Geisinger and AMC Health use telehealth technology to reduce readmissions
DANVILLE, PA – A remote patient monitoring and care management program implemented by Geisinger Health Plan using technology provided by AMC Health has shown a 44 percent reduction in hospital readmissions, the company announced recently.
The Geisinger Monitoring Program (GMP) uses a range of technologies from interactive voice response (IVR) to Bluetooth-enabled scales from AMC Health designed to automate the collection of patients' clinical information, which allows care managers to more effectively follow up with at-risk patients for 30 days after being discharged from the hospital.
"That first week or two post-discharge is when you really see readmissions happening," said Joann Sciandra, RN, director of case management and strategic planning with Geisinger Health Plan. "Having the ability to have a couple more touches or encounters with that patient makes this a very valuable tool."
The two-year old program was designed to see if the use of IVR technology for a population of Geisinger patients would produce significant improvements in hospital admissions rates compared to patients who did not receive IVR follow-up.
According to Maria Lopes, MD, chief medical officer with AMC Health, the IVR technology provides customized, automated follow-up with patients to gather symptom, medication compliance and other information that is entered directly into their electronic medical record.
"The program is as simple as it is elegant," said Lopes. "In an environment where you already have superb care management… how can we use technology to create a more scalable and cost-effective way of integrating that information with the care manager to use nurses much more productively?"
The results, say both Sciandra and Lopes, speak for themselves. Previously, nurse and care managers spent as much as 30 minutes calling patients for their post-discharge follow-up. Now these healthcare providers can use that time to follow up with those patients most in need of intervention.
"Our success in leveraging AMC Health's technology to reduce readmissions underscores our belief that providing clinicians with the right data, at the right time, to drive the right interventions is critical to driving the best patient outcomes," said Jim Peters, system vice president at Geisinger Health System and head of Geisinger's strategic industry partnering activities, in a press release.
Geisinger and AMC work together in other areas as well. A remote monitoring project begun in 2008 focused on roughly 900 patients in its complex care heart failure program. In this iteration, patients were provided with Bluetooth-enabled scales that would feed daily weight data to Geisinger and would also received IVR calls.
Based on the success of that program, Geisinger broadened the use of IVR to include patients with hypertension and diabetes.
"These patients are among the most challenging to manage," said Janet Tomcavage, RN, vice president of health services for Geisinger Health Plan. "The acuity of their condition requires constant surveillance to detect emerging exacerbations. If left unaddressed, this inevitably leads to increased emergency department utilization and costly hospital readmissions."
In Sciandra's view, the GMP has helped fill a gap in care that exists for most patients after they have been discharged from the hospital.
"We really wanted to do something around transitions in care," Sciandra stated. "By having someone to hand off the patient to for outpatient (management) we are able to prevent some of those problems we had in the past."