Real World Health Care Blog

Cost-Savings

Health Care Innovation is a Game That Everyone Can Play

Why?  Because everyone has been a patient, experienced a pain point, identified an unmet need, or had an idea to improve the health care experience.  However, one of the really challenging parts of health care innovation is that, while there are a lot of respectable ideas out there, the vast majority of these ideas get lost in the gap between idea and tangible venture.

BIO International Convention, Idea Design Studio

BIO International Convention, Idea Design Studio

At MIT Hacking Medicine, we often refer to this gap as the “valley of death”, because it’s where good ideas go to die.  To that end, our organization is dedicated to assisting aspiring innovators and entrepreneurs in bridging this gap.

MIT has a long and storied history of “hacking,” so it should come as no surprise that our signature event is in the form of a “Healthcare Hackathon.”  These events help to break down the siloes in health care by encouraging unlikely players to work together.  Instead of thinking independently, attendees from multiple disciplines spend the weekend designing solutions to real world medical challenges.  Our unorthodox approach to health care innovation has helped over a dozen teams turn their weekend “hack” into viable startups, backed by over 70 million in investment capital.  The model is now being used across the globe to accelerate health care opportunities into reality.

The MIT Hacking Medicine team was on site at the 2015 Biotechnology Industry Organization (BIO) International Convention to run the Idea Design Studio.  Unlike our typical events that last 48 hours, participants at the BIO Convention were asked to roll up their sleeves and tackle pressing health care challenges in less than 4 hours.

The call to action was amazing – in less than 4 hours participants broke into 8 teams within the themes of personalized medicine, clinical trials, and patient engagement.  Next, these researchers, clinicians, business executives, designers, educators and students discussed challenges and problems within these three themes.   They spent the remainder of the time developing a solution.  Before wrapping up the workshop, teams were given three minutes to pitch their innovative solutions to the audience.  Some of these solutions included reducing the clinical trial dropout rate through gamification, providing easy access to genetic information for patients and providers, and my personal favorite, educational and support tools for the family care providers of Alzheimer’s patients throughout the progression of the disease.

The Idea Design Studio aimed to bring together some of the brightest minds in biotechnology with a shared passion for transforming health care.  In only four short hours, participants demonstrated an incredible amount of ingenuity while crafting solutions to opportunities within the space of personalized medicine, clinical trials, and patient engagement.  New partnerships were formed and continued collaborations are in the works. We truly appreciate the energy and dedication on display by the participants and are extremely grateful to BIO for giving us the opportunity help raise the profile of healthcare innovation and entrepreneurship.

The Idea Design Studio is a wonderful example of applying out-of-the-box thinking to solving today’s healthcare problems. Have you encountered other examples? Let us know in the comments section.

The Caregiver Act and AARP’s CARE Act Aim to Reduce Readmissions

Hospitals nationwide have gone to great lengths in an effort to reduce readmissions and improve patient quality. However, despite these concerted efforts, hospitals continue to incur fines from Medicare for excessive rates of patient readmissions, which are projected to total more than $428 million. Even worse, readmissions cost patients a collective $17 billion.

Eric Heil, RightCare

Eric Heil, RightCare

However, these numbers and rates are starting to drop thanks to new tools and programs, such as the Delivery System Reform Incentive Payment (DSRIP) Program. We’re also seeing new legislation being introduced in several states aimed at reducing readmissions by ensuring hospitals and their patients communicate better after they are discharged.

The Caregiver Act and AARP’s model state bill, called the Caregiver Advise, Record, Enable (CARE) Act, are examples of legislation currently being discussed in several states. Together, they have the potential to prevent hundreds of thousands of unnecessary hospital readmissions. Oklahoma was the first in the nation to pass legislation back in November 2014 and New Jersey followed suit later the same month.

The new laws would require hospitals to work directly with a patient’s caregiver (usually a family member) to ensure that necessary preparations are in place for the patient to successfully recover at home after being discharged. This process includes providing discharged patients and their caregivers with a clear path to follow for addressing medication, nutrition and living needs in-home.

To achieve this level of customized, high quality care, technology is essential to streamline the care coordination process and support the unique needs of patients. RightCare, a growing medical technology company, has an end-to-end software solution designed to assess patient risk and needs at the time of admission, ensure the most appropriate post-acute care plan is offered, and seamlessly transition patient information to post-acute care providers. RightCare’s software is based on 10 years of academic and clinical research and has helped hospitals nationwide optimize workflow, reduce length of stay times, reduce readmissions and ensure hospitals meet Medicare-mandated standards for preventable readmissions.

