Home Health News

by Sylvia Talkington

In the spring of 2006, Home Healthcare Partners (HHP) began placing remote telehealth monitors in patient homes. Today, the Dallas agency reports a 30-day rehospitalization rate that has dropped from near the national average, approximately 29% according to most reports, to a point just under 6%. Just as significant, rehospitalization among patients that are not monitored is less than 15% as a result of approaches to care that grew from the telemonitoring program.

HHP has accumulated a mountain of data in four years, data that can be analyzed in a number of ways to provide insights into the agency’s remarkable success. Twelve hundred patients are being monitored from 35 office locations and the plan is to double that number in 2010 but that is just the beginning of the data story.

HHP has captured data from more than 11,000 completed telehealth episodes. By the end of the year that will translate to almost a million patient days of data. At this point, HHP may have the most robust data repository, collected over the shortest period of time, related to home health remote monitoring, perhaps surpassing data collection on remote monitoring programs from grant funded academic studies and non-academic reports with relatively limited data.

Impressing referral sources

Healthcare reform has many complex ramifications but everyone is clear that reducing preventable hospitalizations is a top priority for cutting healthcare costs. Hospitals will soon pay penalties for uncontrolled recidivism rates and will be looking to post-acute care centers for help. Dropping to 6% and 15% for monitored and non-monitored patients, respectively, HHP will have quite a story to tell to area hospitals.

By all national comparisons, these are almost unheard of reductions. They become even more significant when considering that HHP’s service areas in Texas and Louisiana have the highest rates of uninsured in the country. Add to that evidence of increased use of healthcare services by new Medicare beneficiaries without previous insurance and the increased liklihood that these patients will have multiple chronic conditions propelling them to the ER and hospital.

What is HHP doing with all that data?

HHP has the ability to analyze data any way it chooses, using a particular analysis tool. Clinical and telehealth systems data are combined and housed in a data warehouse owned by HHP. As a result, data can be sifted and sorted to track, compare or contrast. The more data they collect, the more opportunity for analysis.

Using a prevailing motto shared by Wayne Bazzle, CEO, and Georgia Brown, Senior Vice President of Operations, “You can’t manage something without measuring it.”

Example. National studies identify medication management and compliance as a serious contributor to rehospitalization (up to 40%). What better data to add to the warehouse? HHP now enters all patient medications. Clinical and telemonitoring data is not collected haphazardly, however, nor does it exist in a vacuum. It is derived from very specific processes, processes that took two years evolve and mature.

The single purpose? To understand a patient’s needs as much as possible. Before he or she leaves the hospital, at the time of admission to home care, and throughout the care episode. Clinicians at every step are skilled at interviewing patients in person and over the phone about their health care concerns and medications. Telemonitoring is just one part of the process that can provide reliable data that add to understanding each patient’s needs.

Creating value for hospitals, clinics, and physicians

With the data HHP produces, owns, and can provide, participants in healthcare delivery across the continuum gain a better perspective about what sends patients to the hospital. Perhaps even more important, what keeps patients from being hospitalized. Imagine information specific to care provider, by age, gender, location, case mix weight, to name a few.

Evolving from a home health care business to a telehealth company for disease management

Data over time showed that the percentage of patients classified as having a chronic disease grew from 30% to 67%. That change had to lot to do with how HHP’s telehealth program was built. Historically, most home telemonitoring programs place monitors in homes of patients with specific diagnoses. It was not long before HHP discovered that patient health issues should be the driving factor.

When approached from a patient needs perspective, the entire care delivery model shifts from putting a box in the home for a particular diagnosis to providing a patient with access to an experienced clinician. Telehealth clinicians are required to have a substantial amount of critical care experience. Ms. Brown clarifies, “It is not about triaging [numbers]. We expect our clinicians to be confident in their decision-making skills.”

Telehealth clinicians at the Vital Station (where data is delivered) are skilled healthcare coaches and include nurses and respiratory therapists, working collaboratively. Each has clinical expertise and the necessary self confidence to work through a patient’s health issues without precipitating an unwarranted trip to the ER. Or, just as much confidence to advise when to go to the hospital.

Case in point: It is not about the numbers but what you do with the data. Reducing rehospitalizations is about connecting patients with health issues to experts with advanced clinical decision making skills to assess, advise, and coach the appropriate health care behaviors.

Where will the data lead?

Medicare home care patients are not the only chronically ill population contributing to unnecessary hospitalizations. Brown stressed, “You don’t need to have home health to make telehealth work. We’ve just used home health as our laboratory.” HHP is moving beyond program implementation and early outcomes monitoring.

The next phase, Phase II, is taking this incredible amount of data and working with an academic institution to validate the data and produce corresponding papers. From there, validated data can be used to build predictive models. What better way to affect preventable hospitalizations? Keep Home Healthcare Partners on your radar.

Sylvia Talkington is a senior consultant with Telehomecare Applications and former clinical subject matter expert for CMS, where she was a member of a development team for the design, development, pre-post production of a web based training targeted to the home health segment.