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Bringing Telehealth to Scale: Three Pioneering Health Systems

February 04, 2013 | Carolyn Newbergh

Telehealth technologies are often seen as a promising way to ensure that patients with serious health conditions receive the coordination in care they need after leaving a hospital so that they don’t wind up back in the hospital for the treatment of largely preventable complications. Remote patient monitoring (RPM) devices, in particular, can facilitate transmission of patient data to a health care provider and interaction between the patient and care provider in real time.

But use of these devices is only in its early stages – do we have evidence yet that they work?

telehealth in a doctor's officeIn a series of three case studies, Andrew Broderick, codirector of PHI’s Center for Innovation and Technology in Public Health, reviews three “early adopters” of RPM technologies and answers a resounding yes. At the Veterans Health Administration – which operates one of the largest health systems in the nation – and two other prominent health systems, Partners HealthCare, and Centura Health at Home, RPM is enhancing care coordination for chronically ill people, lowering health care costs, engaging patients in their own care and producing high levels of patient satisfaction.

The three health systems are pioneers in recognizing the potential of these technologies to extend health care for target populations within their systems. All three began with pilots that generated encouraging evidence that RPM would reduce avoidable hospital readmissions and costs – which reinforced the case for them and led to their expansion at scale.
 

Connected Cardiac Care: Saving Lives, Saving Money

For example, the Connected Cardiac Care Program at Partners HealthCare in Boston has provided telemonitoring together with education for 1,200 heart failure patients since its 2006 pilot program began. Since then, hospital readmission rates related to heart failure have continually declined about 50 percent; hospital readmits for non-heart failure have decreased by 44 percent. The program has resulted an estimated total cost savings of more than $10 million since 2006. The Center for Connected Health, Partners’ research center for developing, testing and implementing patient technology innovations, has led the organization’s ambitious move into telehealth-enabled care solutions.

In his look at Partners, Broderick finds that the technology has a positive impact on patient involvement in care and outcomes once placed in their hands, which demonstrates to providers that such programs can support behavior changes that lead to improved health and quality of care. “Participants receive constant feedback about how lifestyle factors affect health outcomes, as well as just-in-time care in which remote monitoring and intervention by nurses sends strong messages to patients that they are accountable,” Broderick writes.

Veterns Health Administration: Cost-Effective, Quality Outcomes

The Veterans Health Administration likewise demonstrated the benefits of remotely managing the care of chronically ill patients who are at risk of needing long-term institutional care. The VHA’s experience with remote monitoring is especially important, given that it is “the largest individual purchaser” of home telehealth devices in the world and plans to become even larger. “The VHA piloted, evaluated, and deployed home telehealth in a continuing process of learning and improvement, and found that an enterprise-wide implementation can be achieved and can lead to cost-effective, quality outcomes for chronic care patients,” Broderick writes.

The VHA program, Care Coordination/Home Telehealth, monitors more than 70,000 veterans via home telehealth devices that transmit health data to care coordinators. Noninstitutional care and targeted case management are provided to patients with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder, chronic obstructive pulmonary disease and depression. The results are strong: patient satisfaction levels exceeded 85 percent from 2003 to the end of 2010; the number of bed days of care declined 40 percent compared to pre-enrollment numbers.

Although expanding telehealth so broadly has its challenges for all organizations, the VHA was able to quickly and robustly put RPM in place for many reasons. Broderick points to the organization’s systems approach to coordinating the clinical, technology and business aspects of the program; a VHA culture shift that emphasizes continuous quality improvement; contracting with vendors on a national basis; the existence of a technology infrastructure; and the capacity for change along with a commitment to training staff to use this new tool.

“The VHA’s history has made it the health care industry’s test case for how to successfully plan and implement a program that has been embraced throughout the organization from senior leadership to the patient population,” Broderick writes. 

Centura Health: Extending Reach

Centura Health at Home in Colorado, like Partners, an integrated health system, merged a clinical call center with a remote monitoring telehealth program for patients being readied for discharge from the hospital. In a 2010-11 pilot, 30-day readmission rates for patients with three chronic illnesses declined by 62 percent, while emergency room visits dropped from 283 to 21 after the program was in place one year. The number of home visits declined to an average of three visits in 60 days from the previous average two or three visits per week before the program began. An estimated $1,000 to $1,500 was saved per patient.

Using RPM together with the telehealth call centers “benefited older adults’ health while making more effective use of existing health care resources and extending the reach of nursing staff,” Broderick writes. The merged program’s success has led to it now becoming the standard of care for all patients in the target population preparing for discharge home.

Technologies such as RPM play a pivotal role in achieving the goals of the “Triple Aim” – better health, better health care and lower health care costs – by facilitating a more integrated model of care that is team-based, patient-centered and accountable. The experiences of these three organizations provide not only evidence that deploying telehealth programs for target populations at scale is feasible and can lead to improvements in clinical and financial performance, but offer best practices that can support care providers with their planning and successful implementation at scale.  

Organizations interested in building technology-enabled programs to improve care management should explore the ADOPT Toolkit for practical toolkit resources to assess their organizational readiness and to support the design, planning and management of programs.

Read the synthesis brief and case studies:

Find out more about PHI's work in telehealth.  

 

Carolyn Newbergh is a writer and editor in PHI's communications department