Researchers at Penn Medicine report that a simple, automated messaging platform that connects with patients after they've been treated in the ER greatly reduces the chance of rehospitalization or further emergency care. It's also great for staying in touch.
New research has found that even a simple 'How are you?' e-mail or text from a care team can improve clinical outcomes post-discharge.
This comes from the University of Pennsylvania's Perelman School of Medicine, whose researchers analyzed the effects of an automated messaging platform from primary care providers to patients who'd recently received emergency care at a hospital. The study, published in the Journal of the American Medical Association's (JAMA) online site, points to the value of a simple messaging platform in improving patient engagement, reducing rehospitalizations and boosting overall outcomes and wellness.
“Contact from a primary care practice can help patients feel more connected and enable them to access care in a timely manner,” Anna U. Morgan, MD, an assistant professor of internal medicine at Penn Medicine and the study's senior author, said in a press release.
“In a fragmented healthcare landscape, relatively simple applications of technology can help patients feel more connected to their primary care practice,” added Eric Bressman, MD, a fellow in the National Clinical Scholars Program at Penn Medicine and the study's first author. “This is especially important as patients recover from acute illness, as it reminds them that they have a medical home to which they can turn for support.”
In the study, researchers compared outcomes for more than 400 patients who opted into the digital health program against more than 1,000 who did not participate. Patients were contacted by phone two days after discharge for an emergency care visit and asked if they'd like to enroll in the text messaging program. Those who did were sent check-in messages at regular intervals over a month, with the texts tapering off as the month progressed.
According to the research, patients in the text messaging program were 41% less likely to need any kind of acute care after discharge; more specifically, they were 33& less likely to return to the emergency department and 55% less likely to be rehospitalized.
"The program’s high degree of automation required minimal effort beyond usual care," the study pointed out. "To the best of our knowledge, this is the first study to experimentally test the benefit of an automated texting program on post-discharge outcomes among primary care patients. The mechanism through which this compound program prevents use of acute care is likely complex, but we theorize that more frequent check-ins and a lower friction medium for patient-initiated outreach lead to earlier identification of needs and a greater likelihood that issues will be escalated to and handled by the primary care practice than another setting."
Bressman and his colleagues also noted that almost 83% of the patient enrolled in the program responded to at least one of the introductory messages, a much better response rate than to the traditional phone calls. And less than 9% opted out of the program.
The study points to the value of simple, even automated, contact, giving patients the reassurance that their care providers are looking after them after a healthcare emergency. This, in turn, prompts patients to be more mindful of their care plan and their health, and to respond quickly if they have any concerns or symptoms.
The annual survey by the College of Healthcare Information Management Executives recognizes healthcare organizations that have successfully adopted digital health technology.
The organization's survey, covering more than 38,000 healthcare facilities in 10 countries, targets healthcare systems that "exhibit an outstanding record of leveraging the power of digital technology within a visionary corporate strategy." The list is divided into acute, ambulatory, and long-term and post-acute care (LTPAC) organizations.
It also points to the growing interest in adopting digital health tools and strategies in the wake of the pandemic, during which healthcare organizations looked to expand their connected care options and develop more programs to reach consumers. CHIME executives noted that this year's survey has grown by 20%.
“Deeper analysis of the data shows the major efforts underway to transform the way we deliver care as facilities up their digital game in areas such as patient engagement, clinical quality, security, and data analytics,” Russ Branzell, CHIME's president and CEO, said in a press release.
The health systems awarded Level 10 status in the acute care category are:
Jefferson Health- Abington
Cedars-Sinai
Geisinger Health
Jackson Health
Jefferson New Jersey
Jefferson Health - North East
Lehigh Valley Health
Mayo Clinic
NYU Langone Health
Parkview Health
Spectrum Health
Thomas Jefferson University Hospital
UC Davis Health
UCHealth
UPMC
University Health (Texas)
University of Utah Health
West Virginia University Health
This year's survey included an unscored section on digital transformation to, as CHIME put it, "allow for data gathering on responses to emerging digital health trends without impact to an organization’s rating."
