Six years ago, the Geisinger Health System's health plan saw a problem developing in its case management program. The patient population was about to grow from 250,000 to 470,000 patients, partly as the result of new relationships with long-term care and other facilities. To keep the same level of care, more than 100 full-time case managers would be needed.
Rather than boosting the budget, Geisinger looked to telemonitoring. A pilot program was started with 50 patients at risk of heart failure. They would be monitored at home using Bluetooth-enabled scales and an Interactive Voice Program (IVP). The system and technical support was provided by AMC Health.
The program first engaged with patients when they were discharged from the hospital. Each patient was sent home with a kit. In almost all cases, patients were able to set up the device without any help (those who needed help assistance were supported by AMC Health).
Doreen Salek, director of population health business intelligence for the Geisinger Health Plan, and Joann P. Sciandra, the health plan's associate vice president of population management, shared results from the program at "Technology Advances in the Intelligent Medical Home, " a day-long symposium on Sunday that helped to kick off the 2014 mHealth Summit at the Gaylord National Resort and Convention Center just outside Washington D.C..
“The first year was about learning,” said Salek. “We needed to look at the workflow and see how this program could connect to the nurses.” The goal, she said, was to spot weight changes, an indicator of fluid retention that would call for an intervention. Case managers would evaluate the data and, when necessary, call patients to identify potential issues and contact nurses for an intervention.
The pilot proved successful almost immediately. Within the first year, the number of patients in the program was increased to 300. The program is now monitoring more than 1,100 patients at any given time. A total of 1,708 patients have taken part since launch.
Comparing the program’s results with the overall population of patients at risk of heart failure, Salek and Sciandra said the odds of admission are 23 percent lower. The odds of readmission 30 days after discharge, they said, are 44 percent lower for patients in the program. And at the 90-day mark, those odds are 38 percent lower. For every dollar spent, they concluded, there was a $3.30 return on investment.
The average age of the patients was 79, with a high prevalence of co-morbid conditions; hypertension and CAD were the most common.
Salek emphasized that the key to success lies in involving nurses and doctors. “We found out early if we don’t have the doctors involved, we wouldn’t get anywhere,” she said. Ninety-minute meetings are scheduled every other month with the care managers and doctors to review the cases and evaluate the program.
The heart failure program is part of Geisinger’s Proven Health Navigator initiative, a partnership between Geisinger’s hospital system and its insurance arm, Geisinger Health Plans.
The initiative is now looking at telemonitoring programs to address care coordination of diabetes and COPD patients.