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Telehealth increases access to care

 

Telehealth increases

access to care¹

 

 

Providing access to care for Veterans across the country at hospitals and in their homes is a challenge shared by Medical Directors and Network Directors. Increasing costs and staffing demands make this problem more complicated. Innovative telehealth and telemedicine methods and tools can complement the VA’s current programs.

 

Cost and staffing difficulties

 

Increasing health care costs affect the VA, as they do other healthcare systems. Some recent numbers highlight this trend.

  • The top 1% of the US population ranked by health care expenses accounted for 22.7% of total health care spending, with an average of $97,956 a year. Overall, the top 50% of the population accounted for more than 97%²
  • The top 5% of patients in the US with four or more chronic conditions accounted for almost 30% of costs, with an average of $78,198 per year³
  • Veterans may be in a more precarious position than the general US population. Considerably more Veterans than non-Veterans age 46-64 reported two or more chronic conditions.⁴

 

At the same time, health care providers are experiencing staffing difficulties. A shortage of both RNs and LPNs is anticipated in several states and in rural areas.⁵ High turnover rates may further worsen the problem.

 

Philips innovative telehealth solutions for hospital and home care

 

Dr. Brian Rosenfeld, Chief Medical Officer, Philips Hospital to Home, outlined these troubling conditions at a recent conference.⁶ Rosenfeld also touched on Philips’ innovative integrated telehealth insights and technology that help to address these issues. Two speakers, who have collaborated with Philips on extensive successful telehealth programs, joined him.

 

Monitor more in-patients more often with more complete care

 

Wendy Diebert, RN, BSN, at the time of the conference was Vice President of Telehealth Services at Mercy Hospital St Louis. She spoke about telehealth and telemedicine on the in-patient side. Mercy is the seventh largest Catholic health care system in the US. Currently it includes more than 46 acute care and specialty hospitals across Arkansas, Kansas, Missouri and Oklahoma.⁷

 

The eICU allows specialized physicians and nurses to support the bedside care team even on nights and weekends. Critical care nurses with an average of 18 years’ experience can monitor patients, write orders and notes, and identify high-risk medications. They also back up bedside nurses with two-way audio video. Care delivered through this hub has resulted in fewer central line infections and less ventilator-associated pneumonia.

 

One of the advantages of this system is the improved lifestyle for clinicians and specialists who are supported by the eICU team. The result? Care providers have a work-life balance that may help reduce burnout and turnover.

 

One issue the hospital had was a lack of neuro specialists, so it was lagging in successful and complete coverage for stroke patients. With the telestroke program, a collaborative group of five specialists and a telehealth service provide far better and complete coverage. Mercy now has a successful quality offering in this area allowing much better care for stroke patients.

 

Diebert emphasized that managing and improving care is about real time data, and the system developed dashboards for everything it provides. With telehealth tools and collaborating with Philips, the dashboards clearly point to Mercy’s ability to be far more productive than if it grew solely by traditional means.

 

With telehealth tools - more complete monitoring and care delivery for patients at home

 

Julie A. Reisetter, RN, MS, Chief Nursing Officer, Banner Telehealth Services, spoke about working with Philips expert researchers. Together, they figured out how to establish programs and leverage technology for home care. Like the VA, Banner health has patients all over the country.

 

Banner Health offers services in Arizona, Nevada, California, Colorado, Wyoming, Nebraska and Alaska. Banner’s largest remote operations center is in Mesa, AZ. It also has three more in Denver CO, Santa Monica CA, Mesa AZ and Tel Aviv Israel.

 

Reisetter spoke about a project that enrolled a cluster of patients in NW Phoenix. These patients had multiple, complex issues, high utilization on claims and a life expectancy of a little more than one year. Each patient had a primary physician or gerontologist who maintained a traditional role. However, for this group, a telehealth team that included a health coach, medical assistants, a social worker and a pharmacist, supported the primary physician.

 

The teams addressed two discoveries immediately. Many patients had a high level of depression, often untreated. And, every patient had major medication issues. Some were taking duplicate or expired medications or not filling prescriptions because of costs.

 

Health coaches and medical assistants, trained by Philips visited patients. These coaches brought a new level of well-being into the home and gave the main caregiver a chance to take a break.

 

The entire health team was in contact with each other using integrated telehealth tools. Technology provided a real time picture of data, so they could deal with or escalate patients’ issues before they were beyond control.

 

So how well did it work? Reisetter reported in her presentation⁸ that data from the period of 12 months before the program and since show terrific preliminary results. The cost per member per month reduced from $500 to $150 and in-patient costs decreased by 50% for this population.

 

If it worked here, it could also extend the VA’s far reaching capabilities

 

By collaborating with Philips experts, Banner Health and Mercy had great success in reaching more patients more often with better service wherever they were located. Innovative telehealth was crucial for success. Other systems can adapt these solutions, so they too can enjoy similar success.

 

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¹Several articles point to increased access for patients. For example, Telemedicine and e-Health. May 2012, 18(4): A-1-A-146. doi:10.1089/tmj.2012.9994. Accessed 15-Dec-15. Another example, “Survey: Telehealth Increases Access to Care, Continuity”

http://www.aafp.org/news/practice-professional-issues/20151111telehealthsurvey.html. Accessed 15-Dec-15

 

²Cohen, S. Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2012. Statistical Brief #448. September 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://meps.ahrq.gov/mepsweb/data_files/publications/st448/stat448.shtml. Accessed 8-Dec-15

 

³Cohen, S. Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2012. Statistical Brief #448. September 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://meps.ahrq.gov/mepsweb/data_files/publications/st448/stat448.shtml. Accessed 8-Dec-15

 

⁴Veterans aged 45–64 were significantly more likely than nonveterans to report experiencing two or more chronic conditions (19% compared with 13% for ages 45–54, and 31% compared with 25% for ages 55–64). http://www.cdc.gov/nchs/data/databriefs/db101.htm#veterans Accessed 15-Dec-15

 

⁵The Future of the Nursing Workforce: National and State-Level Projections, 2012-2025, published December 12, 2014 by DHHS, HRSA. Accessed 8-Dec-15 http://bhpr.hrsa.gov/healthworkforce/supplydemand/nursing/workforceprojections/

 

⁶Enterprise telehealth presentation at the March 2014 ACHE Annual Congress in Chicago. https://www.youtube.com/watch?v=hAQ5sDdYmAM Accessed 9-Dec-15

 

⁷Mercy Hospital St Louis Fact Sheet. https://www.mercy.net/newsroom-mercy-hospital-st-louis-quick-facts Accessed 9-Dec-15

 

⁸American College of Healthcare Executives (ACHE) annual meeting in Chicago (March, 2014)
https://www.youtube.com/watch?v=hAQ5sDdYmAM Accessed 18-Dec-15

 

⁹ Dahl, D., Khurana MD, H. (2015). Impact of an intensive ambulatory program on both financial and clinical outcomes in Banner Health. Unpublished internal study. Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.