The future of home health will be a daunting journey during the next few decades as the industry faces challenges never seen before. The landscape looks like this:

• Many boomers are about to enter their 70s.
   
• People prefer to age at home.
   
• Health care spending is a major economic problem.
   
• Care in the home is much less expensive than in a facility.
   
• Value-based pay is here to stay.
   
• The caregiver shortage is by far the biggest challenge to home health—it will only get worse.
   

One percent of patients account for about 33 percent of health care spending, and 6 percent account for about 66 percent of spending.
 

In short, there is about to be huge demand for care, a short supply of available care, not enough money to pay for care, and managed care organizations (MCOs) will be scrambling to measure everything in order to extract the most value from every dollar. The consequences of this rising demand are extraordinary, and finding a credible solution is mandatory.

What if remote patient monitoring, also referred to as RPM, could be combined with machine learning predictive analytics? What if an algorithm could predict a negative health event before it happened, so appropriate intervention could prevent the hospital admission?

Patient Data and Prevention

Imagine a remote monitoring system that utilizes Bluetooth devices to measure a half-dozen vitals daily: blood oxygen, weight, blood pressure, pulse and blood glucose, and information about the care plan. Patients simply need to take their own measurements on a daily basis—a five-minute daily commitment on their part.

Individual measurements are automatically uploaded via Bluetooth in real time and fed into an algorithm that acts as a digital physician. The magic happens not when there is a dramatic change in any one category; instead, it happens when there is a combination of subtle changes in multiple categories.

Take for example a congestive heart failure (CHF) patient who experiences a slight drop in weight, accompanied by a slight increase in blood pressure and drop in blood glucose. A human may not be able to discern any reason for alarm, but an algorithm may know that there is an 80 percent risk of a hospitalization within the next 48 hours, based on previous cases.

That algorithm could then calculate a risk score and alert the members of the care team—physicians, the home health agency, family members and the patient themselves. The next step would be to take preventive measures to prevent a negative health event rather than letting nature take its course.

This experiment exactly was carried out in Toronto over the course of a two-year study with Southlake Regional Health Centre. The study was completed with a chronically ill set of patients—chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF).

Four Key Findings from the Study:

1. Remote patient monitoring did successfully keep patients out of the hospital. There was a reduction of emergency room trips by 73 percent and a 64 percent reduction in their hospital admissions.

2. The number of patients who needed at least one hospitalization dropped by 35 percent from 57 percent to 22 percent.

3. Over a three-month period, remote patient monitoring costs were $50,000, but the savings in reduced hospital visits amounted to $150,000—a 300 percent return on investment.

4. Patients learned to better self-manage their condition. Their post-study usage of the health system was 65 percent lower than their usage prior to the study.

Unexpected Study Results Included:

Beyond the Study

• Gender was a major factor in readmissions—men were 3.5 times more likely to be hospitalized and twice as likely to have multiple emergency room visits.
   
• Of all the vitals measured, it was the patient’s weight that was the strongest predicting factor in hospitalizations.
   

Remote patient monitoring has been shown to reduce expenses and achieve better outcomes at the same time. While the focus of this study was on COPD and CHF patients, the benefits of RPM and predictive analytics can be applied to other conditions.

The most encouraging finding from the study was the discovery that the patients did not return to their pre-study baseline. They learned how to be better at caring for themselves and that their conditions are largely controllable with the right education and habits.

Imagine a world in which we do not even have to rely on the cooperation of the patients. Instead of a Bluetooth scale, the patient’s bed can serve as both a scale and a wearable device can track vitals.

As we move into the internet of things era, devices can track what needs to be measured in an invisible manner.

For that matter, intervening care can also be somewhat automated with medical device implants. For example, a cardiac monitor could be implanted as an outpatient procedure and linked to a smartphone so that a patient can not only monitor a heartbeat in real time, but can also gamify a healthy resting heart rate and can have alerts triggered to notify the appropriate parties in the event of a negative health event, such as texting emergency contacts or dialing 911.

While no technology can replace face-to-face visits, remote patient monitoring can allow health systems to prioritize limited resources and provide the greatest amount of care for the greatest number of people. That means more people aging in place, less stress placed on hospitals and other health system facilities, less wasted money and a happier population. This is the future of health care.

Home health agencies (HHAs) are in the challenging position of providing continued care for patients once they leave the confines of a hospital or clinic. HHAs are often the final point of contact for patients as they move through the care continuum and work to transition into their daily lives after being discharged.

