Chronic Disease Prevalence is Increasing Home Health Demands
In 2020, the number of individuals over 60 surpassed the number of children under five for the first time in history[1]as lifespans increase to over 70 in many countries. In the US, people live longer, with an average life expectancy of 77.8 years in 2020[2]predicted to increase to 85.6 by 2060[3]. As of 2020, 56 million US people were ages 65 or older, expected to increase to 84 million people by 2040[4]. Chronic conditions are already prevalent in the US, with more than 85% of seniors over 65 having at least one chronic condition[5]. At the same time, nearly half of all US people have at least one chronic condition, and 30 million people have five or more[6]. The likelihood of developing chronic conditions only increases with age, making chronic care management a significant portion of the nation’s healthcare expenditures. 84% of healthcare costs are estimated to be directly related to chronic care management, which will only increase with diagnosed patients. 99% of Medicare spending goes towards chronic care management. Seniors have already expressed their preference for home health care, with 90% reporting that they wish to stay at home as they age[7]. Increased technology makes this possible, ensuring that patients receive hospital-quality care in the comfort of their own homes. Skilled home health providers enable patients to receive therapies and treatments at home, in addition to services that help them with daily activities. The myth that often persists with home care is that it caters to younger, generally healthier patients. However, this is untrue, with patients over 85 accounting for one-fourth of home health visits while they only account for slightly more than one-tenth of the total Medicare population[8]. In addition, nearly half of all home health patients have five or more chronic conditions, while this population makes up less than one-quarter of all Medicare beneficiaries. With the demand anticipated to continue, the home health industry is expected to reach $225 billion by 2024, more than double its market value in 20164. These demands can be met by the evolving hospital-at-home model, for which CMS expanded flexibilities in late 2020[9]. Hospital at home programs have already seen success across the country, so this expansion will only serve to improve the availability and affordability of these home health services. The program requires healthcare providers to screen patients for medical and non-medical factors and conduct an in-person evaluation before beginning home health care. In addition, remote patient monitoring will also be a significant component of home healthcare, enabling providers to monitor for changes in vitals or symptoms that may indicate worsening conditions. Home healthcare helps to achieve two goals: improving patient outcomes while reducing the cost of care. Studies have shown that at-home care is, on average, less expensive than traditional care at a skilled nursing facility. In addition, patients benefit from lower rates of readmissions and other hospitalizations[10]. Fewer patients in emergency departments and fewer admitted to the hospital will increase the capacity and ability of physicians to treat higher-acuity ED presentations. By making home health care widely available, patients with chronic conditions can receive quality care in the comfort of their homes and benefit from improved patient outcomes. This will be especially valuable as the number of patients with chronic conditions continues to rise, reducing the burden it would place on healthcare systems. Instead, patients get to remain home longer while still accessing the care they need to enjoy their senior lives. [1] https://www.weforum.org/agenda/2021/03/what-is-the-biggest-benefit-technology-ageing-longevity-global-future-council-tech-for-good/ [2] https://www.cdc.gov/nchs/data/vsrr/VSRR10-508.pdf [3] https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1145.pdf [4] https://www.mcknightsseniorliving.com/home/news/home-care-daily-news/should-home-healthcare-be-a-new-focus-for-medicare-advantage/ [6] https://www.americanactionforum.org/research/chronic-disease-in-the-united-states-a-worsening-health-and-economic-crisis/ [7] https://www.mcknightsseniorliving.com/home/news/home-care-daily-news/should-home-healthcare-be-a-new-focus-for-medicare-advantage/ [8] https://homehealthcarenews.com/2021/01/top-home-health-trends-for-2021/ [9] https://homehealthcarenews.com/2020/11/cms-launches-unprecedented-hospital-at-home-strategy-to-manage-latest-covid-19-surge/ [10] https://www.ajmc.com/view/improved-cost-and-utilization-among-medicare-beneficiaries-dispositioned-from-the-ed-to-receive-home-health-care-compared-with-inpatient-hospitalization
Improving Chronic Care Through Remote Patient Monitoring (RPM)
