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News Roundup: May 6, 2016

How One Home Health Provider Cut Readmissions 75%

Published by Home Health Care News
By Amy Baxter
May 6, 2016

Getting patients to comply with care instructions, whether following a specific diet plan or taking medications at the right time, is one of the biggest challenges for the home health industry. It’s also one of the leading causes of hospital readmissions and an issue that innovative startup businesses are taking on.

Health Recovery Solutions (HRS) is one startup tackling that issue, and it’s already seeing some great results after teaming up with HomeHealth Visiting Nurses of Southern Maine (HHVN), the largest home health care provider in Southern Maine. HRS’ system works off a tablet, which patients use to track their own health, work face-to-face with nursing staff and inform family members of their status with mobile app check-ins.

Since implementing the Patient Connect Platform software and outfitting 474 of HHVN’s high-risk patients with tablets in 2015, readmission rates have plummeted 75% to just 4.2% of this patient group as of April 2016. The state readmission average in Maine, by comparison, is 16.6%, according to HRS.

“We’re really impressed from the results, because with the patients who are on our program, they’re the frailest with really advanced chronic diseases,” Mia Millefoglie, vice president of development and marketing at HHVN, told Home Health Care News.

HHVN has utilized telehealth since 2002, but have experienced better results over the last six from using virtual video components with patients, according to Millefoglie.

“[Our specialist] can really look and do more of an assessment,” Millefoglie said. “It’s live and virtual, and they can make more recommendations, contact the doctor and do interventions more quickly and accurately. It’s essentially a HIPAA compliance Skype visit by a specialty nurse who is right there.”

While HHVN has been able to get seniors and home health staff to implement new technology to drive better health outcomes, the industry at large faces headwinds when it comes to tech adoption and how seniors use health and wellness apps.

“What we focus on is how do we engage patients so that they stay out of the hospital,” HRS CEO and Founder Jarrett Bauer told Home Health Care News. “We want the patient to be more proactive in their life. They are the ones who answering reminders, tracking their daily activity and seeing what their trends have been.”

The system works when patients engage with it, and HHVN patients spent an average of 24.6 minutes daily engaging with the tablet over the last year, the data revealed. Patients watch educational videos, track their daily activity and answer survey questions about their health and experience. The use of the tablet can update care teams about a patient’s current condition, which can catch health changes sooner and potentially eliminate a trip to the hospital.

“When we see that the average engagement is [over] 24 minutes per day, that’s exciting,” Jarrett Bauer told HHCN. “Over a month, that’s 12 hours of education someone received or 12 hours of nursing that they normally wouldn’t have.”

Over the last six months, the readmission rates continued to improve for HHVN’s patient groups. Among its congestive heart failure and chronic obstructive pulmonary disease patents, readmissions fell to 2% and 1%, respectively. Readmission rates for diabetes patients dropped to 3.3%.

HHVN’s dramatic results might be an indication that more seniors are willing to engage with technology and take more responsibility in their own health care plans at home. That could spell good news for top corporate venture capitalists (CVCs) that have recently begun setting their sights on innovative startups within the space.

“We are betting on engagement,” Bauer told HHCN. “We’re betting on software being the answer and the idea that in the future there is going to be more leveraging around the patient with technology and family members.”

As the health system continues to shift toward value-based purchasing and new reimbursement models like bundled payments, technologies that reduce hospital readmissions—and therefore financial penalties—are going to continue to play a bigger role in home health. Getting seniors and nursing staff alike to engage with technology is just one piece of the puzzle.

“The only way to get better is to use technology to think differently,” Bauer said.

Elderly, Ailing—and Treated at Home

Published by The Wall Street Journal
By EZEKIEL J. EMANUEL
May 6, 2016

A few years ago, Luberta Whitfield suffered a stroke that left her right side paralyzed. The wheelchair-bound 87-year-old has emphysema and diet-controlled diabetes, is dependent on oxygen, and recently tore the right rotator cuff on her good arm. She also, amazingly, still lives in her own apartment.

