EXECUTIVE SUMMARY
A remote monitoring program can save thousands of dollars per patient by giving case managers and providers real-time data and trends of vital signs and other health information.
- Monitors can measure blood pressure, glucose levels, weight, oxygen saturation, and other vital signs.
- If a case manager notices a sudden change or problem, he or she can contact the patient’s physician or advise the patient to head to the ED.
- The daily data provide reassurance and encouragement to patients for their efforts to improve their health.
Remote monitoring can support case management and disease management programs by providing real-time, data-analyzed medical information of complex patients at home.
One of the drawbacks of telephonic case management is that case managers are limited to information from healthcare provider visits and the most recent symptoms patients report. Patients might gloss over symptoms or be reluctant to report aches and pains. But a remote monitoring device reports objective data, telling a true story of the patient’s health changes.
“We do remote monitoring on a co-management basis,” says Kevin Jacoby, MSW, CCM, CCP, manager of case management at Geneia of Harrisburg, PA. Jacoby is scheduled to speak about integrated remote monitoring at the 2017 Annual Conference & Expo of the Case Management Society of America (CMSA), June 26-30, 2017, in Austin, TX.
One study found that a patient remote monitoring pilot saved $8,375 in costs per monitored patient over a one-year period.1 The study highlighted case studies, including one of a 75-year-old man who was diagnosed with heart failure, hypertension, chronic obstructive pulmonary disease (COPD), and diabetes. His reliance on continuous oxygen kept him homebound and increased his fall risk. As a result of remote monitoring, he no longer needed continuous oxygen, his blood pressure normalized, his doctors decreased his medications, and he had no ED visits or hospitalizations. From the patient’s perspective, his quality of life was greatly improved, as he was no longer homebound and could even attend a family wedding.1
“Not everyone needs this equipment,” Jacoby says.
“What we do is enroll people and screen for case or disease management,” Jacoby adds. “And if we feel the member would benefit from this monitoring equipment, we will have them enroll in a disease management program and offer extra support through the home monitoring program.”
The typical patient who benefits from remote monitoring is someone who has complex medical needs. These patients also need many supportive services.
“If you’re just doing home monitoring, it’s not as effective unless you’re supporting other areas,” Jacoby says.
Remote monitoring programs work by enrolling patients based on their diagnoses. Nurses deploy the equipment, teach patients how to use it, and establish a relationship. The nurses also assess the patient’s ability to use the equipment. The remote monitoring equipment might include screening devices that check heart rate, respiratory rate, weight, blood pressure, glucose levels, and oxygen saturation. Patients use the screening technology each day and their results are sent wirelessly to a portal monitored by care managers. “Nurses look at the values and see if there is anything of concern,” Jacoby says.
“Right now we’re focused on congestive heart failure, but we’re looking to expand it,” Jacoby adds. “Some patients have comorbid diagnoses of diabetes.”
If clinicians notice a value that is higher than the patient’s typical range, it’s left to the professional to decide whether the reading could be a legitimate concern or is an outlier.
“If the nurses know patients are heading in a bad direction, then they can head it off,” he explains. “Or the nurse might call and say, ‘Your blood sugar was a little high today; what was going on last night?’”
When there is a problem revealed by the remote monitoring, nurses can contact the patient’s physician to suggest a change in medication, he adds.
“If it’s a major concern, they might advise the patient to go to the emergency room,” Jacoby says.
Or if data show that a patient is stable and doing well, the information is sent to the doctor at least monthly to let he or she see over time how the patient is managing.
Occasionally, the data will indicate a major change. When this occurs, case managers can troubleshoot to see if there is something wrong with the equipment or how it is being used.
Case managers find that they can focus on a comprehensive picture, using the monitoring data to adjust and improve patients’ care, Jacoby says.
“Patients feel so much more in control because they know when they’re veering in the wrong direction, they get immediate feedback,” he says. “They love getting feedback about how their diet and activities are impacting their health.”
Their positive daily actions result in positive health changes that they hear about immediately, rather than having to wait months for a doctor’s visit.
REFERENCE
- Geneia study finds remote patient monitoring could save more than $8,000 per patient annually. Published June 15, 2016: http://bit.ly/2np88uC.
A remote monitoring program can save thousands of dollars per patient by giving case managers and providers real-time data and trends of vital signs and other health information.
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