We’ve seen time and time again how effective post-care planning with providers, community organizations and technology can significantly decrease readmissions, so it’s encouraging to see these efforts are now supporting caregivers.

Readers: Are you a family caregiver? What are some of the challenges you face, and what tools are you using to help? Let us know in the comments.

Many Insured Americans Not Getting the Healthcare They Need

Last month, FamiliesUSA.org issued a sobering report about the disconnect between having medical insurance and receiving the healthcare one needs. The report concluded that for many Americans with non-group coverage (as opposed to having insurance from an employer or a public coverage program), deductibles and other out-of-pocket costs are prohibitively high and are associated with many of these insured consumers forgoing needed healthcare. According to the report, more than one in four adults who bought insurance for themselves or their families last year had to skip medical care because they couldn’t afford it.

Linda Barlow

Linda Barlow

“The Affordable Care Act has increased access to health insurance and financial assistance for millions of Americans,” wrote the report’s authors. “But even with the new assistance that helps consumers pay their premiums and out-of-pocket healthcare costs, one-quarter of consumers who buy insurance on their own still have problems being able to afford needed care.”

According to the report, adults with non-group coverage went without:

  • Tests, treatments or follow up care (15% of adults)
  • Prescription drugs (14%)
  • Medical care (12%)
  • General doctor care (12%)
  • Specialist care (11%)

High deductibles, copayments and coinsurance can leave some people in the position of having to make very tough decisions. Pay for needed medications or the electric bill? Pay for a doctor-recommended test or make a car payment? Pay for treatments and follow up care or pay the monthly mortgage?

These are decisions no one should have to make. No one should have to decide between cancer treatments and putting food on the table. No one should have to sell their car to pay for their child’s asthma medication. No one should go into bankruptcy just because they’ve been diagnosed with a life-changing illness.

If you or someone you know is facing decisions like these, know that help is available. Patient advocacy organizations, drug manufacturers, and charitable patient assistance programs may be able to provide financial assistance.

Do you know of an organization that helps provide a financial lifeline to Americans with inadequate insurance? Let us know about it in the comments section.

 

 

Awareness and Assistance Are Crucial to Fighting Hepatitis C

May is Hepatitis Awareness Month, a time when the healthcare and patient advocacy communities rally support for the millions of Americans afflicted with the disease, including an estimated 3.2 million suffering from chronic Hepatitis C (also known as HCV).

HepatitisAwarenessMonthOver time, chronic Hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. In fact, Hepatitis C is a leading cause of liver cancer and is the number one cause of liver transplants.

While millions live with Hepatitis C, many don’t even know they are infected. This “hidden epidemic” can strike just about anyone, but those born from 1945 to 1965 are five times more likely to have the disease than those in other age groups. That’s why the CDC has issued a recommendation for all Americans born during that time to get a blood test for the disease.

In addition to the baby boomer generation, others may be at high risk for HCV infection, including those who:

  • Use injection drugs
  • Used unsterile equipment for tattoos or body piercings
  • Came in contact with infected blood or needles
  • Received a blood transfusion or organ transplant before July 1992
  • Received a blood product for clotting problems made before 1987
  • Needed blood filtered by a machine (hemodialysis) for a long period of time due to kidney failure
  • Were born to a mother with HCV
  • Had unprotected sex with multiple partners
  • Have or had a sexually transmitted disease
  • Have HIV

For people at risk, knowing they have Hepatitis C can help them make important decisions about their healthcare. Successful treatments can eliminate the virus from the body and prevent liver damage, cirrhosis, and even liver cancer. But sometimes, the cost of those treatments are out of reach, even for those with medical insurance.

Financial Relief Available

The HealthWell Foundation’s new Hepatitis C Fund is bringing financial relief to underinsured people living with the disease. Through the fund, HealthWell will provide copayment assistance up to $15,000 for HCV treatment to eligible patients who are insured and have annual household incomes up to 500 percent of the federal poverty level. To determine eligibility and apply for assistance, or learn how to support this program, visit http://bit.ly/HepC2015.

“The new generation of hepatitis C treatments has brought excitement to patients who have been hoping for a breakthrough,” said Krista Zodet, HealthWell Foundation President. “Through the generosity of our donors, our Hepatitis C Fund is able to help more people receive these treatments while minimizing the worry over financial stress.”

