TELEHEALTH AND REMOTE PATIENT MONITORING

(RPM):

Provider Case Studies 2013

2519 Connecticut Ave., NW

Washington, DC 20008-1520

Phone 202-508-9438

Fax 202-783-2255

Website: LeadingAge.org/CAST

LeadingAge Center for Aging Services Technologies:

The LeadingAge Center for Aging Services Technologies (CAST) is focused on accelerating the development,

evaluation and adoption of emerging technologies that will transform the aging experience. As an international

coalition of more than 400 technology companies, aging-services organizations, businesses, research universities

and government representatives, CAST works under the auspices of LeadingAge, an association of 6,000 not-for-

profit organizations dedicated to expanding the world of possibilities for aging.

For more information, please visit LeadingAge.org/CAST

Introduction

Te LeadingAge Center for Aging Services Tech-

■ Staff Efficiencies

nologies (CAST) is pleased to provide the follow-

■ Quality of Life/Satisfaction with Care

ing six case studies on the impacts and benefits of

■ Hospitalization and Hospital Readmissions

telehealth and remote patient monitoring (RPM).

We hope they will demonstrate for providers the

■ Cost of Care and Return on investment

benefits of using telehealth and RPM products.

(ROI) to:

Providers;

Te case studies are designed to help long-term and

post-acute care (LTPAC) providers understand the

Payers; or

benefits that telehealth and RPM products can offer

Consumers.

to their care settings.

•

Organization Name

Tis set of case studies is a companion to the 2013

•

Organization Type (Housing with Services,

CAST whitepaper entitled Telehealth and Remote

Home Health/Home Care, Hospice, Adult Day

Patient Monitoring for Long-Term and Post-Acute

Care/Senior Centers, Assisted Living Facilities,

Care. Te whitepaper includes a Telehealth and

Acute Rehab Facilities, Long-term Acute Care

RPM Selection Matrix that compares 23 telehealth

Hospitals, Long-term Care Rehab Facilities,

and RPM products from 16 vendors with respect to

Skilled Nursing Facilities, Intermediate Care

embodiments, different LTPAC settings, functional-

Facilities, Intellectual Disabilities/Mental

ities and features. Telehealth and RPM vendors that

Retardation/Developmental Disabilities

chose to participate in the self-review were offered

(ID/MR/DD) Facilities, Continuing Care

an opportunity to nominate a provider to write a

Retirement Communities (CCRC), Program of

case study on its use of the vendor’s telehealth and

All-Inclusive Care for the Elderly (PACE))

RPM product.

•

Other Partners (Payer/Health Plan, Physicians’

1.1

Case Study Guidelines

Offices, Emergency Department, Hospital,

Accountable Care Organizations (ACO),

CAST provided guidance as well as a template for

Pharmacies, Others)

the case studies to help case study contributors. Te

template included the following required sections:

•

Organization Description

• Case Study Category (case studies may cover

•

Project Description

more than one category)

•

Telehealth and RPM System Type (Store-

Impacts and Benefits of Telehealth and

and-Forward: Interactive Voice Response

Remote Patient Monitoring (RPM) in:

System (IVR), Store-and-Forward: Biometric

■ Health Outcomes (Blood Pressure, Blood

RPM, Other Store-and-Forward Systems:

Glucose, etc.)

Other than IVR & Biometrics (e.g. Imaging,

Telehealth and Remote Patient Monitoring (RPM): Provider Case Studies 2013

Consultation Notes, etc.), Real-Time Biometric

RPM, Real-Time Interactive Two-Way Video

Conferencing with Clinician)

■

Telehealth and RPM System Embodiment

(Single-User/Patient Home Base Unit, Single-

User/Patient Mobile/Wearable Unit, Staff-

Operated Multi-User Mobile Unit, Multi-User

Unit/Kiosk)

•

Business Model (Medicare Reimbursement,

Medicaid Waiver Coverage, Private Health

Insurance Coverage, Private Pay, Standard

of Care, ACA-Related Opportunity (ACO,

Hospital Readmission Reduction Program,

Bundling of Payment, etc.))

•

Implementation Approach

•

Outcomes (Health Outcomes (Blood Pressure,

Blood Glucose, etc.), Staff Efficiencies, Quality

of Life/Satisfaction with Care, Hospitalization

and Hospital Readmissions, Cost of Care and

Return on investment (ROI) to Providers,

Payers or the Consumer, etc.)

•

Challenges and Pitfalls to Avoid

•

Lessons Learned

•

Advice to Share with Others

CAST received six completed case studies from

nominated providers. We believe that LeadingAge

members and other LTPAC providers will benefit

from these case studies and learn from other pro-

viders who have already selected, implemented, and

used telehealth and RPM products.

