Telehealth News

Home Care Providers Find Success Using Telehealth to Connect to Doctors

A telehealth program tested in Washington DC finds value in using telepresenters to coordinate home-based healthcare for frail elderly patients.

Source: ThinkStock

By Eric Wicklund

- A test of a new telehealth program that uses skilled homecare workers as stand-ins for doctors could help to improve in-home care for frail elderly patients.

Developed by national in-home care provider Senior Helpers in a partnership with Capitol Coordinated Medicine and Curavi Health, the telemedicine platform – piloted earlier this year in Washington DC – reduced costs by more than 40 percent and in some cases improved care.

The key to the program’s success, organizers said, was replacing the home visit by the primary care physician with a connected health model of care that puts a telepresenter – most often a certified nursing assistant – in the home, coordinating treatment with a PCP through virtual care.

"Our goal with this study was to showcase how trained in-home care workers can help HBPC (home-based primary care) practices better manage their staff resources to scale the benefits of primary care visits to larger cohorts of patients,” Michael Hughes, vice president of strategic development at Senior Helpers, said in a press release. “There’s been a resurging demand for in-home health consultations as the elderly population continues to climb. Our results illustrate that there is promise in using field-based telepresenters to help manage this demand.” 

During the first half of this year, the program was tested with 33 elderly patients in and around Washington DC who required in-home care. The main take-away from that test, according to executives, was that the telemedicine platform reduced the cost of in-home care by some 44 percent, mostly due to the difference between having a physician travel to the patient’s home and having a telepresenter (at about 25 percent of the cost) stand in for the physician.

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The pilot program also saw cost savings in travel and set-up time, the amount of time spent in a patient’s home and the amount of time spent in the consult.

If viable, the telehealth model of care could greatly reduce the cost of in-home care and make it feasible for a much larger population of seniors, many of whom rely on Medicare and Medicaid or have limited financial resources.

Other benefits to the model, as shown in the pilot program, include:

  • Improved clinical workflows. Instead of traveling to each patient’s home, a physician could stay at home or in his/her office, fitting several virtual visits into a daily or weekly routine. A home care agency could then use the platform for a much larger population of patients and a much smaller supply of clinicians.
  • Patient engagement. Patients reacted positively to the telehealth visit, with some saying they could see a doctor sooner through telehealth than they could in person.
  • Clinical experience. While some physicians lamented that lack of “hands-on” care, the telemedicine platform did help the home care service eliminate seven trips to the emergency room that would have happened had they not had access to telehealth and relied instead on a phone call. The physicians also reported that they had confidence with the telepresenter model in enabling them to deliver care.

The project also saw some setbacks. Some sessions were delayed or inconvenienced by connectivity issues, adding roughly 10 minutes to the session. In addition, reimbursements through Medicare and other payers for in-home telehealth visits are few and far between.

Those involved with the pilot project offered several recommendations, including lobbying for better reimbursement for the use of telemedicine in home-based care, training caregivers to become more active in the connected health program and developing home evaluations prior to the program that evaluate social determinants of health.

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They also said this pilot is a good first step to proving that a telepresenter-based platform can improve home-based care programs, both in cost and outcomes.

"The ability to be seen sooner by an HBPC physician benefits patients, physicians, and the healthcare system alike," Alan Abrams, MD, a consulting physician on the project, said in the press release. "Patients receive more immediate care, physicians can increase the numbers of patients seen, and responsive onsite examinations provide an opportunity for informed decisions in care escalation."

"HBPC is widely recognized as an effective method of providing medical treatment for elderly and homebound patients, yet these care options can be limited where shortages in qualified medical professionals exist," added Amy Schiffman, MD, founder and Medical Director at Capital Coordinated Medicine. "Bringing the doctor and equipment to the patient in the near term gives us opportunities to further diagnose and triage their related conditions, and make more informed choices about escalations in care, such as referrals to the emergency department."

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