HEALTHCARE AT HOME:
THE  ROWAN TECHNOLOGY REPORT

Serving the home health, home care and hospice industry since 1999.

by Tim Rowan, editor

In late 2018, CMS announced it would remove the rural setting as the only form of reimbursement for telehealth. Until new reimbursement models for remote patient monitoring in home health take shape, the U.S. healthcare division of Royal Philips is turning to hospitals, payers, and ACOs to keep sales strong. We spoke with General Manager of Population Health Management Niki Buchanan to learn about the company's population health program.

While CMS ponders a new reimbursement structure, Philips' Population Insights and Care Group is focusing its population health effort on ACOs, health systems and Medicare Advantage. Home health agencies, perennially a light investor in home telehealth technologies, are not expected to be in the mix.

"We will be working with partners to allow them to work with ACOs," Buchanan told us. "Once there has been an initial diagnosis and an in-person visit, we will provide technology patients can use to communicate with their personal physician and family members."

Philips' population health programs focus on patient cohorts most at risk for rehospitalization after discharge, such as persons with multiple chronic conditions. Care managers interact with patients that have been identified with data analytics tools. First contact occurs during hospital discharge and continues for 45 to 90 days.

"As healthcare organizations implement remote monitoring tools, we are a part of the data capture component that happens at discharge," Buchanan continued. "We design the most appropriate monitoring system for their condition. It may or may not include video visits. It may be regular telephone check-ins. The 2019 Physician fee schedule includes new HCPCS codes relating to heart, diabetes, and COPD that have created a way for physicians to be paid for remote monitoring.

She explained that work with hospital systems, ACOs, and payers includes segmentation and stratification of population cohorts under their care. "We use that analysis to help clinicians find the right patients to resolve care through scalable care management opportunities, from those who need only low-tech, high-touch care to advanced monitoring for those with multiple chronic conditions."

Another differentiator she described is the plan to survey patients about their feelings, to get a picture of loneliness and mental health that can be shared with clinicians. Some patients will receive medication management devices that allow adherence to medication instructions to be shared with clinicians and caregivers. "If someone is not compliant," she explained, "he can receive reminders."

The overall strategy is to make the home the center of care, bringing in opportunities for family and others to be part of the care team. The goal, as always, is to reduce readmissions and facilitate a hospital's ability to have earlier discharges. "ACOs are looking for revenue and improved patient outcomes to report," she emphasized.

One example of the program's efficacy comes from New York Presbyterian. Philips has helped them design a program to reduce hospital length of stay, preventable readmissions, and frequent, costly ED visits. As part of its broader population health effort, NYP has also implemented telehealth systems right in the Emergency Department. People can consult with specialists who may not even be at that NYP hospital.

The specialist can decide to admit or determine this is a non-emergency and schedule an appointment. Equipment in "The Telehealth Room" must be sanitized between users but it is still a fast way to reduce wait times. NYP also allows patients to go to a Walgreens where they have installed similar telemonitoring rooms. "Soon they will have telestroke technology in their ambulances," she added. "We are looking for many non-standard ways to care for co-morbid patients."

Device agnostic 

The most striking part of the program is that the Philips population health effort does not necessarily use only Philips telehealth equipment. The plan is to remain open to existing relationships partners may have with device providers, perhaps with iPads or other tablets. Patients may prefer to use their own device. "We are focused on software programs to help outcomes, not telehealth equipment," she said. "We remain focused on ROI, defined as patient outcomes and satisfaction." They do put potential suppliers through extensive compliance checks that can take up to a year.

Once an outside telehealth equipment supplier becomes part of the supply chain, they are evaluated quarterly, plus subjected to random audits. "If we run across tech glitches (video loss, patient breaks equipment), they are given a short period of time to fix it. We use our own Philips devices when we can, but in some remote areas they do not have suppliers." Philips has agreements with Samsung, Vidyo, and others.

Philips will purchase, on behalf of customers, the logistic supplies needed to do these programs. For example, for a health system partner outside Philadelphia, they will ship chosen equipment to their nurses. The system will deploy care managers to the home first, who will help patient and family get used to equipment, then establish the first remote connection back to the patient's primary care provider or specialist to make sure all connections work and the patient knows how to use it. Upon discharge after 45, 60, or 90 days, Philips picks up the equipment. Services are charged per patient per month.

Where is home health care? 

Buchanan explained that, in order to evaluate the success of a program like this one, you need large numbers of patients in your analytics database -- preferably five times the number of current patients in order to meet your quality metric goals. In the case of NYP, Philips examined claims data and analyzed it for 30 days to identify all co-morbid CHF patients. By then, assigning them a Johns Hopkins acuity score, NYP was able to focus its population health efforts on high- and medium-acuity patients.

"When we first tried a program like this three years ago, we started with home care agencies. But it turned into a tremendous cost to our business because an HHA would put 10 or 15 patients on their telehealth service. The amount of work for that small of a number never made the cost-benefit. So we pivoted strategies last year to focus on partners that have an expanded, cohort mix of patients, which turned out to be IDNs and healthcare systems, payers, ACOs, and pharmacies. Our recent acquisition of Blue Willow will help us expand to monitoring residents in SNFs."

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com