The Michigan Value Collaborative

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

Tag: reducing readmissions (page 1 of 2)

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.

Managing High-Needs Patients can Help Improve Outcomes at Michigan Hospitals

Abeer Yassine

Abeer is the MVC Hospital Engagement Associate

Only about 5% of patients are considered high-need, yet these patients constitute nearly 50% of total healthcare costs. High-need patients typically have more complex diagnoses and significant barriers to accessing healthcare that impacts the self-management of their condition(s) outside of the hospital. In a recent, pre-publication report, Effective Care for High-Need Patients, the National Academy of Medicine (NAM) outlines various characteristics of high-need patients, patient taxonomy models, along with care models. This report is a compilation of feedback from relevant workshops, presentations, discussions, and literature and stresses the importance of identifying and managing care delivery to high-need patient populations.

High-Need Patients Characteristics

To better create targeted initiatives in a hospital setting for high-need patients, there needs to be better identification of characteristics using data. Although there is not one, specific definition of “high-need patients”; functional limitations, complexity of care/disease, and health care costs are all characteristics that can be used to identify and analyze these patient populations. These characteristics not only impact the care that is delivered within the clinical setting, but also the ability for that patient to self-manage their health outside of the hospital.

High-Need Patient Taxonomies

NAM reviewed two patient taxonomy models in use by the Harvard T.H. Chan School of Public Health and The Commonwealth Fund to better segment patients for improved identification of high-need populations. Using a taxonomy model can guide health systems to more suitable integration of behavioral, social, and functional characteristics in the patient care plan outside of the clinical setting. What is unique about the taxonomy developed by NAM is that it builds upon clinical and medical characteristics to identify behavioral health and social factors that affect care delivery decisions. More detail about this starter taxonomy and a conceptual model can be found here.

Successful Care Models for High-Need Patients

This NAM report also uncovered common characteristics among care models that are successful in managing high-need patient populations. The report mentions that successful care models typically expand upon domains related to health and well-being, care utilization, and costs. Furthermore, these care models include details on dimensions related to service setting focus, care attributes, delivery features, and organizational culture. By targeting a specific high-need patient population (ex: age group), health systems are better able to create care models and initiatives geared towards improved, more integrated care delivery. The report also outlines an analytic framework that helped NAM identify successful care models for high-need patients.

The MVC Coordinating Center can help member hospitals identify domains and care utilization of high-need patients.  If you are interested in identifying these populations within your hospital, please reach out to Deby (debevans@med.umich.edu) or Abeer (abeery@med.umich.edu).

Interested in learning more about optimizing care delivery for high-need patient populations? More information and a copy of Effective Care for High-Need Patients can be found below:

https://nam.edu/effective-care-for-high-need-patients/

https://nam.edu/wp-content/uploads/2017/06/Effective-Care-for-High-Need-Patients.pdf

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