“We are excited to recognize those in the forefront of digital excellence,” H. Stephen Lieber, chief analytics officer at CHIME and a former president of the Healthcare Information and Management Systems Society (HIMSS), said in the press release. “Their pioneering performance inspires other organizations by example. Patients in communities around the world receive better care because these providers drive change through digital transformation, as they have proven through their success in this rigorous survey.”
Healthcare organizations are using digital health technology to help doctors and nurses communicate with patients who speak different languages, aren't comfortable using English, or have other communication challenges.
With more than 800 languages spoken in the New York City area, communication challenges are a very real possibility. And nowhere is that more dangerous than in a healthcare facility, where an incorrect translation could affect clinical outcomes.
Healthcare organizations are turning to technology to address that challenge, with partnerships and digital health platforms that enable care teams to access interpreters in real time.
"We deal with a melting pot as far as diversity goes," says Kerry Donohue, MSN, RN, manager of patient experience and culture leader at Manhattan Eye, Ear, and Throat Hospital (MEETH), a division of Northwell Health's Lenox Hill Hospital. "Every day, I'd say one out of every five patients [speaks a language other than English}, and it can be challenging."
When confronted with a patient speaking Farsi, Romansh, Mandarin, or any other language, the traditional tactic would be to look for a multilingual family member or grab the nearest staff member who just happened to speak that language—at least that's what happened in St. Elsewhere—or grab a phone, call the hospital's translation service and hope they had someone nearby who knew that language.
Digital health technology has made that process easier. Care teams can now use a smartphone or tablet to connect through an mHealth app with an interpreter in real time, even by video, on a platform that specializes in translation services. MEETH, for instance, uses LanguageLine services on tablets provided by Equiva Health, a digital health patient engagement company based in New York.
"It's like FaceTime," says Donohue. "You're connected with someone who knows the language."
Making sure patient and provider are speaking the same language is critical in healthcare, and it goes far beyond patient engagement. Doctors and nurses not only need to know exactly what happened and how a patient is feeling, but that their questions, diagnoses and care plans are understood. Something lost in translation could result in a missed symptom that indicates a more serious health issue, or a misunderstood prescription or treatment plan that could make things worse, even fatal.
"It's really not best practice to use a fellow clinician or a family member as a translator," Donohue says, noting that a trained medical interpreter can pick up nuances in both language and clinical terms that others might miss. In addition, this resource means providers don't have to pull in colleagues to help with translation, interrupting other workflows and affecting patient care.
The language barrier isn't just in New York City, either. From Maine to Hawaii, in communities and healthcare sites large and small, the chance of coming across someone who speaks a different language—and who may not speak English at all—has grown. And with the advent of telehealth, more hospitals are engaging in virtual care with patients and other providers in different parts of the world.
In Boston, Brigham and Women's Hospital is testing a device-agnostic website and app called CardMedic, designed to tackle both language and communication barriers, including visual, hearing and cognitive impairment.
"You need as many tools as you can get to help communicate with patients," says Andrew Marshall, MD, an emergency medicine physician. "Clinical questions don’t always fit well into a box, and interpreters aren't always available."
Marshall sees the technology addressing a key social determinant of health that affects care for a wide array of underserved populations. If someone is uncomfortable talking to a care provider in another language or has issues communicating, he or she might delay going to a clinic or hospital or even skip the visit altogether. Or that person might come out of a visit to the hospital or doctor's office with questions about what was said or communicated.
"Brigham and Women's has a robust interpreter service, but you need to make sure" that every word is understood correctly, he says. That might mean using sign language, or providing visual cues or a vocabulary for someone with cognitive issues.
"God forbid you end up having to use Google Translate" to explain the intricacies of diabetes or a heart condition, he adds.
