Whitney Palmer

Riding the Wave of Home Health Technology

Published in the Aug. 8, 2012, Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

The next wave in healthcare is coming, and it has nothing to do with reimbursement, practice models or even new clinical strategies. Often referred to as “the Silver Tsunami,” it is the flood of Baby Boomers who require regular health services to manage their chronic conditions and maintain their independent lifestyles.

Ten years ago, before the mainstream adoption of consumer-friendly technologies like smart phones, tablets and associated mobile apps, this demographic and their family caregivers most likely looked primarily to long-term care (LTC) facilities for assistance. Now that mobile health technology and new care protocols are evolving – and coming down in cost somewhat – the home health industry is beginning to play a greater part in keeping these older adults in their homes and out of often cost-prohibitive LTC facilities.

Technology adoption is key to this evolution, even though providers have no financial incentive under the government’s Meaningful Use program to implement these methods. Using remote monitoring devices, telemedicine, and telehealth tactics gives older patients the power to self-manage their medical needs while keeping them tied to trained healthcare providers.

Forecasting the Need for Services
It’s a trend that’s growing nationally and globally in both dollars spent and patients served. According to a report earlier this year from global research firm Frost & Sullivan, North American spending on home health technology will jump from $126.8 million in 2010 to $294.9 million in 2015. Additionally, Swedish research firm Berg Insight reported the number of patients worldwide with home monitoring devices equipped with cellular connectivity jumped from 420,000 in 2010 to 570,000 in 2011. The report predicts this number will reach 2.47 million by 2016.

In light of cost containment efforts under the Affordable Care Act, these technologies are rapidly becoming indispensable from an economic perspective. According to 2010 Medicare data, 84 percent of beneficiaries live with at least one chronic condition, such as diabetes or congestive heart failure. Managing these maladies accounts for 34 percent of all healthcare spending, based on a 2010 RAND study. Without successful home healthcare technology implementation, these expenditures will balloon.

Strategies for Home Healthcare Agencies
As part of a home health patient’s individualized care plan, clinicians determine how best to use technology to maintain and improve the patient’s health. And, there are many tools that bolster home health’s efficacy, said Richard D. Brennan Jr., Executive Director of the Home Care Technology Association of America (HCTAA).

“We want people to think of home healthcare differently – we’re a significant player, not just Mom-and-Pop operations that send you a nurse,” he said. “We have a very sophisticated delivery model, and we’re very serious about our ability to use technology to not only lower costs and provide excellent care, but to also make sure other providers benefit from our involvement.”

The gateway-technology is often the home health provider’s laptop or tablet. These devices open the door to additional technology use by transferring information about a patient’s home and condition directly into the agency’s electronic health record (EHR). The EHR can also connect to a wearable monitor – a device worn by the patient that continually captures data and automatically sends it to providers for examination. Some tools even include a video component, allowing for face-to-face communication between patient and provider. Noticeable short-term or long-term changes, including weight fluctuations or a significant rise in blood pressure, are red flags, prompting either a home visit or a phone call from a healthcare provider.

Incorporating a wearable monitor into a care plan also empowers the patient to take more responsibility and control over their health status, Brennan said. The device creates a greater awareness of factors that directly impact their chronic conditions, such as diet, exercise, alcohol-intake, medications and stress levels.

Recent research indicates forging a connection between technology and providers is successful in keeping patients out of hospitals and LTC facilities. The Community Care Coordination Service studied 791 high-risk Veterans Administration patients with chronic conditions including hypertension, heart failure, diabetes or chronic obstructive pulmonary disease. The report revealed telehealth reduced emergency room visits by 40 percent, hospital admissions by 63 percent, and nursing home visits by 64 percent.

The next level of technology integration involves cloud-based mobile or wireless strategies, Brennan explained. For example, wireless glucose meters, blood pressure monitors, weight scales and pulse oximeters keep home health providers connected to patients with less equipment. Ultimately, the goal is to move patient data collection and analysis into a cloud-based format. Along with helping providers manage a patient’s care plan, a cloud-based system makes it possible to fix malfunctioning equipment remotely.

In addition to these telehealth strategies, the HCTAA is working on a smartphone app that will help patients find the home health agency that best fits their needs.

One Agency’s Experience
Ellen Bolch, president and CEO of home health agency THA Group, first realized the extent to which technology could improve home healthcare in 2000. When she saw a home telemonitor demonstration at a cardiology conference, she was an instant believer in the technology’s utility. Soon, THA integrated it into its toolkit, and the effect, she said, was rapid and significant.

Within three years of implementation, THA – with its 65-70 percent Medicare-recipient clientele – reduced readmission rates from 35 percent to 20 percent, slashed the number of emergency room visits per home health episode from 20 to 11, and increased patient capacity by nearly 50 percent without adding new nurse care managers.

The company quickly realized, though, that using health devices is just one prong in an overall strategy to keep older patients at home. To provide the best service, she said, home healthcare staff had to become proficient in telehealth.

“Telemonitoring is pretty cool – you can watch over a patient in their home from many miles away,” Bolch said. “However, it is in the critical thinking, judgment, and what a clinician does with telemonitoring tools where we learned how you build a clinical practice around telehealth.”

And, creating an effective telehealth strategy requires buy-in from all parties involved, she said, including patients, physicians and home health agencies. THA created such a system in 2007 through a partnership with a physician group that serves chronic-condition patients in South Carolina and Georgia. In this project, patients – all of whom had been hospitalized at least once in the previous year – agreed to contact their home health provider for assistance rather than the emergency department, and THA committed to responding immediately or facilitating a doctor’s office visit, if necessary, within 24 hours.

The results, especially when benchmarked against a similar New England Journal of Medicine (NEJM) article published at the same time, indicated telehealth can make a significant impact, Bolch said. At the end of six months and 12 months, THA’s participating patients had a 7 percent and 23 percent readmission rate, respectively. Patients from the NEJM study experienced 34 percent and 50 percent readmission rates at three months and 12 months.

“We knew, then, that we were really onto something,” she said, adding that another THA collaboration with the American Heart Association to help congestive heart failure patients saved a 600-bed medical center $4 million in one year.

Challenges to Home Healthcare Technology Use
Despite the benefits of using technology in home healthcare, the industry still faces challenges to complete implementation. As mentioned earlier, the Affordable Care Act and Meaningful Use requirements provide no monetary incentive for home health agencies to invest in technology strategies. For that reason, agencies have been slow to migrate toward these tools.

However, patients also present additional roadblocks in home health’s march toward a technology revolution. Research from RAND revealed that older home health clients aren’t familiar enough with technology, don’t have enough health literacy to use tools appropriately, or they lack confidence in their ability to effectively self-manage their chronic conditions.

To fix this problem, the RAND report called for payment incentives, as well as for home healthcare technology manufacturers to price products affordably and use clinical effectiveness and cost effectiveness data to prove these tools produce favorable results.

The benefits of using technology to bolster patient independence far outweigh any barriers to implementation, said Teresa Lee, Executive Director of the Alliance for Home Health Quality and Innovation. They play a critical role in fulfilling the home healthcare industry’s main mission – bolstering patient health and enabling them to stay at home.

“There are many challenges to implementing technology in home health well – it’s a decision you want to enter into confidently,” Lee said. “Most definitely, technology is a critical tool to put in place to solve key issues. It truly makes a difference in improved patient outcomes as opposed to putting patients back into an institution.”

To read the article at its original location: http://www.billianshealthdata.com/news/SiteNews/news_items/2012/August/Home_Health_Technology.html

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