Each year, $3.8 trillion is spent on healthcare services, with 90% of the cost attributable to the care of chronic conditions1. Of the national health expenditure, 21% or $799.4 billion was spent by Medicare alone2. This number is only anticipated to grow as “baby boomers” age and increase Medicare enrollment to more than 73 million individuals by 20303. The increase in a senior population creates more than just budgetary challenges, it will drastically increase the demand for specialized services that treat and manage chronic conditions that affect nearly 80% of older adults4. However, as the public health crisis has demonstrated, physicians and patients need alternatives to in-office visits that may pose health risks. In April 2020, 25% of patients with chronic conditions expressed fears of going into a doctor’s office or hospital5. This fear is understandable, as 73% of patients hospitalized with COVID-19 had a preexisting condition6, making it essential for patients with chronic conditions to appropriately mitigate the risk they have for contracting such an illness. COVID-19 has only accelerated existing trends, like telehealth and remote patient monitoring (RPM), to deliver quality, effective care to a patient in the comfort and safety of their home. Even before the public health crisis, Medicare made steps forward when they announced reimbursement for RPM in January 20196. This allowed physicians to receive reimbursement for remotely reviewing a patient’s biometric data. It was further expanded in January 2020, allowing physicians to bill Medicare for additional time spent reviewing data and allowing more diverse practice staff to participate. Additionally, the Quality Payment Program and Hospital Readmission Reduction Program provide further incentives for physicians to improve patient outcomes through RPM7. RPM has been successful in both lowering emergency room visits and readmission rates by up to 92% and 40%, respectively6. Rather than collecting health data from patients at infrequent office visits, RPM works by providing patients with the tools to measure data such as blood pressure, heart rate, blood oxygen, or glucose levels at home. The data is then recorded and shared with their healthcare providers, who can remotely monitor patient status. This enables physicians to assess the health of their patients more frequently and before something goes wrong. Rather than reactively treating a patient, RPM allows physicians to take a preventive health approach to reduce emergency room visits, readmissions, and health complications. Especially when it comes to patients with high-risk and chronic conditions, deterioration in their health can be detected far sooner than if they had waited for significant symptoms to appear or an in-office visit to alert the doctor of any changes in their health. Patients benefit from improved outcomes, while physicians can deliver better care, and payers are faced with reduced costs. Many RPM devices currently available integrate with sophisticated mobile apps that share data in near real-time or sync with apps like Apple Health so that both patients and physicians can easily view the data. By making patients an active part of the healthcare process, they become more engaged and understand what is needed to improve their chronic conditions. RPM facilitates collaboration between healthcare providers and patients to avoid preventable deterioration. By avoiding hospitalizations and managing symptoms of their chronic conditions, patients are provided with a higher quality of life. Sources:
How Technology is Helping Congestive Heart Failure Patients Get Better in Their Own Homes
As we mark American Heart Month this February, a combination of virtual care and monitoring technology enables CHF patients to stay connected to care in the comfort and safety of their own homes. Home is where the heart is – it’s also the place we usually feel most comfortable, which can be a boon to the healing process. And being at home instead of the hospital reduces the risk of infections and dramatically reduces cost. Linking Home and Hospital At the University of Pittsburgh Medical Center (UPMC), a team of physicians has been working with remote patient monitoring and telehealth to help CHF patients heal at home and prevent ER visits and hospital readmissions. Patients’ smartphones, laptops, and even landlines become the eyes and ears of their care team. When connected wirelessly to scales and blood pressure cuffs, for example, the devices can transmit vital signs back to the hospital, where they can be analyzed and interpreted. If data received indicates a problem, the patient is contacted via phone or video call and given instructions to perhaps amend their medication or pay closer attention to their diet or make an appointment to see their doctor. Small issues can often be treated before they can trigger a hospital admission. Empowering Patients with Information and Guidance The initiative has also helped CHF patients better understand their condition and learn how to effectively care for themselves at home, according to Kimberly Armahizer, clinical supervisor for innovative homecare solutions at UPMC. “The programs are for 60 or 90 days, and afterward, patients are more aware of their symptoms and can better assess themselves daily.”[1] A program piloted at two Kaiser Permanente locations in California experimented with a telemonitoring program for their CHF patients that provided in-home training in the use of a device that measures weight, blood pressure, heart rate, and blood glucose for those patients who are also diabetic. Via modem, patients transmit daily readings to a call center monitored by nurse case managers. Software sorts and ranks the data, allowing nurses to see at a glance who most urgently needs contact. Careful daily monitoring helps patients stay on track with their care plan and learn more about which symptoms need immediate attention. Philip Madvig, MD, Associate Medical Director of The Permanente Medical Group in Oakland, California, reports that their remote monitoring program has cut the rate of hospitalization and readmission for CHF patients to about a third of the average rate system-wide. “This was not a controlled experiment, the patients weren’t randomized, but there is nothing else to explain this dramatic change,” says Madvig.