Equiva and CardMedic are part of a wave of innovative ideas aimed at tackling communication barriers in healthcare. Aside from apps and websites that can handle interpretation, there's ongoing research into natural language processing (NLP) and voice activated technology—imagine Alexa handling these tasks in an ER or doctor's office. Other ideas include robots, avatars, and wearables, even smartglasses and hearing aids, that can handle translation.
"At the end of the day you're making physicians into better physicians," says Marshall.
UNC Health's system director of digital health and innovation wants to take complexity out of the healthcare journey and give patients a simple path to care.
For many health systems, consumer activation is defined by the digital front door, and that doorway enables the visitor to quickly identify and find the resources that he or she needs for that healthcare journey.
"It's a continuing, evolving platform," says Dan Dodson, system director of digital health and innovation for the Chapel Hill, North Carolina-based health system. "What we need to know is how do we get it into [patients'] hands so they can begin their journey."
To borrow an analogy familiar to North Carolina Tarheel fans, many health systems see the patient's healthcare journey like a basketball play, with players passing the ball around until someone sinks the basket. But in today's patient-centric healthcare world, that patient wants to get to the basket in as few moves as possible, without the annoyances and stress of passing through so many different players and hands.
That's why health systems like UNC are pulling together all the apps they've launched over the past few years and combining them into one platform.
Dan Dodson, system director of digital health and innovation, UNC Health. Photo courtesy UNC Health.
"This is the use-case call to action that's relevant," says Dodson (who, for anyone still following the analogy, went to both Kansas and Kansas State). "You need to go to where the people are to get their attention."
While there are many different ways that a visitor accesses a health system, the majority of visitors are looking to connect with someone for a healthcare concern, and they want to know who to connect with, where, and when. With that starting point, UNC health partnered with digital health companies Gozio and WELL to create a wayfinding platform that sends text reminders about upcoming appointments and directions to that appointment.
That's just part of the journey, Dodson says. That appointment reminder includes a smartlink to the app, which the patient downloads. That app is pre-populated with patient-specific information on locations and other resources, even parking tips, and then synched with a calendar, giving the patient all that he or she needs for that appointment.
"That's how we start to make it efficient," he says. "The experience has to be seamless [for the patient], or they might find something that is easier next time."
This focus on the digital journey was, in many ways, shaped by the pandemic. COVID-19 prompted many health systems to jump onto the virtual care bandwagon with both feet, fashioning online portals and apps so that patients could access needed healthcare services from the safety of their own homes. In the process, they created multiple online platforms, adding new apps to those that had been launched over the past few years—but not all of them play well together.
"Digital platforms fail to meet consumer expectations because of what I call 'Frankenstein' apps," Gozio Health CEO and founder Joshua Titus said earlier this year when the company released a survey on patient engagement platforms. "This is when an organization launches a mashup of mobile features that are not cohesive, resulting in a disjointed experience for the consumer. This problem is exacerbated when an organization has multiple mobile offerings—one app for labor and delivery, one app for ortho, one app for EMR access, etc.—each vying for the consumer's attention, essentially moving from a Frankenstein app to a Frankenstein strategy, which is unlikely to deliver strategic value to the organization as a whole."
Gozio's survey found that many health systems are struggling to develop a cohesive strategy. Of the 82% of health systems reporting that they do have a mobile presence now, only 38% rated that presence as an 8 or higher in terms of effectiveness.
"Given that a health system's digital strategy impacts so much of the organization, it needs to be thoughtful and cohesive," Titus said in the press release announcing the survey. "This is only becoming more important as health systems seek a competitive edge in their communities."
At UNC Health, Dodson says that strategy is constantly evolving. Integrating Gozio and WELL was a challenge, he says, because each have specific services that hadn't been connected in the past. And now they're working to synch some of the back-office tasks to the platform, including the Epic EHR, and looking out towards new functions, like scheduling.
