Enhancing care experience and outcomes, improving population health and reducing costs is healthcare’s “Triple Aim,” a concept introduced by the Institute for Healthcare Improvement to help navigate a shift in focus from “health care” to “health optimization.” When it comes to achieving these laudable objectives, anecdotal experiences and data emerging from several pilot programs led by senior living providers and Medicare managed care organizations suggest that remote monitoring technology has a crucial role to play.
Today’s remote monitoring technology utilizes sensors to observe and measure key wellness indicators such as sleep quality, daily activities and other physiological information, with very little training required. Unobtrusive sensors placed throughout a patient’s living quarters—under the mattress pad, medication cabinet, fridge, main door, and motion sensors on the walls in the living room and hallways—continuously monitor activities of daily living (ADLs) and pick up on subtle clues to potential issues, alerting caregivers to possible emergent health conditions.
By facilitating early intervention, it is possible to avoid an escalation that could require a trip to the emergency room, hospitalization or a permanent worsening of chronic conditions. The end result is more informed and proactive care decisions that reduce costs and slow the progression through the senior care continuum.
For example, while a few days of more frequent urination may mean nothing to a healthy middle-age female, it can signal a urinary tract infection (UTI) for an elderly woman. This was a recent case for an 81-year-old where sensors in the home picked up on increased toileting. The system alerted the woman’s caregiver to inquire about symptoms and a subsequent trip to her doctor resulted in a positive UTI diagnosis and appropriate medication. Avoiding a trip to the ER saved an estimated $650 to $800, but more importantly the patient quickly recovered without the severe discomfort and other more harmful outcomes of an untreated UTI.
In the case of a 51-year-old woman with congestive heart failure and diabetes, a few restless nights and pattern of decreased toileting and eating triggered an alert. A nurse was able to evaluate the data in context with the patient’s diagnostic history and electronic medical record (EMR) information and determine it was indicative of an exacerbation of chronic obstructive pulmonary disease (COPD). The woman’s case manager was notified, a doctor’s appointment was scheduled and steroid medications prescribed. Remote monitoring prevented a possible inpatient stay and saved nearly $11,000.
Data—even seemingly inconsequential information about eating, sleeping patterns, urination frequency or altered activity levels—holds the power to influence care outcomes and overall wellness. A change in ADLs can signal that a chronic condition is no longer stable or a patient is getting sick. Remote monitoring can pick up on these changes and alert a caregiver or managed care case worker that something may be amiss, triggering an intervention that may otherwise have come too late.
A recent Healthsense study among six different senior living communities studied found remote monitoring increased staff efficiency by 40 hours per week, provided three times greater revenue in service packages, and created an environment with 27% fewer move-outs.
Information collected by remote sensors is particularly powerful when it can be combined with what we already know about the patient, whether through integration with an EMR or enrollment data collected when a patient signs up for insurance coverage. This enables the alerts to be viewed in the context of the patient’s history, providing a richer tapestry against which to determine the appropriate action.
Why is the patient’s sleep more restless this week and why is he or she urinating more frequently? The answer may be dramatically different if the patient in question has a history of heart failure or kidney disease.
Measuring the impact in-home sensors and remote monitoring technology have on improving health outcomes and reducing overall care costs is the focus of several pilot programs in which Healthsense is currently involved. The first, with Humana Cares / Senior Bridge, involves 100 Humana Medicare Advantage members in Florida, North Carolina, South Carolina, Kentucky and West Virginia who are enrolled in an in-home, year-long study aimed at helping members remain independent and in their homes. The pilot will measure the impact of in-home sensors and remote monitoring technology on improving health outcomes and reducing frailty and fall-related hospital admissions for Medicare members with chronic health conditions.
It utilizes the Healthsense eNeighbor remote monitoring system, which reports changes in the member’s normal patterns of movement and activity to Humana care managers through in-home sensors that measure routine daily activities, such as sleeping, eating, physical activity and toileting. The sensors, which are placed discreetly around the home, work with Healthsense software to establish the routine for each member. Through passive monitoring, this routine becomes the benchmark for establishing when the member may need assistance without asking them to check-in, push a button, or pull a cord.
The second Healthsense pilot program is being undertaken in collaboration with Casenet, which is integrating eNeighbor into its TruCare enterprise care management system to allow for real-time workflow case and disease management. This enables more precise targeting of early care intervention for seniors with chronic diseases and other major health concerns. The pilot is underway at Fallon Health, which will use the integrated platform to advance the quality and delivery of care to its senior members by increasing identification of the early onset of chronic disease episodes for more effective care coordination.
Anecdotal evidence abounds demonstrating the potential remote monitoring technology holds for achieving the Triple Aim. We eagerly await the results of pilot studies, which we anticipate will confirm what we already know—ADL data holds the key to enhancing care experience and outcomes, improving population health and reducing costs.
Charles J. Fazio, M.D., M.S., is Chief Medical Officer of Healthsense, Inc. Since the writing of this article, Dr. Charlie Fazio has moved to the position of Health Plan Medical Director for HealthPartners.
For more information, contact Leah Davidson at Healthsense.