Remote Patient Monitoring Technology Connects Patients and Providers, Supports Chronic Disease Management

// By Jane Weber Brubaker //

What happens to patients with chronic diseases between office visits? What if their vital signs need to be checked more often than every few months? As health systems shift to population health management, staying connected with high-risk patients is one way to prevent conditions from escalating.

Many healthcare organizations, health plans and accountable care organizations have turned to Vivify Health, a cloud-based remote care management platform. Vivify Health is a technology-enabled remote monitoring solution that enables providers to proactively manage changes in health status before a patient ends up in the hospital or ER. The company is under contract with 500 healthcare facilities, among them Ascension Health, CHRISTUS Health, UCLA Health, Memorial Hermann, and Intermountain Healthcare.

Samsung Tablets Preloaded with Individualized Care Plans

Founded five years ago, Vivify Health ships “fully managed health kits” directly to high-risk patients identified by client organizations. The kits contain Samsung tablets paired with Bluetooth LE devices. The technology relays biometric information back to a care portal that is monitored by a care team. The tablet is preloaded with a care plan tailored to the patient, health surveys, educational videos, and video conferencing for virtual visits.

“We have a large menu of conditions that are being monitored,” says Robin Hill, Vice President of Clinical Solutions at Vivify Health. “Most of our customers start out with the complex chronic patients and really targeting those penalty DRGs (diagnosis related groups)”. The Centers for Medicare and Medicaid Services (CMS) penalizes health systems based on excessive readmissions related to acute myocardial infarction (AMI), heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and total hip and knee arthroplasty.

Remote Monitoring Helps Kids Stay in School

But home monitoring is not just for the Medicare population. Children’s Medical Center of Dallas deploys the kits to pediatric patients. “We’re monitoring their post liver and kidney transplant patients,” says Hill. School-age children can return to school and have virtual visits from the nurse’s office without having to disrupt their day for a trip to the doctor’s office, and parents don’t have to leave work to take them. Here’s a patient story about Isobel Tutor, a 17-year-old high school student who received a liver transplant and uses Vivify’s health kit.

BYOD Solution Uses Web App; Native App Coming Soon

Vivify recently announced a new BYOD (bring your own device) solution that will make remote monitoring more cost-effective. “It’s a much cheaper solution because we are using the patient’s own device, including their own data plan,” says Hill. Patients will access the BYOD service through a Web app, and self-report biometric information. A hybrid model based on a native app is in development. The hybrid solution will give providers the option of collecting biometric data directly from Bluetooth devices through the app on a patient’s smartphone or tablet.

Many Devices, One Management Solution

Hill compares the three solutions to the three levels of care in a hospital: The high-risk managed kit is like the ICU; the hybrid solution is like the step-down unit; and the BYOD solution is like general floor care. She emphasizes that, on the back end, all three solutions run off the same algorithms to monitor changes in patient status. “Our back end tool, which is what the clinical team uses to manage and measure that data and react to it, doesn’t change based on the technology that’s been assigned to that patient,” Hill says. “[Nurses] learn one product that covers all three scenarios. They have the same processes and workflows regardless of the solution.”

ACO Plans to Pilot BYOD Solution

Catalyst Health Network, an accountable care organization (ACO) launched in January in the Dallas-Fort Worth area, plans to pilot the BYOD solution in the coming months. Catalyst Health is managed by primary care providers vs. a major health system. “All the payers and employers in Dallas-Fort Worth wanted a solution that was opposite from all these giant health system ACOs,” explains Dr. Christopher Crow, President of Catalyst Health. Crow is also Chairman of the Board of Village Health Partners, a primary care private practice that is part of the ACO. “They wanted something that was 180 degrees different, which is starting with primary care,” he says. Village Health Partners had the first medical home contracts in Texas. “They performed well, so they want to scale that,” says Crow.