"We want this journey to be more robust, but we need to make sure we don’t create any new silos that make things more difficult," he says.
Dodson notes that journey also has to be measured. And that's not easy.
"One of the challenges of digital health is that it's hard to quantify," he says. Some functions may find their ROI in patient engagement or satisfaction surveys, while others hew towards clinical outcomes, which may take longer to measure. For wayfinding, the health system is charting no-show rates for appointments; for messaging, they're looking at timely responses, such as changed or cancelled appointments, and looking at whether clinicians are filling in those open time slots.
"This is the other side of healthcare: logistics and administration," Dodson says. "All of this ties into making the healthcare experience better."
According to researchers at UCLA, patients using telehealth for follow-up care after ED discharge were more likely to return to the hospital and be admitted than those who followed up an ED visit with an in-person visit.
New research finds that telehealth isn't always better than in-person care, and it can sometimes lead to more healthcare visits and even hospitalization.
A study led by researchers at UCLA and published in the Journal of the American Medical Association (JAMA) compared follow-up care for patients who'd visited the Emergency Department at the California health system between April of 2020 and September 2021, and found that patients using telehealth were more apt to seek in-person care and be rehospitalized than those who'd had in-person care.
The study analyzed almost 17,000 ED encounters from roughly 13,000 patients at two hospitals, and found that 16% of those who'd had in-person post-discharge follow-up visits returned to the ED and 4% were rehospitalized within 30 days, while 18% of those using telehealth for a follow-up visit returned to the ED and 5% were rehospitalized.
The study isn't necessarily earth-shattering, in that telehealth advocates have stressed that virtual care doesn't replace in-person care and isn't appropriate for all services. But it does highlight the need to compare the two treatment modes and study when and where telehealth is appropriate.
"While telemedicine has been heralded for its potential to improve health care access and convenience, the findings of the study … highlight the need to better understand the limitations of this care modality," Charlie Wray, DO, MS, of the University of California, San Francisco and San Francisco VA Medical Center, said in an accompanying editorial. "Like any other medical intervention, telemedicine can have unintended consequences that eclipse its benefits. Some of these limitations include diminished patient-clinician relationships, decreased efficiency of health care delivery, and lower quality of care."
The study was led by Vivek Shah, MD, of Harbor-UCLA Medical Center, and colleagues from UCLA's David Geffen School of Medicine and Fielding School of Public Health, and the University of Pennsylvania's Perelman School of Medicine and Leonard Davis School for Health Economics.
Shah and his colleagues noted that telehealth studies have seen good results in the treatment of people living with chronic conditions, while the results are mixed in the use of virtual care in acute care settings.
"A potential mechanism to explain increased healthcare utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms," the study noted. "It is also possible that independent of the lack of a physical examination, telehealth clinicians may not be able to communicate as well with patients, leading to an inability to fully evaluate or intervene on evolving illness and leading to deterioration in patient condition and subsequent need for hospitalization."
It's also worth noting that ED visits that require follow-up care tend to involve more acute concerns, such as chest pain, abdominal pain, and shortness of breath—all of which could be serious and would need an in-person exam.
This doesn't mean the use of telehealth in the ED is a complete waste of time or money, either. Health systems have seen success using the platform to screen and even treat patients with less-acute health concerns, thus enabling ED staff to more quickly treat those who need in-person care.
The conclusion here is that health systems have to understand the benefits and limitations of telehealth in different departments and for different patient populations, so as to know when it will work and when in-person care is required.
The health system is contributing $250,000 to quadruple the size of an community health clinic in Denver, part of a project that includes 150 affordable living units and space for fresh food providers.
Health systems are investing in innovative partnerships that not only improve access to care but address some of the social determinants that affect access and outcomes.
The latest example is taking place in Denver, where Intermountain Healthcare is funding the expansion of a community health clinic serving the Hispanic/Latinx community, which accounts for almost 30% of the city's population. The $250,000 grant will quadruple the size of the Tepeyac Community Health Center, which sits in the middle of an even bigger project that will include 150 affordable housing units and 5,000 square feet of space for fresh food providers.
