Connected care is not a new concept, but how care connects keeps changing.
Three common terms currently stand out: interoperability, remote patient monitoring and telehealth.
Interoperability finds its value and purpose in electronic health record (EHR) systems, for example. A core characteristic of the EHR’s multi-faceted record development and flexibility for care management and decision-making is that data flows between providers.
AJ Peterson leads the interoperability team at Netsmart, a tech company with deep roots in behavioral health. In recent years the company has dedicated its focus to home health and hospice. Netsmart holds a place on The Sequoia Project, a spin-off nonprofit private driver of what was an initial attempt by the U.S. Department of Health and Human Services (HHS) to develop a standards-based national health information exchange (HIE) system of distributed networks. Peterson is on the advisory council for The Carequality Project (one aspect of Sequoia), which is intended to serve as the interoperability framework for keeping health information data moving uninterrupted, unimpeded by geography or network endpoints.
“For home health and hospices, the comprehensive use of patient data—that power of data flowing—can help decrease the costs of patient care and cut down on duplicated services, such as unnecessary testing, as well as leverage information to deliver a higher quality of care,” Peterson says.
Interoperability also helps service providers along the care continuum by uniting documents and care decision-makers and service providers—not only for business efficiencies but for the continuity of patient care.
“We consider homecare and hospice the true care coordinators,” Peterson says. “They take on the responsibility of navigating the waters of getting DME into the home, for example and, for 2018, the new Conditions of Participation (CoPs) puts to the forefront the care coordinator role.”
Geographic boundaries and end-of-network roadblocks typically hinder health data sharing and utilization, which can be problematic for both patients and providers. Adding to the discontinuity of care are the gaps associated with managing paper trails, trying to remember details of all things health care (and related) that a person receives, and operating outside of networked channels.
“Medications are a good example of where post-acute care providers have struggled,” Peterson says. “We have found that a patient may have seen up to 18 different providers and be on 16 different medications. Leveraging interoperability to aggregate medications from disparate sources, not only saves time but accuracy when reconciling up to 16 medications for a patient.”
Remote Patient Monitoring
Remote patient monitoring involves the use of smart devices and systems that help ensure patients receive proper treatment, as well as detect when patients are stable or in distress, particularly in the process of chronic disease management and for those aging in place.
Remote patient monitoring refers to a coordinated system that uses one or more home-based or mobile monitoring devices that transmit vital-sign data or information on activities of daily living that are subsequently reviewed by a health care professional. CMS values remote patient monitoring services in the same way it values other physician services.
The U.S. Government Accounting Office (GAO) reported that remote patient monitoring technology continues to evolve, and for such newly-developed technology there is not a consensus in how to use and charge for the multiplicity of delivery models, including the range of services and procedures. CMS has developed codes within the Physician Fee Schedule that describe the non-face-to-face care management services that include interactions furnished through communication technology.
Medicare models, demonstrations, and a new payment program have the potential to expand the use of remote patient monitoring and telehealth. In 2017, CMS supported eight models and demonstrations in which certain Medicare telehealth requirements were waived, such as requirements for the locations and facility types where beneficiaries can receive telehealth services.
Telehealth involves the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
Bursts of telehealth developments took place in 2017. This year marked the beginning of new programs made possible by the Patient Protection and Affordable Care Act (ACA), which parted ways for CMS to test innovative payment and service delivery models to reduce Medicare, Medicaid and state Children’s Health Insurance Program expenditures.
Additionally, in October 2017, the Veterans Administration (VA) proposed to amend its medical regulations, with goals to standardize the delivery of care provided by VA health care providers through telehealth, as well as remove the barriers of state licensure laws and regulations. Many states are addressing their rules now—the Center for Connected Health Policy tracks pending legislation and regulation across the United States.
In mid-January of 2018, a MedPAC reported mandated by Congress released information about telehealth reimbursement for Medicare. The many advocates for telehealth or telemedicine believe it has the potential to increase the quality of care, while enhancing convenience, while saving money, a top priority in a time of tight budgets, according to NAHC, the National Association for Home Care and Hospice. For homecare, telehealth has the opportunity to enable providers to expand their services to patients with remote monitoring technologies, while saving money and time on lengthy visits. The goal is to enhance in-person care rather than replacing it, according to NAHC.
Telehealth has the potential to improve patient outcomes by facilitating follow-up care when it is truly needed.
“Some of the drivers of connected care,” says Theodore Harvey, CEO of Atlanta-based SynsorMed, a 3-year-old startup in the telehealth space, “are a higher mobile device adoption rate by the older population, geographic considerations, and earlier diagnosis of conditions such as COPD. The concern for us is that the telehealth services model is not as well reimbursed as with the fee-for-service model, but I feel that within three to five years, policies and reimbursements will catch up.”
Not so fast, says Jeremy Malecha, VP of SaaS Strategy Development for ResMed.
“We must take into account that those who stand to benefit most from digital health may have limited mobility, technology or understanding of its benefits. As we research and develop connected care tools, we should be building connectivity, data analytics and education directly into them—in a way that benefits the consumer without asking them to become tech experts,” Malecha advises.
Earl Lawson, president of CAIRE and the Biomed Division of Chart Industries, adds that one of the challenges of connected care is making it easy enough for both provider and patient. “Traditional forms of communication are rapidly evolving, and the use of connected devices is becoming more and more common,” Lawson says.
Despite the challenges, connected medical devices help health care providers meet patients where they are, especially in hard-to-reach rural areas, where the Federal Communications Commission (FCC) has been addressing this problem through the Rural Health Care Program and Connect2Health Task Force. “In these areas, telehealth is a lifesaver,” says Harvey.
Problem gaps in the telecommunications and broadband services necessary to support care delivery—and the correlation of those gaps with the incidence of chronic disease—have been mapped throughout the country.
Read the full February cover series here.