to curb home health spending, CMS plans to enact a combination of adjustments to home health payments that account for number of visits in an episode, various services in an episode, average cost of care, and other patient characteristics.

The proposed payment changes, due to take effect this year, aim to promote efficiency, flexibility, payment accuracy, and advance care quality in the home health industry as well as the greater Medicare provider community, CMS reported in a fact sheet.

With that on the horizon, health systems are looking to remote monitoring platforms to upgrade their home healthcare service line.

Just last month, Michigan-based Trinity Health joined forces with Vivify Health to deploy the Pathways + Home mHealth platform through its Trinity Health at Home program, which extends to several of the 22 states covered by the health system.

Erin Denholm, CEO of Trinity Health Home Services, says the telehealth service is designed to give patients “an in-the-moment virtual connection” with healthcare providers who can head off potential health concerns before they lead to costly ER visits or hospitalizations.

"As guests in our patients' homes, we can make a greater impact on health and well-being than we can anywhere else because it is here, in this sacred place, that people are empowered and much more engaged in their care experience," she said.. "These technologies will enable us to proactively monitor our home care patients and provide in-the moment interventions that can make the difference between their staying at home or being transferred to the hospital.”

Meanwhile, Arizona-based Banner Health is seeing reductions in spending and hospitalizations through its Intensive Ambulatory Care (IAC) program, a Philips-backed telehealth platform that treats the 28-hospital network’s most complex patients in their own homes.

“The idea is that we can identify patients who have higher needs, such as those who have chronic conditions, those who have multiple hospital admissions, or who come into the emergency rooms multiple times – patients who require more of a proactive approach for managing their care,” Hargobind Khurana, MD, Banner Health’s senior medical director of health management, said.  “We use technology for that, but more important is our care team which is involved in taking charge of these patients.”

“We try to engage patients while they’re in the home with telehealth and remote monitoring,” he said. “We use a tablet which has Philips software on it, and through that tablet, people can connect through audio and video, or have information sent to them. They can read some educational materials; they can answer questions about how they feel on a daily basis. The data is sent back to a central location where the care team can look at it.”

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