How Health Tech Can Transform the Post-acute Care Market
19 May 2021
Hospitals are in a serious bind. Caught between fulfilling their missions to fully treat patients and the need to deal with space considerations and a reimbursement system that dictates how long they can keep a patient under their roof, they’re experiencing “patient déjà vu,” with as many as a quarter of their discharged patients finding themselves back where they started — hospitalized
Whom exactly does an approach with 25% readmission rates serve? It certainly doesn’t serve hospitals. More importantly, the people the system seeks to serve — patients — are put needlessly, in some cases dangerously, at risk. Medical care cannot end when discharged patients are wheeled out the front door into the abyss of do-it-yourself care, but too often, it does, and it is in the days and weeks following discharge when patients are medically most vulnerable.
The Centers for Medicare & Medicaid Services (CMS) seeks to control expenditures for care and placed readmissions in the bullseye to close the US$26bn sinkholes attributed to bounce-back patients.
Their public reporting is one way to shame medical systems with dismal outcomes that need closer scrutiny. It demands medical planning and technologies that keep people on the healing track to recovery, wherever they are. Today, with virtual care models proven in the COVID-19 environment, it may not even demand a room.
Patients can’t be objects in a game of “hot potato” to be tossed from bed to bed and place to place. Solutions are at hand. Do health systems and hospital managers have the will to implement them?
The combination of telehealth, remote monitoring technologies, and private and public reimbursement policies, in tandem with continued medical accountability, is defining features of population health management (PHM), a vital approach to patient care, has the potential to fulfill healthcare’s fundamental goal — to make people healthy.
It requires that the system provide healthcare professionals with the insights and tools to understand and improve patient-care outcomes.
Digital health and health tech can demonstrate immediate, practical additive value here, allowing healthcare professionals to optimise their medical skills and human empathy that will always be essential to providing care.
Referred to by many names — home health, remote care or extended-care management — the PHM sector puts patients at the centre of care.
Continued recovery under PHM requires medical, technological, economic, and interpersonal support, and as such, it has the capability unite these components of the fragmented health ecosystem in a common cause.
The first shoe to drop in the reorienting of the post-acute care sector was in the form of cost-cutting measures put in place by CMS. These parameters meant that payment-per-procedure became a bundle that covered charges associated with a patient’s hospital stay, from admission to discharge.
But here’s the deal: a patient’s return to the hospital for an event related to their original reason for admission was not going to be reimbursed.
Hospitals now had a problem; when it was time for patient's discharge, the hospital would STILL retain responsibility for their continued recovery.
With patients out of their watchful eye, how would hospitals provide care and ensure the patient remained on track?
POST-HOSPITALIZATION SUPPORT DEMANDS VISION AND ACTION
Now, the outpatient care plan is where visionary health leaders must deploy talent and technologies that engage, monitor, and connect with people as they journey from interim care to home care and, eventually, recovery. The process requires a new approach and recognition that recovery isn’t always a matter of days after a hospital stay — it may take months.
“A person experiences a medical event that impacts health — a heart attack or a fall. They visit a doctor or hospital for treatment. In almost all cases, they get good care and advice. Yet, without the post-hospitalisation support, it’s possible that their health may stagnate or decline,”
reflects Alex Markowits, founder and CEO, of Spring Hills, a national system of post-acute care specialists who are combining the best in digital advances with the continued importance of human touch to follow people for 90 days or more after an in-patient stay.
“They can end up in a cycle of ER visits, hospital stays, and readmissions — a bad result for both the individual and the healthcare system,” he adds.
Driven by reimbursement realities, technological advances, provider responsibility, and consumer desire, this new care option is on the rise, and payers, providers, policymakers, and patients should find themselves pleasantly surprised and quick to align.
The cost of readmissions — lost reputation and reimbursement — are reason enough to recognize that engaging people at medical risk is good medicine and morally on point.
