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As payers work to avoid costly readmissions, some organizations are experiencing great success by leveraging virtual care communication platforms.
Readmissions are one of the most expensive episodes to treat; readmissions of privately and publicly insured Americans totaled a staggering $15.7 billion in 2017. In 2014, 14% of inpatient stays were readmitted within 30 days, according to the Agency for Healthcare Research and Quality. More than one-third of these readmissions occurred within seven days, reflecting a seven-day readmission rate of 5%. Costs for readmissions are also considerably higher than index admissions for all types of payers: 5% higher for Medicare, 11% higher for uninsured patients, and 30% higher for Medicaid/private insurance patients.
Additionally, poor care coordination and insufficient management of care transitions, as noted in Health Affair’s “Health Policy Brief: Care Transitions,” were responsible for $25 billion to $45 billion in wasteful spending in 2011-as a result of avoidable complications and unnecessary hospital readmissions. A University of California San Francisco (UCSF) study published in JAMA Internal Medicine reports that over one-quarter of all 30-day hospital readmissions are preventable. The study highlighted that poor communication, inadequate coordination of care, and insufficient post-discharge resources were major contributing factors to the readmissions problem.
Solving the Readmissions Problem with Virtual Care
As payers work to avoid costly readmissions, some organizations are experiencing great success by leveraging virtual care communication platforms. Virtual care technology can help address gaps in providing follow-up care and thus reduce readmissions by making care safer and timelier while also promoting more effective communication with members and improved coordination of care amongst staff.
Virtual care technology can help payers increase communication and engagement with members to improve adherence to the care plan post-discharge. When virtual care capabilities are available on everyday technology like smartphones, tablets, and PCs, payers can easily access members that are recovering from the comfort of their homes or other care facilities. Using the device of their choosing, members can conveniently participate in virtual visits with their care managers. Instead of needing to secure affordable and reliable transportation to follow-up medical appointments, members can participate in virtual visits in which the care managers check in on progress and compliance. Appointment no-shows are reduced while questions are addressed in real-time. Ongoing medical guidance can be provided in the primary or preferred language of the member, as the care manager can also include an interpreter in the virtual visit. Reminders about diet requirements, lifestyle changes, prescription refills, and upcoming appointments can be sent via email or text to these members. Furthermore, any one-time messaging (such as a flu shot reminder) or ongoing messaging (such as medication reminders) can also be translated into the member’s primary or preferred language.
Providing Ongoing, Immediate Access to Care
Virtual care technology also provides payers a streamlined, efficient way to check on members and address any potential issues before they become catastrophic. If a member is unclear about his/her medication regimen or presents with a potentially critical condition, the care manager can easily incorporate a specialist into the virtual visit in order to provide needed answers and eliminate the need for a return trip to the emergency department. Care staff will be able to triage more services-and even include additional participants (such as a clinician, interpreter, remote family member, and/or pharmacist)-to respond to members’ questions in real time without requiring various providers to make a home visit or for members to visit the ER or an urgent care clinic. Unnecessary and costly readmissions can be avoided as the member’s emerging issue can be quickly resolved during the virtual visit. Care managers can also check the members’ usage of virtual visits and the members’ reaction (e.g., open-rates) to emails and messages to determine if the member is fully engaged in his/her care or if more immediate intervention (e.g., a home visit) is necessary to ensure that the member is correctly managing his/her condition.
Streamlining Member-Centric Care
Virtual care also makes workflows more efficient for care managers. While the member is still in the hospital, a care manager can conduct a virtual visit with the member and his/her medical team to ensure that all stakeholders are aligned on key transition points and expectations for the use of virtual care technology post-discharge. GlobalHealth is an Oklahoma-based health maintenance organization which is using a virtual care platform in this manner. Pre-hospital discharge, GlobalHealth is now connecting its members to the case managers who will guide their care post-discharge. The organization’s case managers virtually “meet” pre-discharge with the member to help the member understand the discharge protocols and plan. As a result, the member is better prepared and more engaged for his/her role in post-discharge care, having been introduced to the case manager before leaving the hospital.
Additionally, when virtual visits are leveraged in the follow-up care strategy, care managers’ respective drive times to members’ homes (or step-down care settings) after a hospital stay are minimized and staff productivity can be increased. By converting drive time to member time, a care manager can essentially conduct three remote visits in the time it takes to drive to/from and conduct one in-person visit with a member. With technology, care managers can also virtually engage with their colleagues and supervisors to understand best and new practices in delivering care. As a result, payers’ staff can now attend to the needs of more members and also check in with members more frequently while being able to keep up to date on the latest innovation in care delivery.
Using virtual care technology can also address the critical time when the patient transitions between inpatient to outpatient, as well as the ongoing self-care needed throughout the continuum. Coordinating conversations across a member’s hospital-based and post-hospital care teams can be challenging with busy schedules, competing priorities, and various locations. In this way, virtual care technology allows providers to collaborate with each other, regardless of location and the member’s stage in the treatment plan. Details about key transition points can be shared; questions can be quickly answered. All stakeholders can observe visual cues signifying that everyone is aligned on their respective roles and responsibilities. As needed, home health nurses and the members can also be part of these virtual meetings to ensure that member-centric care is top of mind for all providers and settings delivering care at each transfer point.
Lee Horner is CEO of Synzi.