LeadingAge Center for Aging Services Technologies (CAST)

Lessons Learned and Advice Drawn from the Case Studies

Readers can learn many lessons from the follow-

■ Ensure all patients who qualify for

ing case studies. Each participating provider took a

telehealth are assigned at the time of

slightly different approach to choosing and utilizing

intake, rather than later in the care

a telehealth or RPM system, and shared the factors

episode.

that led to their success. Tey offer the following

■ Ask a trusted clinician to provide an

advice:

introduction to telehealth. Patient

telehealth program enrollment is most

Leadership and Buy-In

effective when introduced by a trusted

■ Engage leaders; their engagement is key

clinician.

to the success of a telehealth and RPM

■ Streamline the hospital and skilled

program. It takes leadership to change

nursing discharge planning process

behavior - and persistence to change

to incorporate enrollment into a

culture.

telehealth program.

■ Engage staff; their engagement, buy-in

Education and Training

and support are critical to a program’s

success.

■

Work with the telehealth partner to

develop a communication strategy

■ Choose a telehealth system that is

regarding the benefits of the telehealth

simple, reliable, easy to use, easy to

program for internal stakeholders and

maintain and affordable to providers

referral sources.

and patients to warrant buy-in and

sustained use. Ensure the telehealth

■

Provide traditional clinical call

solution can easily integrate into the

center nurses with additional disease

patient’s daily activities.

management education. Effective nurse

communication training is vital to

Enrollment

patient enrollment and engagement.

■ Understand the patient population

■

Ensure that case managers and

and plan the program based on the

field staff understand the value of

organization’s unique needs and goals.

telehealth, including what is in it for

■ Establish selection/inclusion criteria

them: reducing readmissions for their

around specific conditions in which

patients and better clinical care.

telehealth has shown efficacy.

■

Empower the patient with the

■ Focus on high-risk, high-cost patient

knowledge of his or her own health

populations, at least initially.

readings. Patients want to be informed,

active participants in their care

program.

Telehealth and Remote Patient Monitoring (RPM): Provider Case Studies 2013

■ Offer real-time education to patients

■

Telehealth technology is an enabling

during a teachable moment. This

tool, not an end unto itself; focus

increases self-management.

on patient services versus telehealth

equipment. Improving wound care

■ Make sure the patient’s primary

or chronic disease management is a

care physician is educated about the

quality initiative, not an information

program, so they can reinforce its value

technology initiative.

when the patient visits them in the

office.

■

The connection between the clinical

staff and the patient is critical to the

Process Redesign and Improvement

success of the telehealth program.

■

Telehealth clearly impacts the efficacy

Integrate visits to the home into the

of health care delivery at every point

clinical program to reinforce the

in the care continuum, providing the

importance of using the telehealth

opportunity to reduce readmissions

equipment to the patient.

and improve the quality of patient

■

Share clinical outcome data with all

care coordination. In nursing facilities,

applicable practitioners across the

telehealth can transform the way nurses

full care continuum. Analyze the

do their work and enable continuous

data, along with the financial data, to

improvement in quality and outcomes

validate system cost savings, and report

while containing costs. Consider how

regularly to the physician group and

telehealth will change care processes

senior leadership.

and workflows, and redesign processes

■

Establish physician pro re nata (PRN),

to take advantage of telehealth data

as needed, orders for telehealth patients

in driving efficiencies and ongoing

to maximize efficiency of monitoring.

process improvements.

■

If managing the telehealth inventory,

■

When selecting a telehealth solution,

make sure to apply an organized

take the integration of telehealth

approach to inventory management

data into the electronic health record

including signing the equipment in

(EHR), which is not straightforward,

and out. Make sure the telehealth

into account. Partner with a

system allows inventory to easily

vendor who not only implements

move between patients. Ask telehealth

interoperability standards, but is

partners for a process to effectively

willing to work with others, like the

manage the equipment.

EHR vendor.

■

Work with the telehealth partner to

establish a clinical program design

that will have maximum clinical and

financial impact.

LeadingAge Center for Aging Services Technologies (CAST)

Financial Data Matter

■ Understand your return on investment

(ROI), collect and analyze the data that

will demonstrate ROI.

■ Develop business partner relationships.

■ Partnership/collaboration with the

organization’s chief financial officer

is important to collect and analyze

financial data.

Planning and Looking Ahead

■ Plan to expand the program to a larger

number of patients. Take into account

the possibility of linking projects into

partnerships with payers, hospitals,

Patient-Centered Medical Homes and

accountable care organizations (ACO).