Ms. Whitfield is a participant in Independence at Home, a congressionally authorized pilot program. The program gives the sickest Medicare patients primary care right where they live. Since launching in 2012, it has been a tremendous success, delivering high-quality care at a lower cost than traditional Medicare.

Unfortunately, because of a legislative quirk, the administration lacks the legal authority to extend the program across the U.S. The project has enrolled 10,000 patients, but that is the limit imposed by the law. Congress should make the program a permanent part of Medicare. It would benefit not only patients hoping for higher quality of life, but also taxpayers.

To qualify for the program, applicants need to have been hospitalized within the past year and to suffer from two or more chronic conditions. They must also require help with basic daily tasks, and have needed some kind of rehabilitation services, such as a stay in a skilled nursing facility, in the past 12 months. These patients are so sick that more than 23% die each year, and they average an extremely high $45,000 in annual Medicare spending, according to Centers for Medicare and Medicaid Services analysis.

Targeting high-intensity patients is key to saving money. Frail elderly people who qualify make up 6% of Medicare patients and account for nearly 30% of the program’s spending, a study in the Journal of the American Geriatrics Society has shown. Fortunately, a care coordinator, nurse or physician can easily identify eligible patients, with no need for complicated algorithms.

Once patients are accepted, they receive coordinated primary care focused on keeping them healthy and in their home. Ms. Whitfield, for instance, has two aides who provide six hours of daily personal care, far more than she would receive in a pricier nursing home. Her primary-care team is available at all times and visits her at home within 48 hours of any hospital discharge or emergency-room visit. It also coordinates care with specialists and mental-health providers, and can even bring in a mobile laboratory for blood tests, X-rays, EKGs and ultrasounds. Physical therapy and other rehabilitation services can be provided at home too, along with hospice care. It is concierge care for the sickest—not the richest.

Hospitalization is avoided unless absolutely necessary, and when it is, the care team coordinates the patient’s transition back home. An earlier study at one of the program sites in Washington, D.C. has shown that home-based primary care reduces hospital stays by 30%. The pilot program’s first-year savings averaged $3,000 per patient. If estimates in a study published in the Journal of the American Geriatrics Society are right, the program could save Medicare tens of billions over 10 years.

Quality of care has also objectively increased. Independence at Home includes 17 sites throughout the country. All of them achieved Medicare’s minimum quality requirements in the first performance year. More than a third of them reached all six of Medicare’s quality measures, which evaluate criteria like the number of inpatient admissions or emergency-room visits.

Independence at Home works because human relationships form its foundation. By treating patients at home, the primary-care team can assess aspects of their patients’ lives, such as diet and mobility. Social workers on the team can then coordinate services such as legal counseling, food, supportive personal care, and home modifications to eliminate hazards like loose carpets.

Physician groups, who join the program and bid to provide these services, receive bonuses for the cost savings they achieve, but only after total costs for their patients are cut by 5%. If they can’t achieve those reductions for two consecutive years, they cannot share in the savings until their performance improves.

Independence at Home demonstrates how care will be delivered in the future: where sick people live instead of in a hospital or a physician’s office. It is a win for patients, providers and taxpayers. Congress should lift the 10,000-patient cap and take the program national. It will provide an example for the rest of the health-care system, while giving millions of seniors the best care available in their own homes—exactly where they want to be.

Dr. Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, was a health-policy adviser at the White House budget office during the passage of the Affordable Care Act.

How Home Health Could Sync Better with Other Providers

Published by Home Health Care News
By Amy Baxter
May 6, 2016

The state of Vermont has aimed to reduce gaps across health care providers by adopting and subsidizing a technology program that enables real-time communication that follow patients as they enter different care settings. Providers not communicating across care settings is one of the biggest issues of an evolving health care system that increasingly rewards care coordination.

Vermont has partnered with PatientPing and Vermont Information Technology Leaders (VITL) for a state-wide adoption of a program that enables health care providers to follow their patients if they are admitted into another care setting via a “ping.” PatientPing is a Boston-based health technology company with a nationwide community of more than 12,000 health care providers in five states. The program is one of the first of its kind to connect providers universally across an entire state.