Because many HCV infections are identified only after the patient becomes symptomatic, community health centers are extremely important for getting patients into care. BOOM!Health is a community service organization located in the Bronx, New York, the epicenter of the Hepatitis C epidemic in New York City. It offers a variety of services to those living with HCV infections, including a fully staffed health center, pharmacy services, case management, nutrition education, counseling, pantry services, syringe exchange, behavioral care, and more.

“People living with HCV continue to face serious challenges, such as stigma and lack of access to treatment,” said Robert Cordero, President and Chief Program Officer, BOOM!Health, a community health center based in the Bronx that supports individuals on their journey towards health, wellness and self-sufficiency. “Non-profits that provide funding assistance like HealthWell fill a gap that we’ve watched grow.”

“Nearly 3.2 million people in the United States and about 150 million people worldwide are chronically infected with HCV,” said Tom Nealon, Esq., National Board Chair of the American Liver Foundation, a national patient advocacy organization that promotes education, support and research for the prevention, treatment and cure of liver disease. “The HealthWell Foundation and other independent copay charities play a vital role in seeing that those who are insured but can’t afford their medication copay are able to access and stay on treatment.”

If you or someone you know is living with Hepatitis C, emotional, physical and financial support are critical. What organizations and programs are you turning to for help? Let us know in the comments.

A Tale of Two Liver Transplants: Altruistic Compassion for a Compassionate Altruist

“Talk about your life changing in an instant,” Helen said, remembering her first diagnosis of acute liver failure. The doctor told her family there was nothing more to be done, and she was given two weeks to live.

Helen Bozzo

Helen Bozzo

Helen Bozzo had spent most of her time being a mother. Her husband, a farmer, worked long hours in the fields in their rural California farm, and early on in their marriage the couple decided that she would stay home to care for their three children. She was the “homeroom mother,” volunteering in classes and with the school’s administration, PTA and athletics department. Helen’s passion was helping others, and not just in the school.

Eventually moving into the town, Helen enjoyed taking others into her home – her children’s friends, her son’s comrades from the Marine Corps – she always had a full house and enjoyed taking these friends in like her family.

“I enjoyed cooking for everyone, reading, knitting and gardening,” she said. “Still things I enjoy doing today, but loving and helping people is my number one pleasure in life.”

Helen had returned from what she remembers as a great family vacation to Disneyland when she began to get ill quickly. Her doctor had her admitted to her local hospital where, after receiving tests and specialists’ opinions, she was given that shocking diagnosis.

But her family could not accept that. They sought a second opinion, and got Helen an appointment at a local cancer center. Here she was evaluated and admitted to the hospital, where she spent a month undergoing “every test known to man” and waiting desperately for an answer. All that was clear was that her liver and now her kidneys were failing. She was placed on dialysis.

“I was going downhill fast,” Helen recalls.

After much deliberation, Helen’s doctors decided to put her on the transplant list. Eight days later, on April 29, 2007, a suitable liver was available and she had the transplant. Her health began to improve immediately.

More than a third of people on the transplant list die each year waiting for an organ, according to Helen. She would later come to realize just how lucky she was, saying, “The odds of finding a match in such an acute critical case as mine are astronomical,” she said. “The doctors told me later that I was within hours of death.”

For the time being, Helen was in the clear. She had great insurance and her payment plan kept her bills covered. Though she was in debt, she was able to keep her medications coming. Considering how hard her recovery was, that was a very good thing. It took Helen a year to be able to walk again, but she eventually made a full recovery.

For the next four years, things went well for Helen. She became active again, and that meant re-embracing her spirit of altruism. She became active in the organ donor/recipient community, particularly in a liver transplant support group in which she helps others through the process of getting a transplant. She became a California Donate Life Ambassador, speaking at various organizations about the importance of becoming an organ donor. What energy Helen had, she gave to others.

Shortly before her third walk with the American Liver Foundation’s “Walk for Life,” Helen decided she had to see her doctor. She had started feeling tired after a recent road trip with a friend, and now she was feeling worse. To her dismay, the doctor’s test showed some major problems. After ten days of testing in the hospital, her liver was failing again. She was placed on the “Status 1” list in five states, the top of the transplant list.

“It was life or certain death,” Helen said.

Three days later, on September 26, 2011, Helen had her second liver transplant.

