St. Mary’s Healthcare System for Children in New York recently rolled out a pilot that blends home care and telehealth for a particularly vulnerable population of patients, known as “medically complex,” that it says can likely lead to lowered costs and improved outcomes.
The health system received a nearly $1 million grant for the pilot from CMS and the New York State Department of Health to work with telehealth vendor AMC Health, which has worked with other systems like Geisinger Health with similarly vulnerable populations; in Pennsylvania, a similar effort led to a 44 percent reduction in risk for 30-day re-hospitalizations among Medicare patients.
At. St. Mary’s, the effort will focus on some 500 children deemed medically complex, meaning they have multiple conditions and are often reliant on medical devices, like feeding tubes or tracheal devices.
“A lot of them require long-term care over the course of their lives,” said Jonah Cardillo, senior director of grants and program innovation for St. Mary’s.
“This population in the last 20 years has started growing rather quickly, in recent years by about five percent,” he said, adding that advancements in medicine and technology have enabled a longer and better quality of life for such patients.
But coordination and monitoring is still a challenge, he said, particularly when it comes to preventing hospitalizations that could be stopped sooner with more interaction outside the hospital or skilled nursing facility. In addition to receiving traditional nursing and rehabilitation home care visits, patient caregivers will receive regular automated calls from an interactive voice response system, which will inquire about the child’s medication adherence, falls, emergency room visits, occurrences of major medical events and any other changes in condition, Cardillo said.
The responses to the two- to three-minute calls automatically generate reports, flagging responses that require immediate outreach by the telehealth nurse manager or other home care staff. Three nurses will oversee the telehealth aspect and will coordinate with other providers and caregivers.
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A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“What we’re trying to do is find an innovative way to increase the amount of communication with the kids who are receiving care at home,” Cardillo said. “If we’re able to communicate with the patients and their caregivers, we can identify a potentially adverse event. If there is a response that is a little worrying, that will trigger an alert to our telehalth nursing staff, who will make a call and identify the problem, and hopefully prevent hospitalization.”
Cardillo said the program is unique in it’s among only a handful that target the medically complex child patients. A lot of telemedicine efforts target the Medicare population or primary care, but few take on the more complex children populations, he said.
The telehealth framework with AMC Health will also eventually be integrated into St. Mary’s Medetech EHR system, Cardillo said, in part to incorporate new streams of data and also to ramp up for New York’s efforts related to regional health information exchange organizations, better known as HIEs.
“We have the capacity,” Cardillo said. “Right now we’re capturing all of the data in a secure online portal. We’ll integrate that with our EHR so we’ll have updates to our EHR in real time.
The grant is part of the Balancing Incentive Program’s Innovation Fund, part of a broader $45 million pool of funding for innovations under the ACA.
Cardillo also noted that with HHS and CMS further pushing for value-based payments over the fee-for-service model, the telehealth effort will be that much more valuable as the hospital, like all others, looks to stem readmission rates and improve patient satisfaction and health outcomes.
