Webinar: Delivering Value through Virtual Care in Home Health

Disclaimer: This transcript is intended to provide an overview of the main topics discussed in the original version of this webinar. Because it has been auto-generated, it might contain errors (including to proper names, industry terminology, numbers, and punctuation) that result in altered meaning. To hear the webinar in full, please view the archived recording.

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Webinar Transcript

Thank you for joining us, Josh and Julie. I know as you guys like to say from ouch to better so today we’re going to talk about the application of virtual care within your home health division specifically. I know Josh, you mentioned you started this a little over a year ago and it was really following that transition to the new payment model of PDGM. So just to begin with, can you provide an overview of the program and how it was set up?

Yeah, certainly. So in the fall of 2019 as most home health agencies were looking at their utilization practices and kind of trying to see how that would fit into this new payment model. We kind of analyzed and we saw what the trends were, where the direction it was going, which was a potential reduction in therapy utilization in home and in an effort to not have that negatively, negatively impact our patients. We thought, well, can we offset that utilizing virtual components? And so I was tasked with trying to develop this program to see how we could provide an adjunct to our in-home care to ensure that our patients weren’t suffering or having a decline in their potential outcomes. And so we started very basically with telephone calls and I was taking referrals directly from clinicians with patients that they thought I might be able to assist them with.

And so we just started experimenting with a phone call a follow-up call with the patient. And very quickly we found that it went from one phone call to three phone calls through their whole course of treatment with our clinicians all the way through to discharge. And what we discovered is that with the virtual component we found a an exciting avenue to continue the education piece specifically that the therapists were working in home. And we really found that with between visits then between the home visits, our clinicians, weren’t having to spend time kind of going over things that they left with the patient or that they tried to educate on in a previous visit. It left the clinicians open to move on to a new or novel treatment with each actual in-home visit which we found kind of really was maximizing the patient’s experience and really moving along their outcomes.

From the phone calls, we then also moved into doing video virtual face-to-face contacts with our patients. And we found quickly that with the home health population that was not necessarily a priority. And so with the flexibility that we have in home health, because we’re not trying to bill for these individually you know, set up virtual appointments we could play around with how we deliver them with a patient. So we really found that the phone calls work well in certain instances, our patients are really do want a face to face. And then we also found that in the moment face-to-face was nice. When we needed to say inspect a wound or you know, review placement of equipment in a patient’s home. So we were able to kind of play around with different modes of providing this virtual care coupled with that. We also, as a system started using the MedBridge app. And so we kind of coupled that with providing our exercises for our patients, providing follow-up, providing assistance with navigating the app, and then again, tying into our clinicians plan of care so that we could continue and move that patient forward.

Great. Thanks Josh. And then Julie, you’re a practicing field clinician. So can you describe a little bit of your partnership with the, the end clinician versus the virtual visits and also what’s changed in your practice in the field? Yeah, absolutely. So obviously with PDGM rolling out I wasn’t available to make as many face-to-face and home visits with my clients. So what I would be able to do is that evaluation I could come in and I would, you know, project how many visits potentially I might need in terms of looking at it from a little bit of a different aspect, whether, you know, can I do this many with face-to-face and then maybe supplement with the virtual really using that virtual aspect for a lot of the educational pieces that I didn’t need to be like in person face-to-face with them, they didn’t really need hands-on from me from a skilled therapist.

But it was still a skilled service. So what I could do is then refer to Josh and provide Josh with the plan of care so that he can really be positively impacting that patient and allowing them to get the services that they need yet without actually seeing me within their home. So a lot of these referrals that I’m making is going to be for things like energy conservation, which we don’t have to be in person necessarily to educate on this or home safety recommendations maybe even just pain management after a surgery or with chronic pain also looking at a home exercise program, how could a virtual visit actually help progress the patient still, but still not have to have an in-person visit. So Josh was able to still progress a home exercise program by following up on a phone call and assessing how they’re tolerating it, and if they can possibly tolerate more repetitions, maybe increased resistance, things of that nature.

Great. Thanks so much, Julie. And Josh early on, you had talked about this being a tool to offset some of the costs versus drive additional value. But in this process you were able to find that you are able, that you were able to still drive value and demonstrate that cost reduction. Could you talk a little bit about how you’re measuring, whether value is created for your patient or your organization throughout the virtual care team?

Yes. So, you know, when it comes down to utilization and the way you know, therapy services are delivered with that, not being a revenue generating factor anymore, going into PDGM we weren’t a high utilization agency to begin with, but we knew that it was potentially going to impact us based off of the cost. And so over the course of this program, we’ve found that we’ve been actually able to reduce our therapy utilization by one visit per episode, which is actually, it doesn’t sound like much, but it’s actually, when you’re looking at all of your episodes, that’s a significant amount. And so by reducing that cost, you know, again, our, our initial concern was are we going to shortchange our and, you know, limit their progress. And so to kind of gauge how this was going to work and, and what kind of progress we’re going to make.

We looked at the OASIS functional measures for those in the home health world. Do you know which ones I’m talking about, the 1800 scores? And so we tracked over the course of most of the year we’d looked at about 200 individual patients and we were tracking those, those scores. And one of the things you’re looking at with those is whether the patient is stabilizing or having a decline that, you know, it shows a negative impact to the patient, but it also shows whether or not you’re providing quality care to that patient to move them along. And as we look at the about nine functional measures over that course of time I tracked their start-up care scores and their discharged score. So as we were going into this, we would average in a month to three month period, about a 25% stabilization rate, meaning again, 20 to 25% of our patients where we’re kind of stabilizing on one or more of those of those scores with the patients that went through our virtual program, we were able to reduce that down to 1%.