HEALTH TECH UNITES SYSTEMS AROUND PATIENT RECOVERY
In the age where health tech is proven again and again to predict and prevent illness and provide prompt care, PHM centers of excellence are tapping these five health-tech tools to advance the post-acute-care system and lower patient readmission rates and keep costs in check:
1. Electronic medical records (EMRs):EMRs are already in use in 83 percent of hospitals, interoperability; however, remains a challenge nationwide. When hospitals and their extended care partners work in collaboration, EMRs are a powerful information tool in tracking medications, instructions, and communications among the care team and caregivers. Facilities that are skilled in PHM and continuity of care planning, can use EMRs to reduce errors and be proactive with patients who may be more at risk for complications to avoid the readmissions that are providers’ and patients' greatest fears in the modern regulatory and reimbursement environment.
2. Artificial intelligence (AI) and data mining: We once judged care centers on their attention to facility details like the watchful eye of staff, meal preparation, and therapy schedules. Now, it’s also about the health risks they are averting. From hospital to home, PHM platforms are geared to handle a patient’s medical data alongside countless inputs — from a patient’s shifting condition in real-time to analysing and applying learnings from data trends over time. A great care facility leverages AI and data mining to set personalised risk levels for specialized medical conditions to anticipate those who may require further additional care.
3. Telemedicine: The possibility of seeing your physician onscreen existed for years, but COVID-19 forced everyone to confront regulatory, economic, and urgent-care realities that diminish access to care. The FDA and state regulators lowered the bar on a range of compliance hurdles, and fee-for-service physicians realised that virtual patient visits were better than no visits and no reimbursement. Telemedicine is nowhere to stay in a post-COVID-19 economy; it will become an increasingly convenient option for most, albeit not the go-to-always approach, and for those recovering from surgeries, a must use for personalized patient check-ins. Now, remote health check-in combines virtual medical visits with smartphone monitoring. Companies such as Vytrac are enabling patients to share a range of vital signs effortlessly.
4. Remote monitoring: Turn over that hospital mattress! Slap on that patch! Consumer electronic models will become embedded in the health system as cutting-edge medical centers untether patients from wired monitors and blinking bedside equipment. Instead, digital remote monitoring systems — built as part of beds, furniture, and convenient medical wearables — will make hospitals stays more customer-friendly and deliver patient information straight to providers’ smartphones and central monitoring stations. Post-acute care specialists are investing mightily to prevent hospital readmissions by using life-protecting technologies such as Bluetooth hemodynamic monitors such as MyNICaS.
5. Space-age physical therapy: When it comes to occupational and physical therapy, at-home healing programs have gone high tech. Population health and patient-management leaders no longer eye their competitors for best-in-class developments. Instead, they look to Olympic training centers and NASA, where loss of weight and bone density — the consequences of weightlessness — are a top consideration, to determine how to equip their post-acute care centers. Beyond the exercise bike, expect to see HydroWorx therapy pools and AlterG Anti-Gravity Treadmills in these cutting-edge centers to provide people pain-free muscle therapy early in recovery.
Post-acute care facilities rising to the occasion welcome rating services that hold a magnifying glass up to their care planning and patient follow-up. The best of the best in PHM systems are not only looking at the days and weeks following a patient’s discharge from a hospital. They are not thinking of their costs alone — they ARE thinking about all the pieces of the health ecosystem puzzle with the patient finally at the center.
“Decisions on where to go for post-hospital care usually have to be made quickly, and patients are just relieved to find a bed. The result is that people end up choosing lower-quality providers. One study found that only 16 percent of Medicare recipients using services at a skilled nursing facility chose the best provider available,” says post-acute care ranking pioneer Russell Graney, founder of Aidin Health.
This Harvard University graduate, who launched his company to empower consumers to make informed decisions and democratize the process of choosing a continuing-care provider, reflected on what happens when finding a bed becomes more important than a person’s path to recovery: “Poor care transitions end up having negative consequences for patients, including additional hospital stays, longer recovery times, and long-term complications.”
Now, with digital health integrating seamlessly with the personal touch of post-operative care facilities, technologists and humanists are finding natural common ground. The benefits of this new approach should find a welcoming embrace from those who have long struggled within the healthcare system to put patients at the center of their efforts.