The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Month: October 2017 (page 1 of 3)

Telemedicine growth in Michigan has the potential to reduce episode spending

Chad Ellimoottil

Chad Ellimoottil MD, MS is Director of Analytics for MVC and is an Assistant Professor and urologist at the University of Michigan.

Telemedicine use is rapidly growing in the state of Michigan and is increasingly gaining the attention of health system leaders, payers and policymakers as a way to improve value in quality of care for patients. Telemedicine is defined as the delivery of healthcare services and clinical information using telecommunications technology. Telemedicine can be synchronous (real-time) or asynchronous (also called store-and-forward). There are several commonly used telemedicine modalities:

  • Video visit: A form of provider-to-patient telemedicine whereby a clinician conducts an office visit with a remotely located patient using live video
  • eConsult: A form of provider-to-provider asynchronous telemedicine whereby a primary care physician sends a specialist a brief question to avoid a formal consultation
  • eVisit: A form of provider-to-patient asynchronous telemedicine whereby a patient submits a question or photo and a clinician answers it a later time
  • Remote patient monitoring: A form of provider-to-patient synchronous telemedicine whereby a patient is monitored by clinical staff at home using a device
  • mHealth: All forms of telemedicine that are conducted using mobile applications

 

The growth of telemedicine in Michigan has been fostered by forward-thinking commercial payers including Blue Cross Shield of Michigan and Blue Care Network who have been telemedicine friendly. For example, in January 2016, Blue Cross Blue Shield of Michigan began reimbursing for telemedicine visits conducted by patients at home. As we move beyond the early adoption phase, it is helpful to think about ways that telemedicine may be able to help reduce episode spending. For more information click here.

Reducing readmissions

Telemedicine interventions such as post-hospitalization video visits and remote patient monitoring may help reduce readmissions for conditions such as congestive heart failure. For example, by engaging the patient one-week after discharge using a video visit, clinicians can ensure that the patient is complying with discharge medications and that he/she understands important dietary recommendations. A video office visit may be more convenient for a patient who has transportation issue. In addition, daily remote monitoring of the weight of patients with congestive heart failure may help clinicians intervene before a hospitalization occurs.  While the opportunities are promising, it is important for health system leaders to know that many studies have shown mixed results on the association between telemedicine use and readmissions [1-2].

Reducing emergency rooms visits

Telemedicine is used in two main ways in the ER. First, telemedicine can be used in the ER itself to help connect ER physicians to specialists.  Second, telemedicine can be used to prevent patients from arriving in the ER by offering them a faster solution at home.  This latter promise of reduced expensive emergency room visits has been driving much of the momentum for telemedicine adoption. Several studies have shown that telemedicine has the potential to reduce unnecessary, low-complexity, ER visits, however, the verdict is still out there [3-4].

Telemedicine offers a number of opportunities to help reduce episode spending. As the technology gains traction with payers and health systems, it will be important to build an evidence base to support its use in an optimal way.

  1. Feltner C, et al. Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Ann Intern Med. 2014 Jun 3;160(11):774-84.
  2. Comín-Colet J et al. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial. J Telemed Telecare. 2016 Jul;22(5):282-95.
  3. Ward MM. Systematic review of telemedicine applications in emergency rooms. Int J Med Inform. 2015 Sep;84(9):601-16.
  4. Uscher-Pines L, Mehrotra A. Analysis of Teladoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff (Millwood). 2014 Feb;33(2):258-64.

Patient Support and Heart Failure (HF) Diets: Meal-Delivery Success for Reduced Readmissions

Abeer Yassine

Abeer is the MVC Engagement Associate

During a recent MVC HF Workgroup, hospitals shared patient education practices regarding HF diets with one another. The feasibility of implementing different programs, barriers in communication, and patient engagement along with potential solutions were discussed. The hospital representatives also shared different programs that their facilities engage in to work with patients on maintaining a healthy HF diet. While hospitals incorporate nutritionists or dieticians and educational materials in diet planning, some take unique approaches to helping patients adhere to their diets. For example, one hospital in the workgroup offers HF patients prepared, in-house meals at a subsidized cost. This helps address barriers such as accessibility to healthy food and any inability to prepare and cook meals due to disability. Addressing these barriers allows for enhanced chronic disease management.

Taking it one step further: What would happen if healthy, HF friendly meals were delivered right to patient homes?

In a recent study, Michigan Medicine observed the impact of nutrition support services, specifically home meal delivery post-discharge, on outcomes such as hospital readmissions and quality of life. In this small pilot trial, 66 HF patients were selected at random to either receive usual care consisting of a pamphlet on low-sodium diets or a meal delivery post discharge.1 The food was delivered to patients through PurFoods/ Mom’s Meals, a service that was also mentioned during the HF Workgroup discussion.1 The results of the pilot were promising: there was a total of 11 HF-related 30-day readmissions among the control group, versus only 3 HF-related readmissions in the experimental group receiving the delivered meals. 2 Although the pilot group was small, it is evident that providing post-discharge support to patients can prove to be significant to patient outcomes and avoidable readmission costs.

Furthermore, providing hospital-to-hospital support has also proven to be helpful through the workgroup discussions as well. During our dialogue, which included representatives from respective nutrition teams, a few hospitals were willing and open to sharing some of their patient education materials, including HF diet tip sheets. This allowed participants to share experiences, and best practices while learning about different initiatives that could have a positive impact on patient outcomes. A synopsis of the HF workgroup discussion on patient education and diet, including resources and a literature review, can be found in the MVC Registry under Resources.

If you are interested in learning more about this initiative, or HF workgroup, please do not hesitate to reach out to Abeer (abeery@med.umich.edu) or Deby (debevans@med.umich.edu).

 

Sources:

1 Geriatric Out of Hospital Randomized Meal Trial in Heart Failure (GOURMET-HF)

2 Does DASH Diet Meal Delivery Help Heart Failure Outcomes?

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