And so that’s a pretty significant change. And so that was at the start of initiating this program. Now, our agency is averaging around 10 to 15%. Now I’m not going to say that that’s strictly because of our virtual programming, but it does add to that. And it does show that you’re able to increase the quality of your services without reducing the impact to the patients or, you know, the virtual hands-on contact with those patients. And one of the things that Julie said with the patients, one of the biggest bits of feedback that I get from patients is that they really appreciate having someone following up with them, keeping them on task which is a huge thing with home health. You know, we’re an intermittent service, we’re not there with the patient daily.

And so anytime we can add in that extra contact point to kind of coach them through, you know, talk them through their disease process, talk to them through their, their, you know, home programs, their you know, whatever needs we might be missing or whatever, little things that come up. We’ve really shown that it’s made a significant impact with these patients. You know, one of the big pieces that we’re looking at is our, our patients with respiratory conditions. Obviously that’s a huge issue right now a large portions of the portion of the patients that we’re treating are post COVID patients. And I, we spend a lot of time providing that education on their respiratory status on respiratory techniques, breathing techniques, energy conservation. I think Julie, we have a patient right now that, that you and I are both working with that, that is in fact, a, a post COVID patient.

Yes. So in, in this typically with a lot of my patients that are post COVID I am seeing them for quite a bit of a time. They come home on oxygen and most of their goals are, I want to get off of oxygen. So a lot of this education can come down to a visit that doesn’t necessarily need to be virtual. So I can go in any evaluation or any of my subsequent visits and really educate and provide that in-person education and demonstration on breathing techniques and maybe different equipment to really help and as well as educating them on different exercise programs that are going to help progress them as well, energy conservation with all of their day to day. And then, you know, Josh has been really supplementing, at least once a week is what he’s doing, and then I’m doing an in-person visit once a week.

So, whereas we used to maybe do a frequency of twice a week for him, like in-person visits, we’re now able to utilize the virtual visits. So that again, we’re kind of cutting that back by 50%, scaling that down so that I only have to make one visit. And then Josh can do a follow up education and continue to keep that patient on track and progressing them with a lot of her respiratory needs, energy conservation, that home program she’s been progressing really well with. And actually this specific patient is now off of oxygen, still continuing to monitor very closely, but now is actually off of oxygen to in the home. That’s great. Those are some really exciting results. And it’s, it’s exciting to hear the specific patient examples too, and how those work together. So you guys have obviously demonstrated success both from outcomes, as well as costs. You started, you know, trying with just a couple of patients you’ve grown the program. I know you have really embraced virtual care really across the full continuum. So as you guys are looking at what’s up and coming what’s next with your virtual team?

Well, so a huge a huge issue for all health systems and that we are a part of a larger health system that includes, you know, inpatient hospitals and skilled nursing facilities is looking at rehospitalization rates. It impacts us as an agency alone, but then it affects the cost of the entire system affects the health of the patient. And so a large area that we’re looking at right now is how can we mitigate that rehospitalization? Right. Kind of reduce that, keep those patients home. And so with our virtual care, as we’ve grown from, you know, specific clinician referrals to looking at actual dedicated populations that are receiving virtual care, we’re moving at, looking at our cardiopulmonary patients who are one of our highest risk for rehospitalization and automatically providing some, some virtual intervention with them. Especially in those that first 48 hours after admission to home care.

That’s when they’re at the biggest, the highest risk for re hospitalizing, you know, between that first and second visit. And so we’re, we’re pretty excited. Our preliminary results are showing that we’re actually able to potentially really reduce our rehospitalization rate by providing this skilled contact with a patient. I think that’s an important thing to highlight with how we’re utilizing virtual care is we’re, we’re utilizing clinicians and we’re providing an actual skilled contact. We’re, we’re providing education, we’re advancing their plan of care. It’s not simply a check-in we’re really trying to continue the work the field clinicians are doing with these patients. And so then moving towards that, that high risk for rehospitalization group. Another huge population I mentioned earlier is our post COVID patients. And something that we’re, we’re starting to test the waters with is we’re finding a lot of patients now who are going home that are new to supplemental oxygen.

You know, historically we would see a lot of, you know, COPD patients congestive heart failure patients who are on oxygen. But these are patients who are on it, new from the hospital with a goal of weaning themselves off of it without any real clear direction of where to go with that. And so we’ve kind of identified a little bit of a gap there that we think our virtual program can kind of step in and kind of bridge that to help those patients to continue to progress and not end up back in the hospital.

Great. Thanks so much. And then just to wrap up, you know, any kind of final thoughts that that you guys want to share?

Well, so I went from working as a field clinician into doing this, this virtual mode of care. And I, I had concerns about it, of stepping away from the direct patient care. But I I’ve found that it’s just a fantastic way to continue that, that interaction and continue to use my skill as a therapist to, to help advance these clinicians. And as we’ve grown as a department, one of the things we’ve been able to do is to tap on some of our other field clinicians to assist in and fill in, in this role to have kind of a bit of a variety to their practice. And, and to see what this is all about and to really see the value as we continue to grow our program.

Yeah. And I feel like I can kind of reinforce what Josh is saying too, from my standpoint, I, in the field I get a lot of great feedback from patients and I see the progress too, from patients at first, it was a little scary cause they were like, well, we can’t do, you know, face to face patient visits, but it actually ended up being a pretty smooth transition and has worked really well for, for our team at least.

Great. Thank you both so much for joining us. Really appreciate it.

Thank you. Thanks.

Stay tuned for a live Q and A where our panel members will be answering your questions. We’ll also have an exclusive raffle drawing for an iPad during this session only we’ll be right back live after a quick word on how MedBridge can benefit both your patients and staff.

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