SeniorCare President Joell KeimSOURCE
July 23, 2013 | Joell Keim, RN, BA, CPC

Historically, telemedicine was used in hospitals and rural settings to help bring specialists to localized patients, including those who are homebound or without a specialist in their area. The goal then was the same as it is today: Allow physicians and caregivers to exchange information electronically to improve care.

Telemedicine’s transformation in recent years stems from the desire to improve healthcare while better connecting patients and providers. With the increased use and capabilities of mobile devices, providers can now actively monitor and transmit patient data through what is commonly known as mHealth technology. The data gathered from these exchanges helps drive decision-making for patient-specific interventions, with the ultimate goal of improving patient outcomes. It also supports shifting payment models and value-based care initiatives that require quality data reporting.

Apart from the improved health and quality-of-life benefits, the combination of mHealth and patient outreach also provides health plans, physicians and others across the care continuum with a better understanding of each patient’s unique care situation. Leveraging mHealth technology to collect data directly from patients’ homes continuously and combining it with clinical care in-home visits will ultimately help improve care quality metrics, manage care costs and increase patient satisfaction rates.

Analytics driving mHealth evolution

Data analytics, improved technology and specially trained clinical staff are the key differentiators that separate the mHealth we know today from that of years past. Through analytics, physicians can pinpoint patients struggling to manage their chronic conditions and those who may require additional engagement and monitoring to avoid a potential hospitalization.

Many physicians, often through a health plan or ACO, now partner with technology-enabled firms to analyze claims, medical records, pharmacy and laboratory data to target gaps in care, help patients better manage their conditions and prevent readmissions. Data analysis technology can identify cohorts of high-risk patients who may have a history of a particular condition but fail to consistently manage their conditions.

As the industry evolves, medical devices are also becoming increasingly sophisticated. Smaller in size but more powerful in possibilities, these devices transmit readings wirelessly and can integrate with a personal mobile device, enabling and empowering the patient while transmitting vital health status data to care providers in real-time through cloud-based technology.

Clinical care visits fill the gaps

Yet the most important, and often overlooked, factor in improving outcomes with mHealth is achieving patient adoption of this technology. Many attempts at home telemonitoring fail because patients become overwhelmed as they attempt to learn how to operate this technology on their own. Compliance and adoption rates improve with clinical care assessments, where providers visit the patients in their homes, help set-up the technology and provide one-on-one, hands-on training.

Based on prior data analysis, patients should be identified and contacted to schedule an in-home clinical care visit. During the encounter, pertinent data regarding the patient’s living situation, medical record and care gaps is gathered and transmitted to the primary care physician. The clinical care visit provider will also set up any mHealth equipment and teach the patient how to operate any devices, which would then immediately transmit readings to a cloud-based engine.

Through this preemptive solution to managing chronic illness, health plans and primary care physicians are able to receive real-time data that can be leveraged to spot an adverse trend and potentially avoid an emergency room visit or readmission.

Data combined with care improves compliance

With an in-person clinical care visit and hands-on mHealth training, practices receive a greater breadth of data as it pertains to their patients and their disease management capability, improving chances of greater compliance, better health outcomes and increased patient satisfaction rates. These clinical benefits translate into improved quality and risk scores for programs such as Patient-Centered Medical Homes, HCC Risk Adjustment and ACO quality initiatives such as Group Practice Reporting Option (GPRO) and Physician Quality Reporting System (PQRS).

All healthcare stakeholders have the same goals: High-quality care, efficient operations and improved patient outcomes. As more providers connect to other physicians, hospitals and health plans through health information technology, collaboration is crucial to help achieve these goals. By using clinical care visits, mHealth monitoring and other patient engagement programs, physicians are able to extend their reach beyond the walls of their practice. All of these pieces are working simultaneously to not only assist physicians in meeting mandates, but also help treat more patients while increasing the quality of care – which, as we know, is the most important factor of all.

Joell Keim is president of SeniorCare (Silent Seniors Community Care, LLC), an analytics-driven patient engagement company that addresses care and data gaps, and the sister company of Outcomes Health Information Solutions.


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