During the past decade, telehealth technology has evolved into a reliable means for HHAs to better supervise a larger number of patients by regularly monitoring their vital signs and providing clinical intervention when required. In addition, recent studies have demonstrated that use of remote patient monitoring can reduce readmission rates by better managing chronic disease states through ongoing vitals monitoring.

But what happens when the paths of HHAs and patients diverge? For years, patients have lacked an effective step-down solution to aid in the transition from clinical oversight to managing their own health.

Long-term Benefits of Telehealth

Chronic disease is prevalent and costly in the U.S., especially among older adults. Chronic disease is the primary cause of death in 7 out of 10 deaths, and in 2010 86 percent of all health care spending was for people with one or more chronic medical conditions. Nearly 92 percent of older adults have at least one chronic condition, and 77 percent have at least two.

The Department of Veterans Affairs (VA) has made a strong commitment to telehealth among its veterans by developing a national program called the Care Coordination/Home Telehealth (CCHT) program. The purpose of CCHT is, “to coordinate the care of veteran patients with chronic conditions and avoid the unnecessary admission to long-term institutional care.”

The VA has broadly deployed a range of remote patient monitoring (RPM) technologies in 50 different health management programs across 18 Veterans Integrated Service Networks, and conducted various studies showing improved chronic disease management, cost savings and reduced hospital admissions and emergency department (ED) visits.

Telehealth technology and its ability to impact patients long-term is significant. The biggest issue, however, is the ability to scale to larger patient populations. The technology—comprised of front-end hardware monitoring tools for the patient and back-end software, on which a nurse reviews progress—is too expensive to maintain in the long-term across broad patient populations.

This begs the question: Is there a telehealth solution that removes the more expensive long-term clinical component, while still delivering the core benefit of monitoring vital signs?

A New Solution

As a provider of medical alert devices, MobileHelp has been working to develop an effective consumer step-down solution for patients moving out of a clinical care environment, or for those who simply want to proactively manage their own health.

The new MobileVitals system is a “telehealth-lite” solution, which allows people to monitor their own vital signs with the added benefit of a medical alert system for personal safety—allowing users to access emergency help if they need it. The average medical alert customer manages at least two chronic illnesses. MobileHelp added tools such as blood pressure cuffs and glucometers to the MobileVitals platform to aid in disease management. Any information collected is transferred via Bluetooth to a secure hub in the user’s home, and sent via a cellular network to a cloud server, which allows users access to personal health data that can be stored and shared.

Pilot Program

The VNA of the Rockford, Illinois, area recently tested the MobileVitals system in a pilot program. The VNA saw the benefit of MobileVitals as a step-down solution to help patients transition from the clinical oversight of the VNA to managing their own care. The VNA’s own telehealth program had been successful in preventing readmissions for high-risk patients through early recognition of symptoms and successful clinical intervention.

The VNA noted early on that many patients wanted to keep their monitors and continue to track their own vital signs after their release. This was an unmet need for patients to leverage the educational benefits of working with VNA nurses every day—without the high cost of clinical involvement.

Patient Benefits

Under the program, VNA patients now have the ability to track and monitor their vital signs on a daily basis, but without clinical intervention. In addition, they still have access to emergency help if they need it.

Patients have responded positively to the ability to manage their own data, and have appreciated the additional features available within the system, such as activity tracking and medication management tools.

Ease of use is another benefit. Typical telehealth vendors usually have products that have to be installed by a nurse. The MobileVitals system, on the other hand, is shipped directly to the customer. The benefits extend beyond patients and providers to family members as well. The system provides a secure portal for family members to keep tabs on their loved ones.

Competitive Advantage

Because re-hospitalizations occurring within 30 days of hospital discharge carry punitive implications for organizations, increasing focus on periods as long as 60 to 90 days is becoming more common. With chronic illnesses, the key to effective management (and ongoing improved health outcomes) is long-term monitoring.

With technology solutions in the marketplace, long-term monitoring is possible without the high cost of clinical oversight. Leveraging this technology allows HHAs to transition patients back to their home with greater peace of mind they can remain healthy and in control of their own health.

This means readmissions after the 30-day period can be reduced—even after the patient has transitioned out of the care of HHAs.

As HHAs continually look for new ways to promote themselves within the landscape of a changing care industry, successful patient results reinforce their ability to provide a competitive solution as they work within hospital and ACO networks.