■ As health care organizations work to

form integrated delivery networks or

become ACOs in order to leverage a

more streamlined health care model,

the system-wide embrace of telehealth

solutions as a communication bridge

for the patient discharge process, can

(quite literally) be the missing link.

Te case studies presented here represent great ex-

amples of using telehealth and RPM products. Each

case study demonstrates how using telehealth and

RPM has impacted each organization, and in turn

the care they provide. Building upon the experi-

ence of these organizations can help other providers

write their own success stories and case studies.

Telehealth and Remote Patient Monitoring (RPM): Provider Case Studies 2013

Reducing Hospitalizations and Hospital Days

through Telehealth

Other Partners

Vidant Health used Ideal Life to provide in-home

monitoring equipment (phone, Internet or cell

transmitting portable open database (POD) station,

and wireless peripheral sensors for blood pressure

(BP), pulse, oxygen saturation, scale, and finger

7.1

Provider: Vidant Health

stick blood sugar (FSBS) and its Employee Health

Contributor: Bonnie Britton, MSN, RN, ATAF,

Wellness Kiosk Program).

Vidant telehealth program administrator

Organization Description

Vidant Health is one of the largest health care

systems in North Carolina. It is the parent company

of Vidant Medical Center, the tertiary services hub

that operates or manages eight diverse community

hospitals throughout the region and a number of

subsidiary corporations including physician prac-

7.2

Vendor: Ideal Life

tices, outpatient services, wellness services, critical

Impacts and Benefits of Telehealth and Remote

care transport, home health, hospice, and more.

Patient Monitoring (RPM) in:

Vidant Health serves 29 counties and more than

• Health Outcomes (Blood Pressure, Blood

1.4 million people through an extensive regional

Glucose, etc.)

network. Te system’s combined operations include

• Quality of Life/Satisfaction with Care

more than $1.5 billion in net revenues, more than

• Hospitalization and Hospital Readmissions

12,000 employees and more than 1,400 licensed

• Cost of Care and Return on investment (ROI)

beds.

to:

Project Description

■ Providers

■ Payers

Vidant Health implemented a post-hospital dis-

■ Consumers

charge telehealth program to increase patient

access to care, lower hospitalizations and bed days,

Organization Type

enhance patient and provider communication

Vidant Health is an integrated health system with

and engage high-risk, high-cost, low-engagement

a tertiary care center, eight rural hospitals, 70+

cardiovascular disease and pulmonary disease

primary care provider clinics, home health, and

patients. A Patient Activation Measurement Tool is

hospice.

used to identify low-engaged patients. Ideal Life’s

Telehealth and Remote Patient Monitoring (RPM): Provider Case Studies 2013

telehealth equipment was installed and medication

pulmonary disease patients. One hundred twenty-

reconciliation was completed in the patient’s home.

six patients declined participation in the program.

Daily, patients collected their blood pressure, pulse,

Fify-six percent of the participating patients were

weight and oxygen saturation level, which were en-

African American females. Patient ages ranged

crypted and sent to a secure cloud server. Data were

from 19 to 101 years of age with thirty-two per-

reviewed by a nurse and actions or interventions

cent of patients between the ages of 18-59, which

were taken as needed.

was significantly higher than expected. Fify-four

percent had a primary diagnosis of hypertension

Telehealth and RPM System Type

and thirty-three percent had a primary diagnosis of

heart failure.

Vidant Health used Ideal Life’s real-time biometric

RPM system.

CVD and pulmonary disease hospitalized patients

were identified through Vidant Health’s electronic

Telehealth and RPM System Embodiment

health records (EHR). Once identified, the patient

Te systems chosen were single-user/patient home

completed a 13-question Patient Activation Mea-

base units and a multi-user unit/kiosk for employee

surement (PAM) tool. Te answers were recorded

wellness.

in Vidant Health’s EHR and patient engagement

scores (0-100) and patient engagement levels (I-IV)

Business Model

were determined. If the CVD and/or pulmonary

Vidant Health’s business model is to reduce un-

patient was a PAM Level I or II, the patient was

necessary hospital readmissions, emergency room

approached by a telehealth nurse technician (TNT)

visits and lower hospital bed days to lower costs,

in the hospital. Te patient and family were in-

maximize reimbursement, and avoid Medicare

formed of the program and consent to participate

re-admission penalties. During the business plan

was obtained. Following patient approval, the TNT

development, initial assessment identified Medi-

contacted the patient’s doctor or care manager for

care, self-insured and uninsured cardiovascular dis-

an electronic referral to the telehealth program.

