HIMSS 2017: Banner Health telemedicine program uses tools, analytics to target complex chronic disease

ORLANDO, Fla.—A telehealth program at one of the largest nonprofit health systems in the country has reduced hospitalizations and overall costs by providing in-home telehealth and analytics tools to a subset of patients with complex chronic conditions.

Building on its prior success in the ICU, Banner Health, the 28-hospital health system headquartered in Phoenix, constructed a unique telehealth offshoot targeting patients diagnosed with five or more chronic diseases. The initiative focuses on the system's most complex population—patients who “live on the edge all the time,” Deb Dahl, vice president of patient care innovation at Banner Health, told FierceHealthcare at HIMSS 2017 in Orlando, Florida.

Within that patient population, catching small changes in weight or blood pressure can offer a pathway for immediate intervention, limiting the high costs associated with a hospital stay while allowing patients to remain at home.

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Patients with chronic conditions serve as a primary driver of healthcare spending across the country. The most recent spending report (PDF) tabulated by the Agency for Healthcare Research and Quality (AHRQ) indicates that 5% of the population accounted for more than half of healthcare spending in 2014, while the top 1% of patients accounted for 22.8% of total healthcare spending.

The hospital system, which is part of Banner Health Network, the state’s largest Accountable Care Organization (ACO), saw this as an opportunity to reduce costs within a subset of patients with mounting healthcare costs. The telehealth program targets patients with chronic conditions ranging from congestive heart failure and chronic obstructive pulmonary disease to diabetes.

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In order to qualify for the program, patients must have at least five chronic conditions and a minimum of $20,000 in healthcare costs over the past 12 months—a low bar for a group of patients that typically require a wide array of services.

“We would be happy if a patient had five complex chronic [conditions] and only $20,000, but most are well above that,” Dahl said.

Those patients that meet the minimum requirements are given a suite of tools tailored to their specific conditions. Often this includes a wireless scale, a blood pressure cuff and a glucose monitor. Every patient enrolled in the program receives a tablet that offers two critical services, according to Dahl: It allows the patient to conduct home visits with a dedicated telehealth team, and it periodically asks the patient to answer basic questions that mimic a visit to their primary care physician. Questions might address issues such as pain or depression screening.

“With that data and vital sign data, the software tool in the telehealth center literally [calculates] early adverse trends and our health team can intervene to turn those around,” she said.

Patients are also connected to a health coach who, along with a pharmacist on the telehealth team, helps walk the patient through the medication reconciliation process on the first visit.

“Out of 1,000 patients in the last three years, not a single patient has their EHR match what they are taking,” Dahl said, noting that patients are often taking old and new prescriptions at the same time, raising concerns about medication errors.

An internal review of 128 patients in the Intensive Ambulatory Care (IAC) program found that overall costs among patients enrolled in the program dropped 34.5%, while hospitalizations and the number of days spent in the hospital were cut in half. The 30-day readmission rate went from 20% prior to enrollment in the program to 5%.

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Philips, which partnered with Banner to construct the system’s ICU telehealth initiative, provides the technology for the program. Last month, the two companies signed a 15-year agreement to expand existing telehealth programs and develop new initiatives. According to Dahl, Banner’s next focus will be diabetes care. Representatives from Philips and Banner are scheduled to begin the planning stages of that program in April.

Although Philips has partnered with several systems across the country to implement telehealth programs, Manu Varma, general manager and head of the Hospital to Home program at Philips, said Banner’s initiative is unique, both in its specificity and its long-term engagement—patients enrolled in the program stay in until they go to hospice or a more intensive post-acute care setting.

“It’s great for us as the healthcare provider from a cost perspective, and it’s great for [the patient’s] quality of life,” Dahl said. “Rarely does anyone want to be in the hospital.”