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Remote monitoring

Remote Monitoring Technology Helps Chronically Ill Patients Avoid ED Use

By Dorothy Brooks, special to

Emergency providers are well-acquainted with chronically ill patients who frequent the ED because their conditions are not well-managed or controlled. Exacerbations of chronic illnesses often do, in fact, necessitate emergency care. However, with many EDs bursting at the seams with patients, it can be frustrating for clinicians to see these patients again and again for problems that could have been prevented with better outpatient management.

The business case for solving this problem is crystal clear, as inpatient and ED use are much more expensive than outpatient care, but figuring out how to effectively engage chronically ill patients so that flare-ups are prevented — or at least caught early enough to address in the outpatient setting — is not an easy task. Nonetheless, Peoria, IL-based OSF HealthCare is making progress on this front through the use of an innovative program that pairs 24/7 remote patient monitoring with a care team that can respond to data alerts or patient inquiries, and act as navigators when patients need to access primary or specialty care.

While the program first launched in 2019 with the specific aim of working with a subset of patients in one payer’s Medicare Advantage population, it since has expanded to include Medicaid patients as well. Furthermore, administrators tell ED Management that the approach has indeed lessened patient reliance on ED use, reduced the need for inpatient care, and lowered the overall cost of care for the complex patients engaged in the program.

Brandi Clark, MS, BS, the vice president of digital care for OSF on Call, explains that eligible patients are first identified for the program through an internally built scoring tool that identifies patients with multiple chronic conditions and comorbidities that are most at risk for hospital or ED use. “It’s a pretty complex data model that brings in a lot of different data sources, so it is not just looking whether a patient has been in the ED four times in the last year; it’s a combination of factors,” shares Clark.

There also is a referral process internally within the health system and for the Federally Qualified Health Centers that the program is partnered with for the Medicaid population, observes Clark. “Providers can make a referral of a patient they think may be appropriate [for the program], and then our team triage has that referral and determines whether the patient is truly appropriate for this program or one of our other lower-touch patient monitoring programs,” she says.

When an eligible patient has been identified, a navigator will reach out to discuss the program, and then if the patient is agreeable, the navigator will begin the enrollment process, explains Clark. “Once a patient is enrolled, their care team is made up of nurses and advanced practice providers. We also have a counselor and a dietician who can help serve patients who have needs that would benefit from their services, and then we also have our pharmacy team supporting a robust medication reconciliation process and medication optimization for the patients as well.”

The health system has partnered with Boston, MA-based Current Health to supply both the remote monitoring technology and the platform the program relies on to collect the remote monitoring data and communicate with patients. “Each patient gets a tablet that is configured so that they just have to push one button to connect to their care team, and then they also have peripheral devices [based on] the patient needs,” says Clark.

For example, heart failure patients will have a scale so the care team can remotely monitor their weights. Other patients may require a spirometer to assess pulmonary function. Blood pressure cuffs and thermometers also may be included in the technology kits that are provided to patients, explains Clark. All the data collected by these peripheral devices will go into the Current Health platform, which then is integrated into OSF HealthCare’s medical record system.

“Our team is monitoring all of this on the back end, so if a patient has vitals inputting into the system that are triggering that something is way out of range — or even just trending a little bit in the wrong direction for several data points, that is going to prompt the team to outreach to the patient and find out what is going on,” states Clark. “That’s how the platform really helps to prioritize where our team needs to focus their efforts with direct interaction with the patients.”

At any given time, the program has between 320 and 350 patients enrolled, explains Clark. “Of those patients we are doing outreach to, we have about a 60% enrollment rate,” she says. “We certainly do see some variability in how engaged a patient is once they enroll, but largely our patients do stay engaged for the period of time that is appropriate for them.”

While some patients reach their health goals and elect to graduate from the program, others prefer to stay connected, observes Clark. “We do see some patients who really begin to depend on and are motivated by the ongoing engagement with our team; it helps them to stay on track,” she says, noting that they are welcome to stay enrolled for as long they prefer.

There also are some patients with complex needs who may need to transition to other programs. “We are really diligent about helping patients to understand what other options are available to them and provide education about both palliative care and hospice if and when those options are appropriate,” adds Clark.

Although originally program administrators were heavily focused on reducing the cost of care, since they have begun working with the Medicaid population, they also have started delving much more heavily into demonstrating how the program has meaningfully affected patient outcomes. This is so the program can justify a reimbursement model that makes sense, notes Clark.

At the same time, the health system is hoping to expand the program to additional populations, including those on traditional Medicare and those covered by other commercial payers, explains Clark. However, she also stresses that the health system sees great value in using remote patient monitoring in multiple ways.

“Sometimes a patient isn’t eligible for this program, but maybe they have hypertension and COPD [chronic obstructive pulmonary disease],” she says. “We have a medium-touch, remote patient monitoring program that is focused specifically on several chronic conditions and types of individuals.”

That program works a little differently and the platform is different as well, but some patients with less intensive needs may be eligible for that program instead, says Clark. “We really look at remote patient monitoring on a continuum to apply the level of intervention and resources that are appropriate for patients based on their clinical condition,” she adds.

For colleagues interested in leveraging remote monitoring technology in a similar fashion, Clark emphasizes that understanding all your data is vitally important. “Where it is coming from and how you are using it is more complex that I might have ever anticipated that it would be, so understanding the population you’re going after and how you’re finding those patients is really important,” she advises.

Clark also highlights the importance of viewing any remote monitoring program as part of a model of care. “What we have found is that ... you can’t just sit a platform on top of an existing model and think that you’re going to get [improved] outcomes,” she says. “You have to think about how you are going to use the data, who is going to be on the other side of the platform you are purchasing or implementing, and truly engage with patients to get to a different outcome. The platform itself doesn’t do it.”

For more on this and related subjects, be sure to read the latest issue of ED Management.