“If you’re a home health agency nurse and your patient gets admitted to the hospital or shows up at the emergency room or transitions to a skilled nursing facility, we will notify them about that in real time,” PatientPing Founder and CEO Jay Desai told Home Health Care News. “The nurse can work with that provider and ensure the patient gets the best possible care.”

The system replaces the current inefficient methods that different care settings utilize to talk with one another.

“The current status quo [of care coordination across providers] is a hodgepodge of emails, texts, fax and phone calls,” Desai said. “In fact, they are probably a pretty sophisticated provider if they are using text and email.”

The ping notifications follow a patient’s movement when they travel across the care continuum and can be viewed and accessed in a few different ways. VITL, a 501c3 non-profit organization that advances health care reform efforts in Vermont, is a vital part of the equation. Having already been working in Vermont for the last decade, VITL already connects to the state’s hospitals and numerous providers to share health information.

“Our role is to connect all of the disparate clinical data in the health care system out there and make sure providers have the information that they need,” Robert Gibson, vice president of marketing and business development at VITL, told HHCN. “We already had a lot of the infrastructure in place. We had connectivity to a lot of the electronic health record systems in Vermont. It was natural for us to play the role of providing data to do the alerts.”

The infrastructure already in place was originally designed to enhance information from health care providers and is now being used as a tool to enable the state’s community of providers to stay in touch. PatientPing is also working with accountable care organizations (ACOs) in the state to outfit the tool to as many providers as possible.

The connections that the program makes could also potentially enable more care to take place in home settings, according to Desai. When hospitals and other acute care settings are discharging patients, connecting with a home care agency or other provider that will handle the transition helps reduce readmissions risks.

“We do know for sure that timely notification of patients getting admitted and being discharged anywhere to the full care team [?], having that care team work together reduces the risk of hospitalization,” Desai said. “It can also reduce the amount of time that a patient is in a rehabilitation facility. By going home with home supports, home care in particular, the patients can get that care in a much lower cost environment and ensure that they are not going back to the hospital.”

With the rollout across Vermont already on the ground, PatientPing is still collecting data on readmission rates. As part of the partnership, Vermont has agreed to subsidize 70% of the service for providers who want the technology, accordion got Desai. While the Green Mountain State is on the forefront of adopting a universal care coordination technology, others are likely to follow suit.

“Vermont is a very innovative state,” Desai said. “We’re talking to a number of other states to replicate the same sort of effect.”

The three-way partnership between a state entity, a technology business and a non-profit organization that straddles public and private lines is leveraging information that was already available and pushing it to become more useful.

“Right now, there is not really a great standard around the country, and that’s a problem,” Desai said. “The last thing we want is for a provider to have to make it really difficult to log into multiple systems and deal with that.”

Home Health Care Continues to be a More Affordable Option for Seniors and Others

Published by Home Care Daily
By Valerie VanBooven
May 6, 2016

For years now, home care has been a more affordable option than any other type of senior care. Compared to nursing home care and assisted living, for example, depending on the state, the cost can be a quarter or less than nursing homes and less than half that of assisted living.

As the Baby Boomer generations closes in on retirement age, there is expected to be an increased demand for these types of support systems for growing numbers of seniors. As men and women live longer than ever, they also often face increased health risks, physical limitations, and other challenges.

Some of these seniors may require a minimal level of care and support at home while others might demand full-time, around the clock care from home care aides, visiting nurses, and other medical professionals.

Home health care can encompass many aspects of care and support, including the aforementioned visiting nurses, physical therapy, occupational therapy, and home care aides.

Parker Franklin and Tracy Ross write a brief introduction on an interview broadcast on NPR regarding home health care, called A Conversation on Home Health Care Treatments:

“Sullivan [Tammy Sullivan of Baptist Health Home Care] says home health is designed to meet patients’ needs, and is adjustable based on each patient. It’s not a service designed solely for those that are extremely sick and need assistance. There are several payer sources including Medicare, VA and private insurance.”