Along with this transplant, however, came three expensive new medications that her insurance would not cover. Charging thousands of dollars to her credit card every month, Helen was becoming massively over-extended. She called every agency she could, but no one could help her until she found the HealthWell Foundation. HealthWell is a nationwide non-profit providing financial assistance to insured patients who are still struggling to afford the medications they need (and sponsor of this blog). Helen qualified for a grant that helped cover her copays for her medications.

Now, Helen and her husband are back on their feet. As always, Helen turned her attention to paying it forward to others as soon as she could, donating to the HealthWell Foundation, continuing to support transplant recipients and raising over $25,000 in her walks for research and awareness of liver disease and failure. She spends time with her ever-growing family and her husband, with whom she just celebrated 40 years of marriage. When she’s not helping others or enjoying the love of her family, she still likes to knit, garden and cook, and hopes to see all 50 states one day.

“We are so very thankful to the HealthWell Foundation,” Helen said. “I know of families in our transplant support group that have lost their homes because they were in the same situation we were in. Thankfully we found the HealthWell Foundation in time. The home we had worked so hard for, we were able to keep. The peace of mind in knowing that every month when I went to the pharmacy I would have the money to pay for my medications meant everything to our family. The stress was gone and I could focus on my recovery in peace.”

We at RealWorldHealthCare are thrilled to see patients like Helen in such good places, doing such wonderful things. Please share your thoughts in the comment section.

Categories: Cost-Savings, General

ACA Update: When Medical Insurance Doesn’t Result in Medical Care

Amid continuing partisan debate on Capitol Hill about the Affordable Care Act, the facts are clear: the law has significantly reduced the number of uninsured Americans. Last week the federal government issued a report indicating more than 16 million people who did not have health insurance before have gained coverage thanks to the ACA. According to the Department of Health and Human Services, these gains have delivered the largest drop in the uninsured rate in four decades, bringing that rate down to 13.2 percent.

Linda Barlow

Linda Barlow

“These numbers prove the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result,” said HHS secretary Sylvia Burwell.

While few would dispute that having medical coverage is better than not having medical coverage, coverage is not always a panacea for all ills. First, consumers need to take advantage of the coverage they now have. The federal government recognizes the gap between having medical insurance and getting medical care and has established a website to help consumers use their new marketplace coverage.

For about 19 percent of privately insured adults, higher cost-sharing responsibilities are to blame for the lack of medical care received. Fortunately, the number of Americans reporting they did not receive needed health care because of its cost dropped for the first time last year since 2003, falling from 80 million in 2012 to 64 million in 2014. Still, twenty-one percent of adults with health insurance spent 5 percent or more of their income on out-of-pocket health care costs during 2014, and 13 percent spent 10 percent or more, according to a report from the Commonwealth Fund.

These underinsured Americans face tough choices every month: Do they use their limited funds to pay for needed health care visits, therapies and procedures, or do they use that money for essentials like rent, utilities, child care and food?

Our sponsor, the HealthWell Foundation, believes that no American should go without essential medications and other therapies because they cannot afford them. The Foundation has helped more than 200,000 underinsured patients afford their medical treatments since its launch in 2004. As we recognize the fifth anniversary of the passing of the ACA, we want to know if you agree. Has the ACA helped you and your loved ones receive needed care, or are high out-of-pocket costs still keeping you from seeking the care you need? Let us know in the comments.

Speaking With: Neil Smiley on the Advantages of Narrow Healthcare Networks

Editor’s Note: Narrow healthcare networks have evolved as health insurance companies attempt to control costs and manage care. Even though these systems limit participants’ choice of doctors and hospitals, they are serving to better align services with patient needs. Neil Smiley, CEO, Loopback Analytics shares his thoughts on why the number of narrow healthcare networks continues to increase.

RealWorldHealthCare: What is unique about these narrow healthcare networks that have increased over the past couple of years? What advantages do they bring to the healthcare landscape?

Neil Smiley, Loopback Analytics

Neil Smiley, Loopback Analytics

Neil Smiley: Healthcare reimbursement models are changing.  The traditional fee-for-service model incentivizes providers along the care continuum to maximize utilization of their services, not improve clinical outcomes or reduce total cost of care.  However, over the past couple of years, readmission penalties, bundled payments and ACOs are moving providers to collaborate with care partners across the continuum to ensure patient transitions are successful and the providers they refer their patients to are delivering high quality, cost effective care.  Narrow networks of highly collaborative, quality providers can improve care coordination, reduce fumbled handoffs and better align services with patient needs.

