By Michael Hughes
For patients with the highest needs, just getting to the doctor can be a challenge. Functional and other limitations often challenge their ability to regularly attend primary care appointments. As a result, little issues become bigger ones and – when care is sought – it’s often in the emergency department.
Bringing doctors into the home (also known as home-based primary care) can be a highly effective way of managing these patients. But its scale is often limited. There are only so many housecall doctors and nurse practitioners to go around. Plus, time spent in travel (or sitting in traffic) is often time wasted.
Telemedicine is a promising solution for these challenges. Patients can be seen more quickly and in-home visits can be better prioritized for those that need them the most. But things are still very new. According to a 2017 study by the Advisory Board, only 3% of Medicare beneficiaries have reported any virtual connection with a doctor in the previous six months*.
This is where home care can help.
A recent pilot study between Senior Helpers – a home care provider, Curavi Health – a provider of telemedicine services, and Capital Coordinated Medicine – a home based medical care practice – showed that home care workers could be effective in introducing and managing telemedicine visits with frail elderly patients.
The study sent certified nursing assistants (CNAs) to patient homes to initiate telemedicine visits if a primary care doctor could not see that patient within 24-48 hours of a visit request. The CNA greeted the patient, advised the physician on patient disposition, set up and managed telemedicine equipment during the patient consult and took, and, communicated basic vitals.
The results of the study are promising both in terms of practice economics - as much as a 44% cost savings versus an in-home visit by a primary care doctor – and in the value in its responsiveness. Over 20% of patients seen through the study would have otherwise been referred to the emergency department if the physician only had information from the initial phone intake to act upon.
Importantly, having a trained ‘telepresenter’ on site also helped to overcome issues with connectivity and technology that would have otherwise been left to the patient or their loved ones to manage. For those unfamiliar with telemedicine, having someone there to guide the experience can be invaluable.
Investing in the future of in-home care.
While the telepresenter model is not yet fully paid for through the Medicare fee for service program, it could prove useful for clinicians managing patients under value-based payment contracts. Responsive, reliable services that can support in-home primary care at scale will be more and more essential to lowering hospitalizations, associated cost, and achieving other key value-based measures of success.
Home care is perfectly positioned to deliver these services. Quality driven home care providers already maintain an employed in-home workforce that is trained and experienced in the care of frail elderly patients. They are also proficient at identifying and mitigating risks associated with social determinants of health which are known to influence 70% or more of health outcomes.
According to the Commonwealth Fund, high-need patients – those with three or more chronic conditions and at least one functional limitation – have more than three times the number of emergency department visits than the average U.S. adult patient***.
Primary care for high-need patients will require new types of partnerships if such hospitalizations are to be meaningfully addressed. At the end of the day, a telepresenter might be just what the doctor ordered.
Michael Hughes is Vice President of Strategic Development for Senior Helpers, a nationwide provider of in-home care services for the elderly and high-need individuals. For more information about Senior Helpers work with telemedicine visit www.seniorhelpers.com/kc.
Don't miss Michael's session during Aging in America in Atlanta March 24-27.