Page 7 Case Studies in Telehealth Adoption Scaling Telehealth Program sLessons from Early Adopters

ScALing TeLeheALTh ProgrAmS: LeSSonS From eArLy AdoPTerS 7

Centura Health at Home: Making Home and case loads of nursing staff, and cost savings of
Telehealth the Standard of Care between $1,000 and $1,500 of total costs per patient.
Centura Health at Home (CHAH) is a division of Centura’s experience indicates that restructuring
Centura Health, the largest integrated health care home service coordination and educating clinical call
system in Colorado. CHAH expands the reach and center nurses on chronic disease management are key
impact of telehealth-enabled home health care services elements to the program’s success. The scaling of the
through the integration of two independent, success- program led to a decision to switch telehealth vendors
ful home health services: a clinical call center and to more cost-effectively support the program while
remote monitoring telehealth program. The integrated meeting the broader patient population’s needs. The
program combines RPM efforts that started in 2004 program’s success has led to telehealth becoming the
with a clinical call center–based program that has standard of care at CHAH. The results of the program
been in existence for more than 20 years. The merged supported the sustainability of the intervention and
clinical call center–telehealth program extends the led to plans to expand the telehealth program within
reach of telehealth to include all patients in the target CHAH and to senior living communities with the goal
populations who are preparing for hospital discharge. of reaching 1,000 patients by 2012 and 2,000 patients
The merged program also broadens the clinical call by 2013.
center’s capabilities to include telehealth assistance Centura’s experience indicates that the use
and coordination of care for patients by using remote of RPM combined with a 24/7 telehealth clinical call
patient monitoring on a 24/7 basis, while adapting the center benefited older adults’ health while making
clinical call center’s traditional business marketing more effective use of existing health care resources and
model to a clinical business model to support a more extending the reach of nursing staff. Key elements of
robust telehealth program. The new program expands the program’s success included: restructuring discharge
service coverage to patients not previously meeting the planning to introduce patients to the telehealth program
Medicare homebound benefit by offering a telephonic while still in the hospital, having clinicians introduce
telehealth-only treatment group. the program to patients to increase the likelihood of
A one-year pilot of the integrated program in their enrollment, educating call center nurses on the
2010–2011 demonstrated successful outcomes in terms clinical management of chronic diseases, and providing
of reducing 30-day hospital readmissions and home real-time education to patients to improve their self-
nursing visits, while improving quality of life and management capabilities. Additional success factors
patient self-management and education. The specific for bringing the program to scale include:
goal of the pilot was to decrease the 30-day readmis-
sion rates across the Centura system by an additional • Engaging staff through evidence-based outreach
2 percent for patients with congestive heart failure, and promotion. Programs need to communicate to
chronic obstructive pulmonary disease, and/or diabetes, home care nurses and clinicians the value of tele-
as well as measurably increase participants’ quality health for patients, nurses, and physicians to reduce
of life. Over the course of the year-long pilot, 30-day the likelihood of resistance and ensure high levels
readmission rates across the three targeted conditions of staff engagement. Forums may include an open
were reduced by 62 percent. Emergency department house for clinicians to interact with the technology
use decreased from 283 visits in the prior year to 21 and ask questions. Key discussion points focus on
visits after one year, and the frequency of home visits outcomes, patient-to-staff ratios, and rehospitaliza-
was reduced to an average of three visits over a 60-day tion rates, as well as patient satisfaction data.
period from an average of two or three visits per week • Restructuring discharge planning and home
prior to the implementation of the intervention (Exhibit 3). service coordination. The discharge planning
This led to improved efficiency, extending the capacity process and home service coordination were