At Banner Health, the Phoenix, Ariz.-based integrated health system, healthcare leaders built an in-home telehealth program targeting a subset of patients with complex chronic conditions following a successful tele-ICU program. The in-home telehealth pilot program, called the Intensive Ambulatory Care (IAC) pilot program, done in partnership with the Netherlands-based Royal Philips, focuses on the most complex and highest-cost patients —the top five percent of patients who account for 50 percent of healthcare spending. The program first launched in 2013 and aims to improve patient outcomes, care team efficiency, and prevent IAC patients from entering the acute care environment where costs are significantly higher.
Back in January, Banner Health, with operates 28 hospitals, reported ongoing successful results from the IAC in-home program. In this updated study, Philips and Banner examined 128 patients who had at least one year pre-IAC and one year post-IAC follow-up to examine the prolonged impact of the IAC program on patient outcomes. The analysis of patient results over the first full year of the program revealed that the IAC program helped to reduce hospital admissions by nearly 50 percent. Prior to enrollment in the IAC program, there were 10.9 hospitalizations per 100 patients per month; after enrollment, the acute and long-term hospitalization rate dropped to 5.5 hospitalizations per 100 patients per month.
Further, an analysis of the program found that it helped to reduce overall costs of care by 34.5 percent. This cost saving was driven primarily by a reduction in hospitalization rates and days in the hospital, as well as a reduction in professional service and outpatient costs, Banner Health officials reported. Additionally, the program reduced the number of days in hospital by 50 percent. Prior to enrollment, the average number of days in the hospital was 60 days per 100 patients per month, compared to 30 days after enrollment.
Banner Health further reported that the IAC program reduced the 30-day readmission rate by 75 percent; the 30-day readmission rate went from 20 percent prior to enrollment to 5 percent after enrollment.
To delve further into Banner Health’s telehealth initiatives, Healthcare Informatics Associate Editor Heather Landi spoke with Deborah Dahl, vice president, patient care innovation, Banner Health, during the HIMSS Conference in Orlando back in February. Dahl outlined the steps that Banner Health took to build a successful telehealth and remote patient monitoring program to improve health outcomes for complex chronic patients. Also participating in the interview was Manu Varma, business leader, hospital to home and Wellcentive, at Banner Health’s technology partner Philips. Below are excerpts of those interviews.
What are some of the initiatives at Banner Health using telehealth and RPM technology?
We started with tele-ICU, and what caught my attention with Philips, as opposed to the many other vendors that we’ve worked with, is they come with a turnkey solution. A lot of companies come and say, ‘Here is your really cool widget, here’s the instruction manual and you’re on your own, have a nice day.’ Philips’ approach with the tele-ICU is ‘Here is your technology, here are the marketing materials, because you’re disrupting how care is delivered at the bedside, and here are the key points you want nurses and doctors to know if you want to do it well.’ And, they say, ‘Here is the team you want to build and some interview criteria to help you’ as you want to make sure you have the right folks behind the camera [with the virtual care.] And, we had amazing results with [the tele-ICU program]. For full-year data, we had about 2,000 people in our over 600 ICU beds who lived who were predicted to die. There were about 4,000 fewer ICU days than were predicted, 65,000 fewer bed surge days, and that’s about $135 million cost avoidance. It’s never just the tele-ICU—it’s the bedside, the organizational structure, the clinical consensus groups, you need the whole thing to be working together. But, we think of ourselves as one of the glue pieces. So that helped us them move into the bed surge, then move into the ED and now into the complex chronic patient population home as we are now responsible financially, as well as clinically, for these folks when they are not in the hospital.
What has been the key to the success of the IAC in-home program for complex chronic patients?
With the tele-ICU program, it gives you those adverse trends so you can intervene before the adverse trends become adverse health. It provides us with tools that are daily reminders our foundational best practices. Our ICU teams, like most ICU teams, I call them adrenaline junkies, they are very busy and it’s not unusual to get an admission and a code and a discharge all at the same time. This tool says out of our 600 ICU patients, these three are missing that test so nurses go in and see what it is and turn to the tele-ICU doc who will write that order and make that happen. Just that core functions that happen every day.
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