Hospitals pursuing a remote approach
Asked about his health issues, Anthony Tramonte of New Castle, Delaware, says: “Do you have about an hour?”
It’s no wonder: The former postal worker, 72, is on dialysis, has diabetes, heart disease, high blood pressure and eye problems. He’s been hospitalized three times for heart failure in the last few years and was blind for a while due to his diabetes.
Tramonte’s wife of 50 years, Phyllis, is his fulltime caregiver, but she’s got help in high places — the Christiana Care health system near their home. There, pharmacist Kelly Ann Steeves is his “care coordinator” after Tramonte is hospitalized to make sure he gets all the medical and social support he needs to avoid a return visit. A monitor checks his heart beat at home and notifies his doctor if it’s irregular, which Phyllis said has saved his life twice.
“I sleep easier knowing he’s got that care,” she said.
Tramonte is one of about 75,000 patients in a Christiana program called Care Link that’s funded by a variety of federal grants through the Centers for Medicare and Medicaid Services. Patients have care coordinators such as Steeves who link them with a nurse, pharmacist and social worker. Similar projects around the U.S. are federally funded and share the goal of keeping people healthy and out of the hospital, at least for preventable reasons.
Under the Affordable Care Act, hospitals now get penalized when Medicare patients are re-admitted within 30 days of a visit, but there are a host of other ways they get rewarded when they keep people healthy. Some are with multiple chronic conditions make up about 50 percent of the cost, said Nevin.
Health IT company Caradigm helps hospitals figure out who their highest cost patients are and what will help those people most. Often, it’s a matter of figuring out why they keep going to the emergency room and may be as simple as the fact that they don’t have a primary care doctor, said Corinne Stroum, who heads program management for healthcare analytics at Caradigm.
A host of chronic conditions
into order,” she said. After hospitalizations, nurses come to their house to take his vital signs and let the doctor know if “something was out of whack,” she adds. They make sure he’s eating and taking his medications correctly given his conditions.
“If someone goes in for breathing issues and their inhaler is changed, if they leave the hospital and don’t make that change, it’s all for nothing,” said Steeves.
These developments will lead many patients to be hearing more from their doctors and hospitals.
“It’s a fine line” how much contact is too much, acknowledges Caradigm CEO Neal Singh.
You can’t be “constantly following up and nagging” patients or they’ll tune you out altogether, he said.
Mandy Cutting, a registered nurse at the Greenville Health System in South Carolina, was working with patient Thomas Keffer, who has diabetes. Even though Keffer’s doctor wanted to put him on insulin, he was reluctant because of the cost. So Cutting convinced the doctor to take him off some of his highest cost medications so he could afford the insulin.
It can be too much for some patients. Binder said the last straw for her with a former insurer was when they kept reminding her to get a mammogram every year while in her 40s. She knew federal guidelines recommended them for her age every two years and, given the possibility of alarming false positives, she didn’t want to go more often.
“I felt like my privacy was being invaded,” she said.
Population health increasingly will help hospitals save or make more money by keeping people healthy, which “creates this opportunity for the patients,” says Nevin.
“But it’s also an opportunity for the physicians because for many of us, that’s why we got into health care,” she said. SILENCE