RWHC: How are these narrow networks being optimized to improve access to care and reduce the cost of care?

NS: You have to have good data to assemble and optimize a narrow network.  Narrow networks require high levels of collaboration between care partners.  Narrow network participants have to come together on standard quality and outcome measures, and create an effective feedback loop to target areas for improvement.

RWHC: The cost of hospital re-admissions is an increasing concern. What can be done to reduce hospital readmissions?

NS: There is no silver bullet.  There is a diverse set of reasons why patients readmit to the hospital.  Consequently, readmission reduction programs must be multifaceted.  A “one-size fits all” approach is prohibitively expensive and probably ineffective.  Data analytics can rank patients by risk of readmission and match them to right interventions at the right time to mitigate patient-specific risk factors that would otherwise lead to hospital readmissions.

RWHC: What is the “sweet spot” for big data analytics in terms of improving positive patient outcomes? Can you provide a real-world example of how data capture and analytics has improved patient outcomes?

NS: Big data analysis of real-time data can be used to proactively identify patients that are most vulnerable to having a bad outcome.  Data patterns can also flag patients that are likely (or unlikely) to benefit from a specific interventions.  For example, medication adherence problems are a major cause of hospital readmissions.  Big data can be used to analyze the history of prescription fill patterns, the number and complexity of medications and available clinical markers to proactively identify patients for pharmacist consultations.

RWHC: How is the role of community based organizations changing in terms of improving access to care, reducing the cost of care, providing for more patient-centered care, and generally improving patient outcomes?

NS: There is growing recognition that the root cause of what ultimately results in a hospitalization may begin with some simple unmet need out in the community. Patients may lack transportation to the doctor or need help in translating their care instructions in a language they understand.  There may be fall risks in their home or old prescriptions that should be thrown out to avoid a medication error.  Community-based organizations can engage patients in their home and address risk factors that would otherwise go undetected.  Hospital systems and payers are adding community-based organizations to their existing clinical interventions to provide more holistic, cost-effective, patient-centered care.

What advantages do you think narrow healthcare networks have? What about disadvantages? Let us know in the comments section.

How HealthWell Foundation’s MS Fund Helped Charlie Get His Life Back on Track

A Note from Our Sponsor: March is National MS Education and Awareness Month. Are you, or is someone you love, an MS patient on Medicare in Need of Financial Assistance? Click here to visit the HealthWell Foundation’s eligibility page.

Charlie Barron was raised to set goals, make plans, get things done. But setting and meeting goals has become exceptionally hard since Charlie, 46, discovered he has multiple sclerosis.

Charlie Barron

Charlie Barron

Because of his MS, Charlie is unable to work and therefore struggles to pay for the expensive treatments he has needed since he was diagnosed in 2010, a decade after his symptoms first appeared. He received HealthWell Foundation grants in 2014 and 2015.

Before his diagnosis, this resident of DeKalb, Ga., had a career as a chef. On the job, he often stood 12-14 hours a day, despite a pins- and-needles sensation in his feet and numbness in his legs that went on for years. For a long time, he considered his physically demanding work the cause of his pain, yet his employer provided no health insurance.

Later, Charlie combined his cooking skills with his interest in fitness to open his own business.  As a personal trainer, he led clients in morning workouts in their homes, then cooked them a healthy breakfast in their kitchens. At that point, he bought himself health insurance.

However, his insurance policies have been unreliable in covering his medications. For instance, his first medication was covered, but when it proved ineffective for him, his insurance company declined to pay for the next prescribed treatment. Moving from private insurance, he obtained Medicare coverage through disability and thought those challenges would change. Recently his doctor recommended adding a second drug to Charlie’s treatment plan which has staved off relapses for the last two years, but the out-of-pocket expense was still unmanageable.

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Editor’s Note: RealWorldHealthcare turns 2 today! To help us celebrate our anniversary, we think there’s no better gift than a donation to our sponsor, the HealthWell Foundation. Learn how you can help support patients in need. Click here.

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In a note thanking the Foundation for its financial assistance, Charlie described how he felt when he found out the cost of his care.  “Even though I was ready to physically fight to get my life back from MS, my finances were not so ready for battle,” he wrote. “I learned that the medication my doctor prescribed would cost upwards of $1,100 per month. I felt that I had been knocked down before I even had a chance to throw the first punch.”