Home care aides are ideally suited to provide lower cost support and care for seniors and disabled adults. They don’t require medical training and, depending on the agency or other home care provider, they may not require any prior experience, but their physical and emotional support for these seniors is often immeasurable.

Each person is different and there is no such thing as a one-size-fits-all approach to home care services. With regard to nursing home care and other options, seniors who may only require minimal care could find themselves in an uncomfortable environment that is far more costly than if they remained home, perhaps in a home they’d lived for many years.

More and more seniors are realizing the value of home care support for basic assistance and even companionship, and with private financial sources, they can be relied upon for anything the elderly client may need. It can be ideal for helping the senior get out of bed, to go to the store, or even assistance preparing breakfast, for example.

The cost factor of home care continues to make it a far better option, according to many, than any other type of elderly care.

Advance care planning vital to true patient-centered care

Published by Modern Healthcare
By Dr. Richard Lopez
May 6, 2016

A report issued by the Dartmouth Atlas Project this year found that as people age, many continue to receive care that does not align with their own preferences.

This is especially true at the end stages of serious illnesses.

While many patients tend to prefer comfort measures over further medical interventions, the Dartmouth team reported that patients are spending more days on average undergoing aggressive treatments in the intensive-care unit, despite concerns over the value of such care.

Although excellent pain relief services are available for patients in need, the report also found that late hospice referrals occur too frequently—adversely affecting not only the quality of care delivered, but also the experience and satisfaction of patients and their families. Rather than rushing through a process of providing pain medications in these situations, hospice professionals need more time to get to know patients and families, building trust so they may truly address their needs.

In too many cases, efforts to prolong life can result in drawn-out, uncomfortable and even painful final days. While not an easy topic for anyone, the report sheds much-needed light on the fact that physicians must be comfortable discussing end-of-life care planning with patients. We owe it to them to respectfully open this dialogue and ensure their care decisions, goals and wishes are honored.

Although the CMS announced last year that it would begin providing reimbursement for end-of-life discussions with patients, they can still be incredibly difficult on a personal level for a clinician to initiate. As physicians, we are conditioned to develop meaningful, long-standing relationships to ensure our patients' health, making end-of-life issues so hard to broach. Patients are also often uncomfortable proactively sharing their feelings on the topic. But these conversations are essential. From an organizational standpoint, it can be challenging to implement practices that help physicians have these discussions, and to document their patients' wishes so they are available when needed.

Send drafts to Assistant Managing Editor David May at dmay@modernhealthcare.com.
Despite these obstacles, the ability of a healthcare system to honor its patients' care preferences at the end of life is essential to providing patient-centered, quality care. Establishing an internal support system, which includes comprehensive training, is an effective way to help physicians learn how to respectfully begin these conversations as part of routine care.

At Atrius Health, those with extensive expertise in advance care planning serve as mentors for their colleagues, using video presentations, interactive sessions and role playing as various means of strengthening competencies among clinicians in initiating conversations with patients about end-of-life care and documenting patient wishes.

These responsibilities should not rest with physicians alone. Patient-centered care is a team endeavor, so all who serve patients should be well-versed in end-of-life care. While it is important that physicians consider these conversations with patients of all ages, such care planning and documentation is especially vital for geriatric or critically ill patients.

In collaboration with a patient's primary-care physician, multidisciplinary palliative-care teams are critical in meeting the needs of patients and their families. This coordinated approach allows specially trained physicians and advance-practice clinicians, case managers, home care nurses, chaplaincy and social work disciplines to treat symptoms and facilitate advance care planning, while also providing psychosocial support through family meetings, bereavement care and referral to hospice when appropriate.

The cultural shift necessary for clinicians to responsibly and compassionately approach end-of-life care will not happen on its own. Just as we are accountable for honoring our patients' wishes, we have an obligation to support our colleagues through these difficult discussions. We owe it to each other to provide this assistance. More importantly, we owe it to our patients to make sure we do it right.