How failure mothered an effective post-discharge monitoring tool

HealthLoop Inc. was born out of clinical failure. Founder Dr. Jordan Shlain had prescribed antibiotics for a 60-year-old woman with pneumonia. She ended up in the intensive-care unit with respiratory failure.

Shlain wondered why she didn't follow up. Then he wondered why he didn't, either. He began keeping a spreadsheet to help track patients and soon met with a computer programmer to automate the process.

Today, HealthLoop's software helps health organizations monitor and engage patients through their smartphones, computer or tablet. Patients receive instructions in bite-sized chunks and answer questions about their health. Their answers are used to collect patient feedback and flag potential complications that could lead to expensive emergency room visits or readmissions.

Services like HealthLoop are increasingly in demand as Medicare changes its payment system to encourage hospitals to become more responsible for patients' clinical and financial outcomes over the entire episode of care—that is from the time they were admitted to the hospital until 90 days after discharge.

“It's the new revenue cycle,” said HealthLoop CEO Todd Johnson, adding that Medicare and Medicaid are shifting billions of dollars in payments into episode-based reimbursement schemes. The CMS' latest program, which covers bypass surgery, heart attacks, hip and femur fractures, represents about $11 billion in annual spending.

HealthLoop was founded in 2009. It was initially conceived as a tool for physician practices and it developed a good following, especially among orthopedists. These physician groups helped it get a foothold in larger healthcare organizations.

Northwestern, which plans to launch a pilot of HealthLoop in September, was introduced to the company by an orthopedist, who was a “strong champion” of the technology, said Jodi Rosen, director of innovation at Northwestern Memorial HealthCare in Chicago. The yearlong pilot includes 19 physicians across three departments.

HealthLoop was also in the right place and the right time. New policies created financial incentives for hospitals to focus on post-acute care. And that, according to Johnson, acted as a “shot of adrenaline.”

There are about 1,500 providers who voluntarily participated in the Bundled Payments for Care Improvement Initiative, an ongoing program that began in 2013. And this year CMS required hundreds of hospitals across the U.S. to participate in bundled payment programs for joint replacements and common cardiac events and procedures, which puts providers at risk if they fail to reduce readmissions because patients experience ineffective post-acute care.

“Large healthcare systems understand that they have to find ways to reach patients outside the four walls,” said Johnson. The company has built a library of over 110 care plans for numerous specialties, including orthopedics and cardiology, and for chronic disease management, he said.

With HealthLoop patients receive a daily text or email from their doctor, asking them to “check in” and linking to HealthLoop's website (it can be either a mobile site or a regular website). Patients answer several questions designed to assess their health and instruct them on what to do in the days leading up to surgery and once they are discharged from the hospital. The questions are also designed to be empathetic and reassure patients, Johnson said.

One question asks: “Rashes, scratches, bruises or scabs may exist around the area where your procedure will be done. While uncommon, they can increase the likelihood of an infection after your surgery. Do you notice any of these issues around the area?” A patient can either check a box saying, “Nope, everything looks great” or “Yes. Please upload a photo of your knee at the end of the check in.”

Algorithms monitor patient responses, flagging potential problems and sending alerts to hospital staff. If the hospital doesn't have staff member to receive the alerts, patients are directed to seek help through a nursing triage line or a physician.

The site also has a checklist for patients to keep track of what needs to be done each day and it allows patients and hospital staff to electronically chat. Patients may ask questions about their care and hospital staff may send messages at key times, like when a patient needs to stop taking blood thinners prior to surgery.

HealthLoop also helps health organizations collect patient reported outcomes, which are surveys used by Medicare as a determinant of hospitals' overall quality of care. That's important because health organizations can get a bonus if they meet the quality threshold and provide care at or below the target price set by Medicare.

About 60% of its patients answered patient reported outcomes questions over a span of about a year, according to the company that used data from 20,326 patients.

Still, it is hospitals and health systems with in-place case managers who can receive and respond to messages during the entire episode of care that are in the best position to take advantage of HealthLoop.

Froedtert & the Medical College of Wisconsin, which deployed HealthLoop this summer in its orthopedic center, began experimenting with bundling orthopedic care four years ago. It created a new role—nurse navigators—who are responsible for educating patients about what to expect before the surgery and overseeing their care through the post discharge period, said Mike Anderes, vice president for Digital Health for Froedtert Health and the chief operating officer of Inception Health, a company formed by the Froedtert & the Medical College of Wisconsin to accelerate the adoption of digital health.

Anderes hopes that HealthLoop will improve nurse navigators' efficiency by automating parts of the job. He hopes the tool will enable them to increase their caseload from about 50 to 200 patients with improved ability to stay in touch and intervene with patients when they veer off course.

In part five, read about the app Northwell built for patient monitoring.

Lisa Ward is a freelance writer based in Mendham, N.J.