A Trinity Health program aimed at helping patients get care remotely is growing beyond its Michigan test bed into six other states, part of a growing move toward telemedicine by an industry looking to save money and improve care.
It's also a way to take advantage of a home healthcare, an industry projected to grow more quickly than any other, fueled by aging baby boomers.
Like most home health agencies affiliated with hospitals, Trinity is seeking to avoid costly, unnecessary hospitalizations or emergency department visits by using technology to assist nurses and home health aides.
Trinity Health At Home's two-way video from Texas-based Vivify Health allows patients at home to communicate directly with nurses any time of day.
Each Trinity Home Care Connect telemedicine kit includes a wireless-enabled tablet and devices that let patients collect weight, blood pressure and other vital information.
The Trinity Home Care Connect telemedicine kit includes a wireless-enabled tablet and devices that let patients collect weight, blood pressure and other information.
After brief training by a home health nurse, patients turn on the device and begin to share vital information through voice and text instructions. The patient's data is monitored, in real time, by medical staff. If necessary, nurses can get doctors to consult with the patients through the tablet connection.
"It's part of our strategy for delivering people-centered care," said Erin Denholm, president of Trinity Health At Home, a division of Livonia-based Trinity Health, one of the nation's largest not-for-profit health systems with 86 hospitals, including 12 in Michigan.
In Southeast Michigan, Home Care Connect will launch April 17, with patients expected to receive their devices the next week. Clinical teams are being trained using the new remote monitoring devices and referring hospitals and doctors also are being consulted.
Nationally and in Michigan, home health, like many outpatient services, is booming, primarily because of the aging population but also because of the effort by hospitals and health insurers to reduce costs of care.
By 2029, when the last round of baby boomers reaches retirement age, the number of Americans 65 or older will climb to more than 71 million, up from about 41 million in 2011, a 73% increase, according to U.S. Census Bureau. A huge proportion of seniors will switch from commercial plans to Medicare, which provides the bulk of funding for home healthcare.
Under Medicare rules, physicians must write a prescription or order for home health services when a patient is discharged from a hospital. Medicare pays for up to 60 days of home health services if a physician certifies the patient needs the services and submits a plan of care. Patients may be recertified for another 60 days if physicians believe it is necessary.
In a study released in December 2015, the U.S. Bureau of Labor Statistics concluded the compound annual growth rate for home health services over the next decade could be 5%, the highest among all industries.
Last year, Trinity conducted a pilot program with the two-way Connect telemonitoring system with 62 seniors with an average age of 75. None of the patients, including those with a high risk of hospital readmission such as congestive heart failure were readmitted to a hospital within 30 days of discharge to their home.
"The evidence shows remarkable decreases in admissions," Denholm said. "For patients with chronic diseases like congestive heart failure, you'd expect a 5% rate. ... They can call every hour and see a nurse if they have problems or questions."
National data shows that 20% of all Medicare patients are re-admitted to hospitals within 30 days and 33% are readmitted within 90 days, costing Medicare more than $17 billion annually. Cutting readmissions to under 5% could save billions of dollars, experts say.
From a satisfaction standpoint, the Trinity pilot study also showed that 90% of patients felt more comfortable knowing a nurse was checking vital signs every day. And 100% of patients found using remote monitoring technology helpful to more clearly understand their conditions.
Most large home health agencies, including Jackson-based Great Lakes Caring Home Health and Hospice and Troy-based Residential Home Health, use a variety of telemedicine mobile remote monitoring devices.
Great Lakes has one of the nation's most sophisticated information technology systems. It features two-way patient-to-clinician video communication, a wireless patient care reporting system, patient education videos, telemedicine systems for medical monitoring of patients and a 24-hour nursing call center.
"Telemonitoring is a critically important component of any world-class telehealth program," said CEO William Deary of Great Lakes Caring. "Telemonitoring technology has advanced significantly in the past three years."
For example, Great Lakes Caring uses communication portals for the patient's primary care or specialty physicians and family care-givers. This addresses care coordination problems between providers and can help to reduce duplicative services. The recent introduction of advanced predictive software technology for computer-based telemonitoring also alerts nurses to risks that could lead to hospital readmissions, unnecessary ER visits and changes in chronic disease conditions, he said.
"The most important capability of our telemonitoring program is our ability to immediately triage a patient's health status (24 hours a day) to provide the best clinical intervention, as soon as we identify the patient's change in condition," Deary said.
Over the next several months, Trinity Health At Home will deploy its Home Care Connect remote care management technology to all its agencies in Michigan, Indiana, Iowa, Illinois, California, Maryland and Ohio, where it cares for about 10,000 home health patients.
Because elderly patients who live by themselves can get lonely, this feature also can help seniors with depression, said Denholm, who also is a nurse. "This allows for a safety net for people who are living alone."
"Trinity to expand advanced home health telemedicine system" originally appeared in Crain's Detroit Business.