ease (CVD) and pulmonary disease patients as the

Upon hospital discharge, the TNT scheduled a time

initial patient population. Afer the first six months

to come to the patient’s home to install the equip-

of implementation, the program began accepting

ment, conduct a home safety assessment, train and

any CVD and/or pulmonary patients regardless of

validate the competency of the patient in the use of

payer. During the first year, 56% of patients who

the equipment, and collect the patient’s medications

completed monitoring were Medicare, 14% Med-

and compare medications at home to the hospital

icaid, and 11% self-pay. Vidant Health is currently

discharge medication list. If there was a discrep-

analyzing year one data to include hospital bed

ancy, the TNT contacted the telehealth nurse who

days, charges, costs and reimbursement.

followed up with the patient’s primary care physi-

cian to perform medication reconciliation.

Implementation Approach

On a daily basis, the patient self-collected his or her

During the first year of the telehealth program,

data (BP, pulse, oxygen, weight, FSBS) which were

Vidant Health enrolled 1,323 cardiovascular and

LeadingAge Center for Aging Services Technologies (CAST)

encrypted and transmitted to a secure cloud server.

first year, hospitalizations were decreased by a total

Daily, the telehealth nurses reviewed the patient

of 550 admissions (820 during the three months

data and contacted all patients who had abnormal

before implementation of the telehealth program,

parameters. Te telehealth nurse conducted an

and 270 during the three months of the telehealth

assessment, evaluated medication and nutrition

program) for patients enrolled in the telehealth pro-

compliance and provided patient education. If

gram. Tis was a 67% reduction in hospitalizations

the telehealth nurse believed the patient may have

as a result of the use of telehealth. Also, the number

needed a medical intervention, the telehealth nurse

of patients hospitalized decreased by 341 during the

contacted the patient’s doctor via the EHR. Patients

telehealth program (512 patients prior to telehealth

were monitored for a three-month period and

use and 171 patient during the telehealth program),

evaluated for discharge from the program or a three

as figure 1 below shows.

month extension.

Hospital bed days during the telehealth program

decreased by 2,596 as compared to before enroll-

Outcomes

ment in the telehealth program, as illustrated in

Patient outcome data were pulled for the three

figure 2 below.

months prior to being enrolled in the telehealth

program, during the three months of telehealth

Hospital costs, charges, readmission and reim-

program and again for the three months post-

bursement analysis will be completed at the end of

discharge from the telehealth program. During the

Vidant Health’s fiscal year.

Figure 1. Number of Hospitalizations and Patients Hospitalized Before,

During and After Enrollment in the Telehealth Program (n = 695 patients total).

Telehealth and Remote Patient Monitoring (RPM): Provider Case Studies 2013

Figure 2. Number of Hospital Bed Days Before, During and After Enrollment in the Telehealth Program

(n = 695 patients total).

Financial Benefits - Total Health Care

Patient Satisfaction

• Hospitalization costs to payers were 68% lower

As illustrated in Figure 3 below, patients were

as a result of the telehealth program

extremely satisfied with the telehealth services and

• More effective and efficient care

equipment. Patient satisfaction was assessed at the

• Improved access to care at the most

mid-point of the telehealth program.

appropriate level

• Increased patient satisfaction

Figure 3. Patient Satisfaction with the

Telehealth Program

LeadingAge Center for Aging Services Technologies (CAST)

Take Home Points

Advice to Share with Others

Conducting in-home medication reconciliation and

•

If one has seen a single telehealth program,

providing RPM services resulted in:

one has seen a single telehealth program.

One needs to design his or her own telehealth

• Early identification and treatment of disease

program based on the desired organizational

exacerbation

goals, population, competencies, and

• Reduced hospitalizations

partnerships.

• Reduced bed days

•

Focus on patient services versus telehealth

equipment.

• Reduced emergency room visits

•

Partnership/collaboration with the

• Reduced health care costs

organization’s chief financial officer is

• Actively engaged patients

important to collect and analyze financial data.

•

Collect and analyze the data that will

Challenges and Pitfalls to Avoid

demonstrate ROI.

• The greatest challenge for telehealth

•

Focus on high-risk, high-cost patient

implementation is having a clear vision,

populations.

business plan and model with quantifiable

return on investment (ROI).

• Hospitalist and primary care provider buy-in.

• The buy-in from the provider organization’s

chief financial officer, which is related to the

ROI mentioned above.

• Integrating the telehealth data with the

organization’s EHR.

Lessons Learned

• Understand the patient population and plan

the program based on the organization’s

unique needs and goals.

• It is much more difficult to integrate EHRs

with telehealth vendor software than initially

believed.

Telehealth and Remote Patient Monitoring (RPM): Provider Case Studies 2013