Serving the home health, home care and hospice industry since 1999.
It is not about the money, at least not yet
Ms. Wheble told us the network is not yet generating enough revenue to pay a staff, including herself, but that a grant she has applied for may change that. In the future, hospitals and payers may be convinced of the wisdom of sharing with the network savings that accrue to them from significant readmission reductions. Pursuing that sales pitch is on her agenda for the future, after more data has been gathered and analyzed.
"None of our participating members joined the network for any reason other than a desire to improve patient care," the Director told HCTR. "We did have some who thought participation would increase their revenue but they ended their network membership when that did not happen. We were happy to see them go back to serving a relatively healthier and more profitable patient population. Every participant that remains in the network is committed first and foremost to providing quality patient care and to improving patient experiences."
TWO CRITICAL SUCCESS FACTORS
1. Home Telehealth
A large contributor to Community Health Initiative Network's drastic readmission reductions is its reliance on remote patient monitoring systems. Network members, especially home care and hospice providers, have access to the services of Fusion Care Systems (FCS). The Las Vegas company's turnkey patient monitoring services and call center remove from the home care and hospice company the burden of purchasing, installing, removing and sterilizing home telehealth devices. In addition, it gives them a menu of technologies that can be mixed and matched to meet unique patient needs.
According to company founder Matt Smith, FCS installs systems in a patient's home, an assisted living facility or a group home. Options include traditional desktop home telehealth vital sign monitors, with or without two-way patient communication systems, electronic medication dispensers, and passive monitors such as bed weight sensors, motion detectors and sensors that indicate opening and closing of refrigerator or food pantry doors.
"One of the obstacles to deploying home telehealth systems is not only the initial investment but the risk that a unit will sit on a shelf gathering dust or become obsolete," Smith told us. "If the home care agency owns it, they are stuck with it. With a turnkey service provider, they rarely if ever see the unit. We deliver it to the home, remove it when it is time and clean it between uses. When a more modern technology becomes available, we add it to our fleet."
Smith also described how the FCS call center service helps control hospital readmissions. "In the middle of the night, when a CHF or COPD patient might become distressed and otherwise call 911, they call us and we triage the situation. Their personal priority list might include a home health care on-call nurse, a relative or a next door neighbor. Depending on their condition, we call the appropriate person to intervene. When someone has to call 911, a hospital admission is almost inevitable."
2. Patient Education
Acknowledging the significant contribution of technology, Janet Wheble puts her faith in the positive effects of patient education. "The number one reason this network of post-acute providers has virtually eliminated hospital readmissions among the most at-risk patients with chronic conditions is because our members partner with their patients. We start in the hospital, educating them both about their medication regimen and the activities for which we expect them to take responsibility, such as diet, exercise and keeping appointments. Anyone who expects to duplicate what we are doing in their own area must begin with the axiom that patient education is the key."
Anyone who wants to duplicate CHIN is welcome to contact Janet Wheble and Matt Smith. Even though their experience with this project is less than a year old, it is easy to see from their early results that they have something of value to offer.
Editor's note: Matt Smith can be found on the web at fusioncaresystems.com. Janet Wheble's contact information is available by writing to us: firstname.lastname@example.org