“Intermountain has a reputable legacy of standing in the gap to serve our communities that are most in need," Tiffany Capeles, Intermountain's recently appointed chief equity officer, said in a press release. "This is fulfilled through offering health care options that are both high quality and affordable.”
The expansion will quadruple the clinic's size to 24,500 square feet, add imaging and pharmacy services, and expand annual patient visit capacity from 20,000 to 37,000.
The clinic has operated in East Denver for roughly 25 years, offering primary, behavioral and dental care services in an area that has seen an 88% increase in growth over the past 20 years.
Tepeyac Community Health Center is the first line of care for the fast-growing community, and sends patients in need of more services to nearby Intermountain St. Joseph's Hospital, which is coordinating the grant.
“For the past 28 years, Saint Joseph’s Hospital has been a steadfast partner of Tepeyac Community Health Center and has stood with Tepeyac at every stage of our growth," Jim Garcia, the health center's founder and chief executive officer, said in the press release. "As we prepare to open our new clinical facility, Saint Joseph’s has once again demonstrated their unwavering support, as we continue our mission of serving (or 'of providing high quality, affordable healthcare') to the most vulnerable members of our community."
A digital health company has unveiled an app and platform that can help consumers identify flu-like symptoms at home and access resources for treatment.
With experts predicting an extremely hectic flu season, a digital health company is marketing a direct-to-consumer platform designed to help consumers identify flu symptoms at home and access resources for recovery.
California-based Evidation, which has developed digital health tools in the past to support organizations like Merck, Sanofi, the US Department of Veterans Affairs, and the Michael J. Fox Foundation, says its FluSmart technology analyzes data from wearables to identify flu-like symptoms and offer personalized insights and links to resources.
The platform is the latest in a surge of digital health products designed to help consumers—and their care providers—identify health concerns like infectious viruses at home, before they go to work, school, or a public location like the mall, and help manage their care instead of going to the doctor's office or hospital.
These products can help health systems in reducing waiting room and ED traffic and speeding up time to treatment, while businesses, schools and government offices can monitor employee health.
HealthLeaders spoke virtually with Christine Lemke, co-founder and co-CEO of the company, about the new offering.
Q. How is FluSmart used by the consumer? What technology is used?
Lemke: To get started with FluSmart, individuals download the Evidation app for iOS or Android and sign up for FluSmart via the app or an online link. FluSmart participants have the option to connect a wearable—the program is device-agnostic—but it is not required. Participants answer questions about how they’re feeling on a weekly basis, in addition to being prompted when an Evidation algorithm notices changes in their wearable device data that suggests they may have influenza-like-illness symptoms.
More broadly, the FluSmart program relies on models Evidation has built over many years engaging directly with hundreds of thousands of individuals over the course of their experiences with flu, COVID, and other influenza-like illnesses.
Q. How are you marketing this, i.e. getting the word out that it’s available?
Lemke: Evidation is recruiting participants for the program from its network of almost 5 million members from all over the country using the Evidation app. The Evidation network is one of the largest, most diverse virtual pools of research participants, and there are already 90,000 individuals enrolled in FluSmart this year.
Q. How might healthcare providers (health systems, hospitals, clinics, etc.) or payers take advantage of this service? In other words, can this be integrated into a primary care practice, health plan or some other provider-based strategy or program?
Lemke: This program can help identify individuals with meaningful changes in wearable data or survey data that are correlated with flu—in a key window of early symptom onset. This could be used to do things like identify individuals and prompt them to consider getting screened for flu or COVID, generate awareness for available interventions in an especially relevant moment, precisely recruit people for a clinical trial, or send targeted messages around self-care and when to contact or see a healthcare provider.