“The HealthWell Foundation has given me the peace of mind to focus my energy on fighting MS and encouraging others to do the same,” Charlie’s letter said.  He continues learning about MS at a local MS center, takes physical therapy and has participated in activities such as a painting class with others coping with MS.

Social media connects him with additional people with the illness. Hearing about others’ experiences with MS, giving them encouragement or simply offering a kind word to lift their spirits gives Charlie strength.

Benefiting from the supportive care of his wife, brother-in-law and 13-year-old daughter, he urges other people with MS to seek support from family or a strong support group.  For caregivers, he recommends researching MS through the Internet, books or the MS Society to know what to expect.

Not comparing the present with the past is important to him as well. “It’s not about what you used to do, it’s about what you are trying to do now,” Charlie says.

Are you an MS patient like Charlie? How are you coping with the disease and its treatment costs? Let us know in the comments.

 

Categories: Cost-Savings, General

Lowering Hospital Readmissions through Remote Monitoring of Post-Acute Patients: The University of Virginia Health System – Broad Axe Care Coordination Model

One of the less known policies of the Affordable Care Act, the Hospitals Readmission Reduction Program, requires that hospitals with higher than national average readmission rates for certain medical conditions and surgical procedures be penalized.  For many hospitals, the readmission penalties result in millions of dollars in profit lost.

David Sheon

David Sheon

A recent Wall Street Journal article shines a light on remote patient monitoring and post-acute care coordination, a service that is experiencing rapid growth and focusing on readmission rate reduction.  The service not only helps more people recover successfully from hospital stays, but it also keeps costs down for payers and helps hospitals avoid the risk of growing penalties.

According to an October 2014 article from Kaiser Health News, “Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released {recently} show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed.”

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A note from our sponsor: Are you, or is someone you love, an MS patient on Medicare in need of financial assistance? Click here to visit The HealthWell Foundation’s eligibility page.

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Leading manufacturers of remote-monitoring equipment include Medtronic Inc., Philips NV and St. Jude Medical Inc., according to the Wall Street Journal article. Sales are expected to total about $32 billion this year, with a compound annual growth rate of 9.2% between 2014 and 2019.

In addition to addressing readmissions, effective remote monitoring represents an outstanding care redesign technique that can be implemented as part of a CMS bundled payment initiative, or as part of the quality program of an accountable care organization or clinically integrated network. The benefits accrue well beyond avoiding the penalties.

“The remote monitoring technology and implementation drives revenue issues beyond the CMS readmission penalties,” said John Kirsner, Partner, Jones Day, an expert on the implications of the ACA on hospitals. “In addition to the penalty avoidance component, this technology can assist in creating shared savings that result in additional topline revenue enhancement.”

Some remote monitoring programs are further along than those mentioned in the Wall Street Journal article. For instance, over a year and half ago, Broad Axe Care Coordination and University of Virginia Health System (UVA) partnered to design and execute a comprehensive platform combining services and technology to reduce readmissions for key conditions where Medicare was imposing penalties, including heart attack, heart failure, pneumonia and COPD.  Because of the success of the program and Medicare’s expansion of the penalty conditions, Broad Axe expanded its service at UVA to remotely monitor patients who had total joint replacements as well. The result for UVA has been a dramatic decrease in joint readmission rates, and a ready for prime time remote monitoring/care coordination program that can be put into place at hospitals across the country.

The system, called C3 at UVA, is a remote care management platform that combines telehealth services from experienced clinicians with robust analytics and an IT platform integrated with the health system’s EMR to provide UVA with a fully-outsourced care coordination solution.

BACC_Image for blog_SM (1)“Broad Axe offered us something unique: a care coordination center that combines outstanding technology with dedicated clinicians — RNs, LPNs, and CNAs — to deliver ongoing care transition and care coordination services,” said Amy L. Tucker, MD, Associate Professor of Cardiovascular Medicine, University of Virginia Health System.  “We’ve seen a great impact on the readmission rate.”

UVA and Broad Axe work together to look closely at those patients who are readmitted to see if the program can be further optimized.

For example, C3 can track not only readmission but when patients have follow-up visits.  The system also can help to ascertain whether patients are following their medication instructions. This provides important feedback to see what areas of opportunity are most important for the health system to target to improve patient care.

Broad Axe executives are pleased with readmission rate performance between 25 and 45 percent below historical benchmarks, depending on the condition and payer population, and the associated penalty savings for the hospital.

