Three years ago the State of Maryland launched a bold experiment to improve healthcare. With a waiver from the Centers for Medicare & Medicaid Services, the state converted its hospital payment system from traditional fee-for-service to a global system, in which hospital total revenue for all payers is set at the beginning of the year. The Maryland Health Care Commission (MHCC) recognizes that if the state is to succeed with the All-Payer Model, providers need to consider adopting non-traditional approaches to care delivery.
In June 2015 the MHCC awarded telehealth grants to three organizations to assess the impact of remote patient monitoring (RPM) on reducing hospital encounters, improving patient care, and decreasing healthcare costs. The three projects explored the effect of RPM on patient populations with varying health conditions and in different settings, according to MHCC, which recently released a report on those pilot projects.
The report noted that as new models of patient care begin to emerge, RPM is considered to be a way to improve clinical outcomes while decreasing costs by enabling providers to proactively manage patient health conditions as they occur.
In 2013, the Maryland General Assembly enacted legislation requiring MHCC to study telehealth. A task force report in 2014 outlined 10 use cases that could be implemented to demonstrate value of telehealth. The MHCC began awarding grants in 2014. As of February 2017, MHCC has awarded more than $450,00 in grants to 11 organizations.
In studying RPM, MHCC awarded a combined total of $80,000 to three grantees over an 18-month period: Crisfield Clinic, LLC (Crisfield); Lorien Health Systems (Lorien); and Union Hospital of Cecil County (UHCC).
Crisfield, a rural family practice clinic in Somerset County, used mobile devices to help middle school and high school aged patients manage chronic health conditions, including asthma, diabetes, obesity, and behavioral health issues. Lorien, a skilled nursing facility and residential service agency, used telemonitoring technology to provide 24/7 access to care among patients that were discharged from the skilled nursing facility to home with chronic heart failure, hypertension, and uncontrolled diabetes. UHCC used mobile tablets and peripheral devices to monitor patients with chronic health conditions post-discharge to reduce prevention quality indicators. The projects shared a common goal of reducing hospital encounters using telehealth. Grantees were required to use a nationally certified electronic health record and services of the state-designated HIE, the Chesapeake Regional Information System for our Patients (CRISP).
MHCC reported that for the most part, grantees were successful in achieving key project goals at the conclusion of their projects”
• Lorien patients had fewer readmissions as compared to their readmission rate prior to the project. It demonstrated a reduction in A1C values or participants with uncontrolled diabetes.
• Crisfield’s patients were successfully managed and avoided preventable emergency department encounters. Crisfield was able to show an improvement in the health of their patients and an increase in activity level throughout the project.
• UHCC patients had fewer readmissions as compared to other hospital patients. UHCC participants also had a lower 30-day readmission rate. All projects reported high levels of patient satisfaction.
One lesson learned from the projects, according to MHCC, is that defining only clinical objectives and measures is not sufficient in designing an RPM project. “Determining the impact of RPM on workflows, communications, provider and patient satisfaction, and care coordination is equally important. Project performance goals were clinically based and most participants’ conditions either improved slightly or remained the same. Somewhat related, grantees reported an increase in participant awareness of their health and a willingness to become more engaged. In addition, a team approach to assessing RPM data is important to making timely adjustments to protocols.”
MHCC said the grantees demonstrated that RPM is a potentially viable way to improve care delivery and patient outcomes. “More than 100 million people suffer from at least one chronic health condition nationwide. These conditions, such as heart disease, diabetes, and obesity are among the most costly and preventable health problems. RMP offers a way to achieve the triple aim of reducing the cost of health care, improving the health of populations, and improving the patient experience.”