Evidation is able to collaborate with health systems, providers, and other partners to use FluSmart with their population. As with every partner, Evidation utilizes industry-leading privacy and regulatory practices, and requires every individual participant to consent for any use of their data.
One day, our hope is that providers could integrate this to help guide their patients into preventive or proactive care journeys to ensure care is delivered at the right time. This technology has the potential to reduce emergency room visits and find patients who need extra support at the right moment.
Q. How do you check or ensure that a consumer knows how to use this technology properly?
Lemke: If someone is able to use an app and answer basic questions about themself, they can use FluSmart. Participants only need to enroll in the program via the app, connect any wearables or other devices they want to contribute data, and respond to prompts for self-reported information as desired. The app walks them through the enrollment process and how to contribute, and there is no special equipment required.
If a participant has a connected activity tracker, FluSmart will alert them when it detects a change in activity data that suggests they might be feeling under the weather – no special setup is needed beyond enrollment. Engaging with this alert will route the participant to the next best action for them.
Q. How might this product or program evolve? How might it be used to address other health concerns or populations?
Lemke: FluSmart is emblematic of the work Evidation does. The core principle underlying Evidation is to help guide individuals toward healthy actions or information when it is most useful to them—and their care teams and broader community. In addition to flu and other infectious diseases, Evidation has explored the utility of data collected from smartphones and wearables to more effectively identify, track the development of, and return insights regarding Alzheimer’s Disease and cognitive impairment, Parkinson’s, and heart health, among other health conditions. There’s great potential for this sort of data to provide better understanding about health in everyday life across a range of therapeutic areas.
Additionally, connecting with a geographically, racially, and ethnically diverse group of people in their everyday life, continuously and longitudinally, offers a profound opportunity to a) generate high impact real world data and evidence and b) offer personalized health programs by being able to identify which individuals a study or program may be most useful for.
The health system's vice president of innovation and IT applications says innovation strategy has to be very flexible.
To Michelle Stansbury, innovation is a necessity at Houston Methodist. It certainly involves thinking outside the box, and now it also means thinking outside of the hospital.
"We're either going to disrupt ourselves or somebody's going to do it for us," says the hospital's vice president of innovation and information technology applications, noting the large number of healthcare organizations in the Houston area and the growing threat of competition from telehealth companies, payers, and retail giants like Amazon.
And that means expanding the playing field.
Houston Methodist already has a Center for Innovation Technology based in its flagship hospital, Texas Medical Center. Now the health system is partnering with The Ion, a 16-acre innovation district hosted by Rice University that's home to a wide range of industries.
"We are advancing the evolution of the hospital's role in healthcare through digital transformation," Stansbury said in an August press release announcing the partnership. "Having a footprint at the Ion will not only provide the Ion's network and Houston community with a window into what we are doing for patients, consumers and providers, but also gives the Ion community and rising innovators an opportunity to bring its own ingenuity and ideas to life with ours."
Stansbury says this new endeavor expands the healthcare innovation sandbox to include people, ideas, and industries that may not have been considered in the past. She points out the Center for Innovation Technology, which opened in 2018, is an ideal location for new ideas within the healthcare setting, while the space in The Ion will pull in concepts that might be new to healthcare.
"We need to tap into the talent that's out there," she says. "There's a lot of hope in what we want to have happen in that space. Some of it will be new to us."
Michelle Stansbury, vice president of innovation and IT applications, Houston Methodist. Photo courtesy Houston Methodist.
Stansbury joined Houston Methodist almost 30 years ago, after holding leadership roles at Compaq Computers and Amoco Oil. Among the many projects she shepherded through the years was the move in 2016 to the Epic electronic health record platform, followed by the opening of the Center for Innovation in 2018.
To Stansbury, integration is a linchpin to fostering innovation. The Center for Innovation, she says, was created with an eye toward breaking down the barriers between innovation, operations, and clinical, and involved executives from each department who took on multiple roles across the board. The goal was to get each department actively involved in discussing new ideas.
