Telemonitoring technology paired with interactive voice response succeeded in cutting 30-day post-discharge readmissions by 44 percent for patients hospitalized for heart failure in a wide deployment at a large, integrated health system.
Geisinger Health Plan, the insurance arm of Geisinger Health System, Danville, Pa., also found an 85 percent patient compliance rate with its monitoring program, according to data released by the organization. Among Geisinger case managers, 96 percent said that telehealth makes them more efficient in monitoring patients with heart failure and 85 percent indicated that the combination of telehealth technology and vigilance by healthcare providers helps keep their patients out of the hospital.
"These patients are among the most challenging to manage," Janet Tomcavage, vice president of health services for Geisinger Health Plan says in a statement. "The acuity of their condition requires constant surveillance to detect emerging exacerbations. If left unaddressed, this inevitably leads to increased emergency department utilization and costly hospital readmissions," adds Tomcavage, a registered nurse.
While payers have always had motivation to reduce costly inpatient admissions, the onus has been shifting to providers as well. Starting in October, Medicare will no longer reimburse hospitals for certain preventable readmissions within 30 days of discharge, though the federal Centers for Medicare and Medicaid Services will make payment decisions based on readmissions data it has been collecting from hospitals since October 2011.
The advantage of accountable care organizations and other forms of payment bundling as part of national healthcare reform also is giving providers and tightly integrated systems such as Geisinger financial incentives to reduce unnecessary hospital admissions.
The two-year study at Geisinger paired AMC Health telemonitoring software and services with IVR technology. Participants submitted weight measurements from Bluetooth-enabled scales to case managers, then IVR prompts allowed patients to provide additional detail about their symptoms. The combination of technology and case management cut readmissions by nearly half, in comparison with a control group that only had case management, Geisinger reports.
"That first week or two post-discharge is when you really see readmissions happening," Joann Sciandra, director of case management and strategic planning at Geisinger Health Plan tells Healthcare Finance News. "Having the ability to have a couple more touches or encounters with that patient makes this a very valuable tool. From a case management standpoint, it gives the case manager a little bit more time they may need with more complex patients."
Geisinger Health Plan has about 1,000 patients with heart failure on remote monitoring at any given time, and the payer has expanded its telehealth program to those with hypertension and diabetes since first adopting AMC Health technology for complex care management of cardiac patients in 2008.
case managers track patient clinical progress in real-time, without the delays inherent in programs dependent on patient-initiated contact and self reported information. These technologies increase the opportunities for proactive intervention using biometric and symptom information captured in the patient's home. Most important, armed with objective, reliable patient data and 24/7 Internet enabled visibility to the patient record, the case managers view telehealth as a beneficial enhancement to proven case management best practices, and not an added task to an already demanding process.
