Telehealth Saves Money, Improves Patient Engagement and Outcomes
First Health of the Carolinas, a four-hospital delivery system serving the mid-section of North Carolina, was an early adopter of home-based telehealth patient monitoring services in 2005.
The organization got multiple federal and private grants over the years, expanding to other care settings beyond the home. But other settings used different remote monitoring systems and the time came to standardize the technology so programs would not conflict with each other, says Patty Upham, director of the FirstHealth Care Transitions unit.
First Health in October 2014 adopted a remote monitoring platform from Health Recovery Solutions, starting with a 25-unit pilot program. Today, 160 units are being used as needed to monitor chronically ill patients, and then rotated to other homes, and more than 800 patients have been served. When setting up the system, the organization experienced minor video and firewall issues but they were quickly worked through, Upham says. “We’ve been doing this since 2005 so we’re pretty experienced.”
The HRS platform was a considerable step above the technology that had been used. Patients get a disease-specific 4G tablet computer customized to support their medications, diet requirements and care plans. The tablets integrate with wireless Bluetooth devices including pulse oximeters, blood pressure monitors, thermometers, activity trackers and scales. The system uses no telephone lines and has a smaller footprint in the house, Upham says.
Upham calls the patient-clinician video consultation capability a “game changer” because clinicians get a fuller understanding of how a patient is doing by checking wounds and having real-time conversations with patients and family members. The platform also includes a large library of educational videos for patients and caregivers to watch in the home.
The remote monitoring is being used to stay in touch with patients suffering from heart failure, COPD, and diabetes, and those recovering from cardiac surgery. Hospitalization rates for participating heart failure patients on the local Medicaid plan are down 40 percent, representing 80 avoided hospitalizations and savings to Medicaid of $560,000, Upham says. First Health’s home health 30-day readmission rate during 2015 is 7.9 percent which is 19 percent lower than its rate last year.
The technology also is saving First Health money, Upham says, by reducing the number of in-person home visits by nurses. Home visits per 60 days in 2015 stand at 4.8 visits, 40 percent lower than the national average. “When you can use technology to increase the number of checkups but cut visits, that’s a big savings,” she adds.
Whereas the older remote technology was more of an exercise in patients reporting and clinicians reviewing health status data, the video consultation and education technology has fostered enhanced patient and caregiver engagement, Upham says. “Telehealth is not just monitoring vital signs; it is a tool to improve their care. They can see the impact of their behavior. If they eat a bag of chips and gain weight, they know why.”
Now, First Health is expanding its telehealth presence more, getting into neurology, cardiology, infectious diseases, and using telemedicine—which are billable sessions—in rural areas.