How Effective Can Remote Monitoring be at Reducing Readmissions?
GOVERNMENT HEALTH IT
by: Julie Carr, RN, Nursing & Clinical Services Manager, Healthsense
Research from the Institute for Healthcare Improvement (IHI) suggests that reducing the rates of avoidable readmissions can be accomplished by enhancing care and support during care transitions, improving patient education and self-management support, enabling multidisciplinary team management and implementing patient-centered care planning at the end of life.
IHI has also compiled a compendium of 15 promising interventions to reduce readmissions, a number of which include early identification and response to symptoms that could signal a worsening of the condition as well as avoidance of “adverse and untoward events that lead to readmission.”
Among the approaches included in the identified interventions are proactive monitoring, home visits, telephone consultations, telehealthcare and telemonitoring. Remote monitoring brings together all these elements and, as a result, can have a significant impact on reducing readmission rates.
Today’s remote monitoring technology utilizes sensors to observe and measure key wellness indicators such as sleep quality, daily activities and other physiological information. Unobtrusive sensors placed throughout a patient’s living quarters continuously monitor activities of daily living (ADLs) and pick up on subtle clues to potential issues, alerting caregivers to possible emergent health conditions. By facilitating early intervention, it is possible to avoid an escalation that could require a trip to the emergency room or readmission to the hospital.
But just how effective can remote monitoring and sensors be?
Several pilot programs aim to measure the impact in-home sensors and remote monitoring technology have on improving health outcomes and reducing overall care costs, including through reduction of readmission rates, is the focus of several pilot programs.
One is underway with Humana Cares / Senior Bridge and involves Humana Medicare Advantage members in Florida, North Carolina, South Carolina, Kentucky and West Virginia.
The year-long study will measure the impact of in-home sensors and remote monitoring technology on improving health outcomes and readmissions for Medicare members with chronic health conditions. Specifically, the study seeks to answer the following questions:
- What is the impact on Total Cost of Care of the study population vs. control group?
- Is there a reduction in ER visits vs. the control group?
- Is there a reduction in hospital admissions vs. the control group?
- Is there an improvement in member experience of care?
- Is there improvement in caregiver satisfaction and engagement?
The pilot utilizes a remote monitoring system which reports changes in the member’s normal patterns of movement and activity to Humana care managers through in-home sensors that measure routine daily activities, such as sleeping, eating, physical activity and toileting. The sensors, which are placed discreetly around the home, work with software to establish the routine for each member. Through passive monitoring, this routine becomes the benchmark for establishing when the member may need assistance without asking them to check-in, push a button, or pull a cord.
Another pilot program is being undertaken by Fallon Community Health Plan, an innovative 229,000-member healthcare services organization that is integrating remote monitoring and case management systems to allow for real-time workflow case and disease management. This enables more precise targeting of early care intervention for seniors with chronic diseases and other major health concerns. Fallon is using the integrated platform to advance the quality and delivery of care to its senior members by increasing identification of the early onset of chronic disease episodes for more effective care coordination.
Though it is too early to extrapolate hard data from the pilot programs, anecdotal evidence demonstrates the potential remote monitoring technology holds for reducing readmissions. In one case, sensors in the home of a 51-year-old woman who had been recently hospitalized for CHF and diabetes triggered an alert after picking up on a pattern of restless nights and decreased toileting and eating. A nurse was able to evaluate the data in context with the patient’s diagnostic history and EMR information and determine it was indicative of an exacerbation of a chronic condition. The woman’s case manager was notified, a doctor’s appointment was scheduled and steroid medications prescribed to treat an exacerbation of COPD. Remote monitoring prevented a possible readmission and saved nearly $11,000.
In another case, sensors were placed in the home of a 58-year-old diabetic who had recently been discharged after a below-the-knee amputation. The sensors triggered an alert after identifying that he had been spending up to 20 hours a day in bed, which put him at risk of developing blood clots and skin integrity issues. During the home visit, however, the patient insisted he was fine and no further action was taken. Ten days later, the patient was admitted with a diagnosis of inactivity-related stroke. During that admission he encountered acute renal failure, pneumonia and bowel obstruction and ultimately spent 60 days moving between the hospital and a skilled nursing facility while recovering due to recurrent pneumonia.
In this case, more aggressive follow up likely would have prevented the stroke and other subsequent issues, avoiding an additional $117,600 in healthcare costs.
Looking toward the future
With approximately 20 percent of Medicare patients being readmitted to the hospital within a month of discharge, CMS considers that rate unacceptably high and is looking to incentivize hospitals to decrease it via the Medicare Readmission Reduction Program.
Initially, the CMS program was focused on readmissions related to acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia. Chronic obstructive pulmonary disease (COPD) and elective hip and knee replacements were added in 2014, and coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA) and other vascular procedures are expected to be added in 2015.
CMS is also expected to eventually include all of a hospital’s readmissions.
Healthsense is the fastest growing provider of remote monitoring technology solutions for the senior care continuum. With our full range of health and safety monitoring systems, providers are empowered to proactively deliver the highest quality care possible through critical health information. Caregivers reduce costs, increase independence and enhance senior experiences when armed with the right information at the right time.