The Patient Joins the Care Team

Catalyst Health plans to use both the BYOD solution and the high-risk health kit to manage patients remotely. Most of the ACOs’ covered lives are less than 65 years old. A very small percentage of patients are over 65, and they are enrolled in Medicare Advantage. Crow envisions a single interface that connects to all of the ACO member practices, like spokes in a wheel, with a centralized care team. “Just think of a big call center where a lot of care is getting managed for all of North Texas, and so all of a sudden, you just virtually added the patient to the care team. It would be great if the patient is giving you information every day in a way that helps drive workflow around urgency and kicking out alarms to do an outreach,” says Crow. “That technology can be the tie that binds and helps grow relationships.”

Reimbursement for Chronic Care Management Made Easier

The low-cost BYOD solution will help Catalyst Health manage patients under the new CMS chronic care management (CCM) reimbursement code, CPT 99490, which reimburses providers $42.60 per month per patient. “We’ll augment their current practices and workflows to make them more efficient, and capture the face-to-face and the non-face-to-face time that they’re currently doing to generate the 20 minutes oversight a month that they have to validate that they are providing to each of those CCM patients,” says Hill. “It doesn’t mean they’re not going to continue monitoring those patients, but they will know when they’ve met the requirement.” With the lower-cost BYOD solution, providers can generate revenue with the CCM program. “It’s pennies to the dollar as compared to the managed kit,” says Hill.

Vivify Connects Medicare Advantage Members to Providers

Alignment Health is a population health management company specializing in the Medicare Advantage population. Alignment Health was founded two and a half years ago and funded in April 2014. “In California, we own a health plan called Citizens Choice where we are contracted with around 52 IPAs [independent practice associations] and we have roughly 20,000 patients,” says Dr. Arta Bakshandeh, Senior Medical Director at Alignment Health. “In North Carolina we have a joint venture between ourselves and Humana.” The North Carolina market covers 1,800 lives. Alignment Health plans to move into four counties in Florida next through a partnership with Guidewell, a Florida Blue Cross and Blue Shield plan.

Alignment Health’s founders have many years’ experience with care coordination and home monitoring. “We looked at a number of different companies that had home monitoring solutions,” says Bakshandeh. “What we saw in Vivify was that they had the most well-rounded infrastructure and user interface.” Vivify is now Alignment Health’s remote monitoring solution. “We have around 250 kits [deployed],” says Bakshandeh. Most of the kits are in North Carolina. There are 50 in California, with plans to ramp up once the kits are available in Spanish.

Managing the Frail and the Pre-Frail

Of the Medicare Advantage population, between 5 and 10 percent would benefit from the high-risk health kit, according to Bakshandeh. “Five percent are considered frail with chronic disease, and about 20 percent have chronic disease,” he says. “We are trying to cover the frail and then what we consider the pre-frail that may be moving into the frail percentage.”

Older Adults Find Solution User-Friendly

With a 65-and-older demographic, technology can be challenging, with the biggest drop-off in comfort level at around 75 years old. “Our 65- to 75- [year-olds] have smartphones, and they know how to use them,” says Bakshandeh. “The over 75 don’t. However, with the kit they are able to use the Samsung tablet without any issues. Surprisingly, it’s been very user-friendly and very easy for that demographic to be able to use.” Vivify provides all technical support, 24/7. “We do all the pairing and locking down of that tablet so the only thing the patient can do is the care plan that’s been assigned to them,” says Hill. “We also have software installed on the tablet that allows us to track it, wipe its data if we need to, and troubleshoot if there’s an issue.”

Video Conferencing Feature Credited with Clinical Saves

Bakshandeh feels the kit’s video conferencing feature is particularly powerful. “The ability to do face-to-face video with patients I think is a huge bonus. We’ve had a number of great stories of clinical saves because we were able to do a face-to-face.” He tells a story of a 75-year-old woman who hit the call button on her tablet. Based on her appearance as well as changes in her vital signs that Vivify was tracking, the care team escalated her case to a physician, who admitted her directly to the hospital, potentially preventing a stroke or heart attack.

Remote care management tools are helping health providers better manage patients who are high users of healthcare by maintaining contact with them between visits, collecting daily biometric and survey information, providing simple-to-use tools, and intervening early when changes in status occur. As provider organizations engage in population health management and assume more risk in value-based contracts, tools such as this may offer a means to provide better patient care at a lower cost.

Jane Weber Brubaker is Editor of eHealthcare Strategy & Trends.