As consumer wearables continue to evolve and infiltrate the healthcare industry, the monitoring of the data that comes from these devices carries the potential to help patients stay healthier and reduce avoidable hospitalizations. For hospitals that are under immense pressure to improve quality and lower readmission rates, there’s even more of an emphasis in leveraging technology like wearables.
For instance, in Salisbury Md., the 292-bed Peninsula Regional Medical Center (PRMC), a subsidiary of the Peninsula Regional Health System that serves some half a million patients per year, operates under the Centers for Medicare and Medicaid Services (CMS)’ All-Payer Model in Maryland—in which hospitals in the state get a global budget which gives them very strong incentives to reduce unnecessary or marginal hospital services.
Indeed, the population health-based payment model which shifts away from traditional fee-for-service healthcare, calls on hospitals to achieve a number of quality targets designed to promote better care and lower costs. This is the nation’s only all-payer hospital rate regulation system, and if certain goals are not hit around readmission rates, avoidable utilizations, hospital-acquired conditions, and other quality measures, the budget will get cut year-to-year. Last July, the medical center received approximately $400 million upfront, and from that allotment must come all of the services for Medicare patients for the year. After that, the balance is on the hospital. As such, says Kathryn Fiddler, R.N., executive director for population health at PRMC, “That’s why our population health effort is so important and programs [within it] are so critical.”
Kathryn Fiddler, R.N.
To strengthen this effort, last year, PRMC partnered with Philips to leverage CareSage, the vendor’s predictive analytics engine that enables health systems to better monitor and care for patients by combining actionable insights with wearable devices and monitoring. More specifically, CareSage provides analysis of real-time and historical data from providers and Philips Lifeline to proactively identify patients most likely to have health issues so clinicians can intervene before problems occur. According to PRMC program manager Bevereley Stoakley, the main objective of this project is to keep patients safer at home by letting them get care without necessarily coming back to the hospital.
CareSage utilizes Philips Lifeline’s AutoAlert technology and wealth of health data to focus particularly on senior patients when they return home after a hospital visit or home healthcare period. At PRMC, if a patient with that AutoAlert pendant falls, related to congestive heart failure (CHF) or some other issue, the alert call will go to a triage person in the hospital who will look at the data and then will contact the appropriate caregiver to get help for that patient who may need a change in medication or something else, rather than going to the ER, notes Stoakley.
Designed to support population health management and knowing that the hospital cannot bill Medicare for readmissions if that patient is readmitted within 30 days for the same condition he or she was originally in for, this project is part of the broader strategic plan of PRMC to reduce costs by keeping patients at home. The wearable equipment is given to the patients or their family members, they take it home, it’s self-installed, and they get it free for 60 days, at which point they can then either keep it or return it to the hospital, says Stoakley. “The family has peace of mind knowing their loved ones can get help because they are getting real-time monitoring 24 hours a day,” she says.
Fiddler notes that PRMC operates in a rural community, on a peninsula surrounded by lots of water on the Eastern shore, inside one of the poorest counties within the entire state. “We do have a lack of resources just because we are so rural, and often patients [travel] long distances to get here. So we had to think about how to do things differently,” she says. In November, PRMC went live on its Epic electronic health record (EHR), and Fiddler says that there will be integration opportunities in the future, though the new technologies, Philips and Epic, are not yet connected.
Indeed, both Stoakley and Fiddler say there is a need to see more data that comes from the wearables before speaking to the project’s results. However, Stoakley notes the strong outcomes for other programs that have CareSage, as they are seeing a 70 to 75 percent success rate in predicting that a patient needs to get a medication changed or needs to get to a care provider. “So there has been real success for programs who have been on this longer than us,” she says. Fiddler adds that with the technology, patients are “one step closer to safety.” She says, “It’s almost like their babysitter. We see it with Fitbits, in that people start to become more accountable. They see this as a backup assistant of sorts.”
In the end, for leaders at PRMC, programs like this one will be necessary for it to thrive under CMS’ demonstration project in the state. Says Fiddler, “For us, we have always been paid similarly to hotels, something that I call ‘hopsitalitis’—so the more people I see and the more people in our beds, the better I will do. From a doctor’s perspective, that’s frustrating since you’re on a hamster wheel. But now we have the opportunity to say, ‘what could I have done yesterday that would have made this patient better, safer, and more supported that would have made a difference? And if you can do something different after asking that question, such as put on a wearable technology, that could trigger a warning sign about something might being off. That’s where we could impact the bottom line,” she says. Fiddler continues, “Our budget isn’t changing, so we need to reduce the number of people coming in the door. We don’t need the number of services here in the hospital since folks are getting them in the community. That’s the only way we can reduce the bottom line.”