[2] Remote Monitoring Provides Reassurance Recently discharged CHF patients have plenty to process and integrate into their new home routine. Being connected daily with their doctor’s office can reduce their anxiety and give them confidence, knowing a qualified medical professional regularly sees their vitals. [1] https://healthtechmagazine.net/article/2020/04/how-remote-patient-monitoring-programs-are-beneficial [2] http://www.ihi.org/resources/Pages/ImprovementStories/GoodHeartFailureCareFollow
Caring for Your Loved Ones When They Have Congestive Heart Failure
Getting a diagnosis of congestive heart failure (CHF) is difficult and often alarming, but the good news is that people can live happy, fulfilling lives in spite of it. If you’re bringing home a family member who’s been discharged from the hospital after a CHF diagnosis, it can feel like a huge responsibility to take on. But you’re not alone. Over 5 million people live with CHF, many of whom are able to be at home relying on family members as caregivers. And with the procedures doctors have honed over time, combined with new technologies like remote patient monitoring and video or telehealth calls, even heart failure patients living alone can take care of themselves. Either way, the experience is likely to spark questions. Below are some of the most common. But be sure to contact your doctor if you need further help. It’s not unusual for patients to feel they are bothering their physician, but that’s what they’re there for. What does it mean to have congestive heart failure? CHF is a bit of a misnomer since your heart has not actually stopped working but has slowed down. As a result, it’s unable to pump enough blood into all areas of your body. Veins can get backed up, with blood creating congestion that causes swelling in the lungs, stomach, legs, and ankles. This congestion in body tissues can cause a number of symptoms, including: How do I treat heart failure at home? When CHF patients are discharged from the hospital, their families can feel overwhelmed by the requirements of their care. Home care can be especially difficult when the patient suffers from multiple chronic conditions. And while it’s true CHF can create serious problems if the condition is not treated on a daily basis, these treatments are manageable at home. They include: Weight gain can indicate a build-up of fluid, in which case you should contact your doctor immediately. And high blood pressure puts a strain on your heart. Your doctor can recommend an easy-to-use blood pressure monitor. In some cases, doctors recommend remote patient monitoring, which allows you to input your daily vitals check into a computer app. This app automatically transmits the data to your provider’s office, where staff continuously monitor their patients’ status. A simple regimen of reminders, either in your calendar, in the form of a note on the refrigerator, or setting an alarm on your phone, can help. Remote patient monitoring programs can also be programmed to automatically remind you. For example, dressing in loose clothing reduces the restriction in blood flow that can cause clots. This is especially important in your extremities. For that reason, avoiding socks with a tight band at the top is important. Also, wearing layers that can be easily added or removed helps avoid extremes in body temperature. Adopting a heart-healthy diet is another key lifestyle change. That means reducing salt-intake and eating a variety of fruits and vegetables. Other heart-healthy options include whole grains, nuts, legumes, low-fat dairy products, and skinless poultry and fish. Good sleep habits are another key stress reduction strategy. Since CHF is linked to sleep-disordered breathing, it’s important to keep track of snoring and report problems to your doctor. Where can I get help? Your doctor’s office will provide a thorough treatment plan that will get you off to a good start. It will guide you through the various health conditions or problems you may encounter, along with a corresponding list of actions to take. Of course, never hesitate to contact your physician if you are unsure about any aspect of at-home care. For patients with multiple chronic conditions, there’s a lot to manage. This was the case for Elena C., a CHF patient in her 60s who also needed to manage her diabetes and HIV. On her doctor’s recommendation, she began working with a home health care agency. Clinicians followed up with her regularly, explaining how to detect the difference between warning signs that require an ER visit and symptoms that just need a phone call follow-up from her doctor. As a result, Elena and her family get daily reassurance and confidence that she is getting the care she needs at home. While heart failure can’t be cured, an effective home health care program that supports a more active lifestyle, positive dietary changes, stress management, and careful attention to your doctor’s treatment plan can slow the progress of the disease and allow you to enjoy life at home.