NEW YORK – A study recently published online that will appear in the December 2014 issue of the peer-reviewed journal, Population Health Management, demonstrated that a Geisinger Health Plan telemonitoring program significantly reduced hospital readmissions and cost of care for members diagnosed with heart failure. The telemonitoring program, which incorporated Bluetooth scales with an Interactive Voice Response solution from Advanced Monitored Caregiving (AMC Health), also improved the efficiency of care managers and delivered a 3.3 return on GHP's investment—in other words, for every $1 spent to implement this program, GHP saved about $3.30. The savings amounted to approximately $216 or 11 percent per patient per month between 2008 and 2012.
A previous GHP study, published in the journal Medical Care in January 2012, demonstrated the effectiveness of AMC Health's IVR solution to significantly reduce all-cause hospital readmissions.
Results of the new study, led by Daniel D. Maeng, Ph.D., Research Investigator at Geisinger Health System – Center for Health Research, Janet F. Tomcavage, R.N., M.S.N., senior vice president and chief, value-based care strategic initiatives, and members of her senior staff, are detailed in the article "Can telemonitoring reduce hospitalization and cost of care? A health plan's experience in managing patients with heart failure." The study compared inpatient admissions and total cost of care incurred by HF patients during the time when they were enrolled in the AMC Health telemonitoring program against those incurred when they were not enrolled in the program, adjusting for patient characteristics and other potential confounders.
A total of 541 members were included in the final evaluation. These patients were all GHP Medicare Advantage plan members, who were at least 65 years old with confirmed heart failure, and who maintained their plan membership for the 70-month study period. They had a high prevalence of comorbid conditions (most commonly hypertension and coronary artery disease) and incurred a significant cost of care (average per-patient-per-month cost of ~$1,600). The implementation of the telemonitoring program delivered an 11 percent cost savings during the study period, which is in addition to cost savings attributable to complex care management alone.
The members in the sample group experienced significant reductions in their probability of hospital admissions, as well as 30-day and 90-day readmissions in a given month. The study showed that the odds of a patient being admitted to the hospital in any given month were 23 percent lower during the months when they were enrolled in the telemonitoring program; their odds of 30-day and 90-day readmissions were reduced 44 percent and 38 percent respectively.
One of the key elements of GHP's successful case management program is timely and appropriate member follow up. Case managers routinely call each member to assess weight changes and ask specific questions about their symptoms. AMC Health's IVR solution automates this process. Because telemonitoring provides near real-time data, case managers are alerted almost immediately when biometric readings or IVR responses fall outside of specific ranges. This enables case managers to better identify pre-acute situations that can be addressed in the least costly and most effective care venues, namely the home or doctor's office, rather than the emergency department or hospital setting. Tomcavage highlights that "leveraging all the tools available to patients and the healthcare team is an important strategy as healthcare organizations look to deliver higher quality and more affordable health care to the populations they serve."
"Evidence that points to the significant value of remote patient monitoring in enhancing population health management efforts continues to mount. We are thrilled that a second Geisinger study quantifies this benefit for patients diagnosed with heart failure," said Nesim Bildirici, president and CEO of AMC Health. "As the nation's healthcare system continues its transition to value-based care and shared-risk arrangements gain traction, reducing hospital admissions and lowering the overall cost of care continue to escalate in importance. We are proud of the role AMC Health played in this important study."
Enrollment in the telemonitoring program was voluntary. To participate in the program, the participant needed a landline or cellular phone service to enable transmission of weight measurements via the Bluetooth-enabled scale and for the IVR calls. The IVR solution included a list of questions specifically designed to detect changes in physical condition indicating exacerbation, such as shortness of breath, swelling, appetite and prescription medication management. This information was then used by case managers to identify patients who were trending toward an acute event so they could work with the member and his/her healthcare team to create the appropriate intervention before a more significant healthcare issue occurred.
"According to research from the American Heart Association, roughly 5.1 million Americans have heart failure, and approximately half of the patients who experience the disease die within five years of diagnosis," added Doreen Salek, director, Population Health Business Intelligence at Geisinger Health Plan. "It is our hope that supplementing a strong case management program with telehealth solutions, as demonstrated in this study, can improve on those odds and ensure better outcomes for our aging population."
The complete study is available for review at: Population Health Management - Geisinger Health Plan Heart Failure Study.