“Historically, the adoption of remote monitoring technology has been stymied by the lack of financial incentives to use the technology,” said Scott Edelstein, also a Partner at Jones Day, specializing in regulated medical technologies. “Recent CMS initiatives such as the Hospital Readmissions Reduction Program and new reimbursement codes for remote chronic care management are fueling a renewed interest in this technology. This should create significant opportunities to increase access to, and quality of, care while lowering costs.”

Do you work in a hospital consider remote monitoring? What are your concerns? Or are you a recent patient who has participated in remote monitoring? www.RealWorldHealthCare.org welcomes your feedback.

Categories: Cost-Savings, General

Elder Care: Living Independently Thanks to Coordinated, Compassionate Care

Vera Brown of Churchville, Pa., was like many elderly Americans. She had multiple health issues including decreased mobility, degenerative joint disease, progressive dementia and aphasia from a stroke. But unlike some in her situation, she was able to live comfortably in her own home until her death in October, thanks to LIFE St. Mary. LIFE is a Program of All-Inclusive Care for the Elderly (PACE®), a unique model of care that helps people live safely at home with assistance from a team of compassionate healthcare experts.

A LIFE St. Mary nurse works with a patient

A LIFE St. Mary nurse works with a patient

Elder care can be expensive and frustrating. Nursing homes and other long-term care facilities can quickly eat up a person’s life savings as well as destroy their feelings of independence. But keeping the elder at home means family members or other caregivers need to drive to multiple doctor appointments, stay informed about medical issues, keep track of medications, and more—not to mention the worry that goes along with leaving their loved one at home during the day.

LIFE St. Mary offers 24/7 support and a range of services for elders and their caregivers: medical and in-home care; medications; transportation; physical, speech and occupational therapy; social work services; nutritional counseling and home-delivered meals; hearing, foot and dental care; adult day care; and caregiver respite. The hub of the program is the LIFE Center, a central location where doctors, nurses and other healthcare professionals offer treatment and monitor changes in participants’ health. Here, participants also receive nutritious meals and join in on a variety of activities to keep active and make new friends.

St. Mary Medical Center started LIFE five years ago to address the needs of the growing population of older adults in the Bucks County, Pa. area,” explains Erin Williams, manager, Outreach & Enrollment, LIFE. “The program is part of St. Mary’s commitment to improving the quality of life for everyone in our community, including elderly residents who need assistance to remain independent in their own homes.”

For Vera Brown, that assistance arrived at her front door three days a week, in the form of a LIFE van, which picked her up and took her to the LIFE Center. There, she received meals, therapeutic recreation, routine physical therapy and a full range of medical services. Vera’s LIFE team—her doctor, nurse, social worker, physical therapist, and home care nurse—collaborate to ensure that the care provided met her needs, and regularly updated her daughter to discuss her mother’s care plans. All of Vera’s medications came directly to the LIFE Center and were sent home with her. This saved her daughter the time of making trips or phone calls to the pharmacy, or coordinating doctor’s visits.

In addition to reducing headaches and hassles for family caregivers, LIFE helps to manage healthcare utilization and costs.

“The program costs about 30 percent less than nursing home care in Pennsylvania,” says Williams. “Program participants pay one monthly fee that covers all services, no matter how many of those services they use or how often. There are no copays or deductibles—even for medical equipment, prescriptions and transportation—so participants know exactly what their healthcare costs will be every month, with no surprises.”

Ms. Williams notes that LIFE’s coordinated care model is also helping St. Mary Medical Center reduce costs relating to unnecessary hospital and nursing home stays, medication errors, redundant tests and unnecessary labs. She says by reducing unnecessary hospital stays, “we’re saving a lot of healthcare dollars.”

“Holistic, patient-centered care can be difficult when elderly people stay in their home,” concludes Williams. “But with LIFE St. Mary, all care—including specialist care—is centrally coordinated, making it much easier for patients to access the care they need. Plus, we see our participants on a regular basis, so we can tailor services to each patient’s medical, psychological and social needs.”

“LIFE St. Mary is a wonderful program and a Godsend to aging and disabled individuals and their families,” says Marie Brown-Etris, daughter of Vera Brown. “For my mom, it was like they were an extended family who treated her with nothing but kindness through smiles, touches, hugs and kind words. The compassion and understanding for the people they serve is palpable.”

Are you a caregiver for an elderly family member or friend? Have you been able to take advantage of a PACE program like LIFE St. Mary? Tell us about your situation in the Comments.