These days, trying to coordinate care for post-discharge patients is harder than getting to the truth behind "Deflategate." But a Chicago-area clinic that deals in orthopedic cases is seeing strong savings and clinical outcomes with a web-based platform that connects patients, their caregivers and providers no matter where they're located.
The Illinois Bone and Joint Institute turned to PinpointCare last year to develop a cloud-based platform and dashboard from which its 90+ orthopedic specialists can keep track of their patients for that critical 90-day period after surgery and discharge. The platform allows the clinicians to check in at any time with the patients and their care teams, making sure each patient follows the individual care plan established prior to surgery. If a care provider reports that a patient is "off plan," a clinician can quickly check in to find out what's wrong.
In one year's time, during which IBJI specialists cared for 2,458 patients, the organization reported a six-day reduction in average length of stay, an 18 percent average reduction in costs per case (per DRG), a 14 percent reduction in hospital readmissions and a 17 percent increase in patients moving directly to home health instead of more costly care. (IBJI officials requested that the average dollar amount saved per patient not be disclosed.)
Those are numbers that even Tom Brady and the NFL could agree are good.
"It's just a whole different ballgame," Matt Fletcher, manager of daily operations for IBJI's rehabilitation services program, told mHealth News. "We're able to (work with) a platform that everyone can use easily."
[See also: Care coordination begins with communication]
Andre Blom, IBJI's director of rehabilitation services, said the platform was a vital component when the organization opted last year to participate in the Centers for Medicare and Medicaid Services' Model 3 Bundled Payments for Care Improvement (BPCI) program for major joint replacement, which combines reimbursement into a single payment for hospital, doctor and post-acute care providers. IBJI needed a means of coordinating care for patients moving through some 16 hospitals in seven different health systems (and countless EMR platforms) and on to any number of post-acute care locations. The care providers needed one location to check into and provide status updates.
"Electronic interfaces between fragmented healthcare providers basically don't exist," he said. "We needed to create a cloud-based platform – basically, a chat room for each episode of care."
Joel Span, PinpointCare's chief executive officer, said the company's "industrial strength platform" needs to accommodate providers of all sizes and capabilities, giving them a place to coordinate individual care plans, whether it’s for someone recovering from hip replacement surgery or going through cancer treatment. "It basically replaces the paper, spreadsheet and call center as a coordinated care solution," he said.
The platform – version 2.0 was released in early April – has to be flexible as well. IBJI developed its own algorithm for ranking each of its patients by risk, enabling physicians to quickly sort through the 1,000 patients, on average, in the system each day to identify those most in need of follow-up care.
According to Blom, the platform also enables IBJI to rate the effectiveness of its downstream care providers, from home health agencies to rehabilitation facilities, to help determine who they'd continue to work with.
Fletcher and Splan said mHealth capabilities will play an important role in the platform's evolution. Splan noted that PinpointCare now has the capability of linking with 125 Bluetooth-enabled devices, such as weight scales and blood pressure cuffs, to pull in more data. Fletcher, meanwhile, would like to see the system expanded to let not only the caregivers, but the patients communicate with providers.
"Let them tell us a lot more about what's happening to them," he said. "The idea of checking in doesn't have to stay with the caregiver in the future."
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