The Iowa-based health system's Remote Patient Monitoring program looks to deliver on its promise to improve rural population health and reduce readmissions and ED visits by using targeted interventions.
At some point the promise of telemedicine will arrive for rural America, and it will look like what is happening right now at UnityPoint Health.
Over the past two years, the Quad State-area health system headquartered in Des Moines, IA has slowly rolled out an updated and enhanced remote patient monitoring program through its UnityPoint at Home division. If the program works as promised, it will reduce readmissions and ED visits, while improving outcomes and maintaining health for the chronically ill population it serves.
"When you have a remote patient monitor, the goal is to help them self-manage their chronic conditions because they are going to have it long-term," says Vicki Wildman, RN, virtual care director UnityPoint at Home.
"Generally, the patients benefit most when they are acutely sick, and we need close tabs on them to best coordinate that care for the 60-days post-acute hospital stay. How are their meds doing? How is their weight? Are they on fluid overload?"
UnityPoint at Home RPM communicates with about 600 chronically patients at any given time through wireless, tablet-based encrypted videos. Most of the patients are seniors on Medicare, ages 65 to 100, and the most common chronic ailments include heart failure, high blood pressure, stroke, lung problems, and dehydration.
"These are the people in the care gap of the health system who are treated episodically who are struggling with chronic health management, which for many, if not most of them, there is no cure for. So, it's about quantity and quality of life," Wildman says. "These are the 5% of your healthcare system [population] that are using 50% of your healthcare resources who need the frequent monitoring."
RPM patients are given pre-programmed kits that accommodate their specific health concerns, and include a Samsung wireless tablet, a wireless blood pressure cuff, pulse oximeter, and scale.
Vital signs are transmitted daily from the patients' homes to telehealth nurses in 13 homecare offices in the multistate service area. The telehealth nurses provide patient education, "virtual triage," and other assessments while coordinating care with the patients' providers.
Wildman says that about 60% of the patients have the RPM shipped to them and complete the set up remotely with the help of a customer service contact, while 40% of the patients require some sort of home visit to get their RPM operational.
UnityPoint at Home has been working with telehealth since 2000, and launched the slow rollout of the upgraded RPM program two years ago.
In 2015, 1,791 patients participated in RPM. The HIPAA-compliant kits cost about $1,500 each, patient use them for an average of 45 days, and Wildman expects that on average four patients will use each tablet before a technological upgrade is needed, at a cost of about $430 per tablet.
The cost is covered, somewhat, under Medicare and some commercial plans.
"There are some monthly costs with telehealth that are going to be hidden in there," Wildman says. There are "communication and user fees that come into play. With that said, if a patient were to participate as a private pay, our fair market analysis, by the time you add the nursing oversight, care coordination, logistics, shipping and all that, is about $10 per patient per day."
The return on investment is still being calculated because the program upgrade is still a work in progress. However, UPH data shows that patients who have heart failure and aren't using RPM are four times more likely to go back to the hospital in the first seven days after a hospital stay.
"When you think about the ROI of telehealth, it's not just the tools and equipment," Wildman says. "What we're wanting is cost avoidance."
Anecdotally, Wildman says the response has been positive from most patients, many of whom say they feel more engaged in their care management.
"We know that some patients have had great success stories, who used to have six or seven ED trips or hospitalizations that haven't had one in a year," she says.
"What determines transition out of the program is patient collaboration and their ability to self-manage and self-monitor, and that they have a transition plan to be under the care of a provider. That is our ultimate goal, to get them moved to their provider."
John Commins is the news editor for HealthLeaders.