MultiCare is looking to reduce costs by offering high quality care in a more efficient manner as virtual visits will take the place of in home appointments. In fact, with this model in place, MultiCare expects to enable home health case managers to double their average case load, moving from 30 to about 70 patients. In addition, MultiCare is looking to improve care outcomes by offering patients the opportunity for clinicians and patients to routinely collaborate on clinical care issues by providing telemonitoring to interact with patients on a very personal level.
To meet the needs of a large number of patients, MultiCare is offering a two-tiered telehealth program. “Tier one will be a full-blown program. These patients will have the telehealth monitor with all the peripheral devices in the home. They will get all of the intensive interventions that we can provide. We expect about 300 to 350 of the 500 patients will be enrolled in this tier one program,” said Kelly Gariando, RN, telehealth specialist at MultiCare
Instead of conducting telehealth sessions without any specific purpose, specific disease management questions are integrated at specific points in the telehealth process. For example, there are specific points in the care process when the telehealth nurses will ask cancer patients about pain control or diabetic patients about sugar levels.
To ensure that patients continue to adhere to their medication regimens, medication management is purposefully integrated into the telehealth nurses’ workflow. For example, the telehealth nurses focus on medication management on Tuesdays by asking a series of specific questions about the patients’ medication compliance. On Wednesdays, the nurses follow up to make sure the patients took action on any gaps that were identified the previous day. And, on Thursdays, the nurses work with the patients to ensure that they are prepared to stay in compliance with the medications over the weekend
Now in its third year of using video technology the program is showing positive results in reducing 30-day readmission rates for both heart failure and COPD. For heart failure, the 30-day RPM readmission rates have never exceeded 5.1%, which compares favorably with national CHF 30-day readmission rates of 25%. In addition, when compared to all of MultiCare’s heart failure patients, the RPM patients experienced 30-day readmission rates of 3% and 4% compared to 22.38% and 18.70% respectively for the two reporting periods (2016 and January – June, 2017).
For COPD patients participating in the RPM program 30-day readmission rates have decreased steadily since the program was implemented – 10.7% in 2015, 6.0% in 2016, and 4.0% January-July, 2017. These readmission rates also compare favorably with national COPD hospital readmission rates of 20.2%.
Patient satisfaction is another area where hospital organizations can demonstrate improvements in care delivery which can also impact reimbursement levels. For all but one question, 93-97% of patients answered positively with an agree or strongly agree response. The highest rated questions (agree or strongly agree) were for reliability and ease of use of the equipment (97%) and whether the patient would use the equipment in the future (96%).
The impact of MultiCare’s RMD program has already resulted in improved patient care, enabling patients to stay in their homes and has increased the efficiency of care delivery by reducing the high cost of rehospitalization.