The center is designed as an innovation lab within the hospital environment, and it became a hotspot for critical thinking during the pandemic, with digital health and telehealth platforms and tools taking center stage. A lot of the thinking focused on the smart hospital and telemedicine processes that could be applied to inpatient services.
"You're still going to need the physical space," she points out. "You're never going to get rid of it. You're seeing a combination of the physical and digital – the 'phygital' space."
At the same time, she notes, the pandemic showed the industry that healthcare could be moved out of the hospital and into the home. But for that to work, healthcare needed to start looking at other industries that had already perfected online and home-based services.
Hence, the partnership with The Ion.
"We're talking about not only the hospital of the future, but the hospital room of the future, the clinic of the future, and the home of the future," she says. "There's a lot of ideas out there that we need to look into when we plan this."
At The Ion, Stansbury expects to see a wide range of ideas tested out, including wearables and biosensors, machine learning and AI, voice-enabled technology, and healthcare applications in smart home technology like TVs. She also sees a lot of interest in technologies and strategies that improve and reduce workflows for clinicians, especially nurses.
"In many cases they're the champions now" of new ideas and technology, she says of the nurses, one of many groups affected not only by staffing shortages, but high levels of stress and burnout. "They're coming up with some nice ideas in care redesign."
These projects and partnerships have positioned Houston Methodist as a leader in healthcare innovation, and Stansbury says other health systems have taken notice and sought advice. And while the health system is certainly open to advising and collaborating, she notes that innovation is often specific to the challenges, cultures, populations, and workflows of each hospital.
"They have to be very careful doing just what Houston Methodist is doing," she says.
In other words, there might not be a right way and a wrong way to do things, she says, just a different way. That's what thinking outside the box—or the hospital—is all about.
The innovation arm of Henry Ford Health is going national with DromosPTM, a tech platform designed to improve specialty pharmacy operations.
Henry Ford Health's innovation arm is going national with technology designed to improve specialty pharmacy operations.
Henry Ford Innovations has announced that the DromosPTM patient therapy management platform is now being used in seven health systems and specialty pharmacies across the country, and others are planning to integrate the technology in the months ahead.
“These partnerships allow increased functionality and provide patients across the country a better experience and care,” Lisa Prasad, the health system's chief innovation officer and leader of Henry Ford Innovations, said in a press release.
Developed in 2013 to help Henry Ford Health's own specialty pharmacy, Pharmacy Advantage, DromosPTM "fills a long-existing gap in the specialty pharmacy industry by offering efficient patient-focused care and service," officials said in the press release. It includes tools to help pharmacies take advantage of patient portals, find financial assistance for expensive prescriptions, improve medication monitoring, and identify best practices.
The licensing agreement for the technology is one of more than 30 that Henry Ford Innovations has enacted since its launch in 2011, representing more than $100 million in potential revenues for the health system.
Health systems and payers are forging partnerships with paramedics and other community health providers in mobile integrated health programs that bring home-based care to high-risk, high-expense patients.
The growing value of healthcare in the home is creating some interesting new partnerships for health systems and redefining the house call.
Sometimes called mobile integrated health (MIH) or community paramedicine, these programs give health systems and payers an opportunity to address gaps in care and reduce ER traffic by sending specially trained paramedics to the homes of selected patients—most often those identified as high-risk or who often call 911 or their doctor. Hospitals or health plans can partner with local fire or EMS departments to offer the service, train their own paramedics or contract with a vendor.
"It allows us to create an integrated system of care," says Patrick Mobley, president of Bright HealthCare, a six-year-old payer operating in 14 states, which launched a partnership in 2021 with MedArrive, a San Francisco-based startup offering MIH services. "We were looking for an in-home solution that provides more proactive care."
While each program is unique, most begin with a provider or payer identifying a population in need of home-based care – most often high-risk patients with chronic care needs who aren't following doctor's orders at home or so-called "frequent flyers," who often call 911 for non-urgent care needs and treat the ER as their primary care provider.
