The shift to managing more patients with fewer resources

Engaging with patients through mobile or other means for preventive care measures helps healthcare providers improve clinical outcomes and control costs at a time of expanding physician shortage.
07:26 AM

By Drew Schiller, CEO & Co-Founder, Validic

I recently had an enlightening discussion with a senior executive at a three-million-patient health system. This particular health system is developing remote monitoring programs for patients with managed conditions such as diabetes and hypertension. The motivation for developing and implementing these programs is not being driven by reimbursement incentives. Instead, this health system is being driven by a single, stark reality: over the next three to five years, a large number of physicians are retiring and even fewer are entering the workforce.

The physician shortage will grow over the next 10 years under every likely scenario. Addressing the imminent physician shortage will be a challenge for health systems that are already facing escalating regulatory pressures, an increasing number of patients in need of healthcare and a growing elderly population being treated for chronic conditions. Already, this health system is seeing their historic 2,500:1 patient-to-physician ratio begin to slip. By 2019, the system is expecting a record-setting 5,000:1 patient-to-physician ratio.

The challenge of managing more patients with fewer resources is not unique. Every health system is now asking the same question: how can we treat more patients with fewer resources? Stopgaps such as extending clinic hours, hiring Advanced Practice Registered Nurses (APRNs) and investing in medical education are necessary. But like many protocols in healthcare, these measures treat the symptoms, not the root cause.

The only way to service a growing patient population with a diminishing workforce is by implementing strategies that yield twice the productivity. I can state confidently, as a technologist, that the only way to create twice the output without doubling human capital is through the use of technology.

Disease management programs are commonplace, but extant services are often comprised of routine in-person visits, personnel that place weekly or monthly phone calls and staff that manually record patient-reported data. These current processes are not only extremely resource draining, but also not sustainable as more patients need healthcare services and fewer physicians are available to provide them. Technology, specifically solutions producing and integrating patient-generated health data (PGHD), can be leveraged to address many of the challenges patients and physicians are facing today.

Sutter Health in Northern California has implemented a remote monitoring program for patients suffering from hypertension. Patients enrolled in the program use their existing smartphones to download the program's app and, with the assistance of nurses, connect a provisioned blood pressure monitor, weight scale and consumer-grade physical activity tracker to the mobile application. Patients take readings with these devices daily and receive regular educational tips to keep them engaged. The patients’ data feed into a Sutter dashboard that integrates with the electronic health record (EHR) and provides care coordinators with the ability to quickly determine how well hundreds of patients are responding to their medication and adhering to protocol. The program also identifies those patients who are not performing as well as expected. The utilization of remotely collected patient data enables Sutter physicians and care teams to spend their resources with those patients who need care the most and allow healthy, adherent patients to continue managing their condition without needless interruptions.

This example demonstrates how one health system is leveraging PGHD to scale its resources and focus efforts on patients in need of regular, hands-on management while also monitoring those adhering to the care plan. Clearly, this is a model for the future of patient care. However, in the short term, how do health systems and individual practices pay for the implementation of these programs when prevention-based reimbursements are not yet a reality?

Brockton Hospital, part of the Signature Health System in Massachusetts, in partnership with iGetBetter, is leveraging PGHD to reduce readmissions for patients with heart failure and COPD. These efforts have led to improved patient care and outcomes, and more relevant, Brockton has witnessed a substantial cost savings. A Brockton pilot involving 31 heart failure patients was conducted in 2014 aimed to reduce readmissions utilizing connected blood pressure monitors and weight scales. Data from the devices fed directly into iGetBetter’s care management portal. Without this intervention strategy leveraging PGHD, Brockton typically sees a 28 percent readmission rate, which would have meant readmittance for eight of the 31 patients at a cost of $27,000 per readmission. In this study, zero patients were readmitted, leading to an immediate savings of $216,000. Programs like this demonstrate the immediate value of PGHD and provide a useful incentive for helping clinicians and IT staff begin to understand how to effectively capture and utilize patient data generated outside of the clinical setting.

Much of the talk about leveraging PGHD is centered around work being done by large health systems in urban communities. So, how can individual and regional practices take advantage of these data without a substantial IT budget? One opportunity is to leverage Centers for Medicare & Medicaid Services (CMS) reimbursement codes that incentivize disease prevention, the remote monitoring of patients with multiple comorbidities, and the remote collection and analysis of patient data. CareSync is one company that is helping providers deliver improved patient care and receive CMS reimbursements. They help physicians better manage their Medicare population by sharing risk and monitoring patients on a provider's behalf. The company provides a turnkey patient platform, meaning there is nothing for the provider to install in order to substantially increase the quality of patient care.

Engaging with patients in preventive care measures, whether through mobile or other means, is essential to improving clinical outcomes and controlling costs amidst the growing physician shortage. And, patient-generated health data is critical to preventative care, personalized medicine, precision medicine – whatever you choose to call it. Leveraging PGHD to guide clinical interventions and care decisions, health systems have an advantage that will pay off in not only improved care quality, but also sustainable financial returns.

The time to act is now. If you wait to start thinking about your digital health strategy and launch in two or three years, you will be far behind the market. The companies that are actively working to solve these problems today are the companies that are going to be successful in the future. You cannot wait for it to happen and then respond. The industry has to be proactive in building a sustainable model to drive value-based care with technology.

Drew Schiller is the co-founder and CEO at Validic.


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