Once that population has been identified, a plan is drafted to send specially trained paramedics and/or home health aides to the home. These providers can perform primary care services and wellness checks, coordinate more specialized care, screen for social determinants of health, even just sit down and chat for a while with someone who's lonely.
"We're the glue between the patient, the provider and the payer," says Dan Trigub, who co-founded MedArrive in 2020. "Healthcare is a lot more than just acute care treatment. The continuity of care is absolutely critical."
Critics of these programs say the cost outweighs the benefits, and the challenge does lie in identifying the ROI and proving sustainability. Aside from patient engagement and improved health and wellness, payers and providers are balancing the cost of these programs against expenses tied to hospital and ED visits, as well as reduced hospitalizations.
In a 2021 study published in the Journal of the American Medical Association (JAMA), researchers at Canada's McMaster University analyzed some 1,740 calls by an MIH program operated by Niagara EMS (NEMS) of Ontario in 2018, and found the program reduced ED transports by roughly 50% (compared to emergency transports in 2016 and 2017) and slashed the mean total cost per 1,000 calls from roughly $297,000 to about $122,000.
"This economic evaluation’s findings suggest that MIH delivered by NEMS was associated with reduced ED transport and saved substantial savings of EMS staff time and resources compared with ambulance for the matched emergency calls," the study concluded. "This service model could be a promising and viable solution to meeting urgent healthcare needs in the community, while substantially improving the use of scarce health care resources."
California-based payer Molina Healthcare launched an MIH service earlier this year in Texas, also partnering with MedArrive.
"The mobile integrated health program will provide more efficient in-home care to members by bridging the gap between the hospital and primary care services, assisting in authorizations, ensuring medication reconciliation, and identifying social disparities that may affect care," Chris Coffey, plan president for Molina Healthcare of Texas, said in an e-mail to HealthLeaders. "Molina members currently have access to services that provide referral to in-home healthcare services; this program goes the extra mile in offering Molina members special after-hour access to Mobile Integrative Health (MIH) caregivers."
Coffey says the program helps Molina by reducing and preventing unnecessary ED visits and hospitalizations and ensuring that resources are directed to members who need them the most. It also allows members to be treated in the comfort of their own home, rather than travelling to a doctor or hospital.
Eventually, he says, the program will expand to other states, and could be broadened to address other populations, such as the elderly, and offer such services as remote patient monitoring, behavioral health and substance abuse care, and hospice care.
"The business model can be used for implementation of a variety of change management projects," Coffey says. "Mobile integrated health services are meant to challenge current systems that underserve populations, specifically elderly patients, and can be used to close quality gaps, provide non-emergency in-home assessments, vaccinations, education, and overall care."
In New York, the Arc of Rensselaer County, a residential support program for people with developmental disabilities, has launched an MIH service to give its target population access to primary care services at home. The organization is partnering with UCM Digital Health, which offers "a digital front door platform with a 24/7 emergency medicine treat, triage, and navigation telehealth service."
Don Mullin, the Arc's CEO, notes that the 150 or so patients they serve "have the same healthcare issues that we have," yet a trip to the doctor's office, clinic or hospital is much more challenging.
"We would be paying [ambulance or EMS services] to bring them to the ER, where they might spend five or six hours, and then they'd bring them back, and Medicaid would be charged for the entire visit," he says. "This reduces a lot of that time and effort and stress. We can see $300,000 a year in Medicaid savings alone."
In addition, he says, "a lot of the individuals we support have high anxiety. Going out into the community is a real challenge for them. And a phone call [with a doctor] isn't always great for folks who can't always communicate that way."
Mullin says the service, which sees about 150-175 visits a year, is coordinated with each patient's primary care provider.
"We've probably reduced primary care visits as well," he says. "That's another savings we haven't considered just yet. These savings are coming out of different pockets."