Care transitions drive new tech

Elder Services of Merrimack Valley recently achieved a 40 percent reduction in 30-day readmissions, which translated to a gross cost savings of $567,071 over six months. Not bad for the Lawrence, Mass.-based organization -- and it gets even better.

After factoring in new investments in hardware and software and an increase in care coordination activities, net savings were $370,721, ammounting to a 257 percent ROI from technology. And that despite the fact that the cost-per-patient rose $8,893 during that time period.
Those figures come from a March 2014 case study published by the Healthcare Information and Management Systems Society, the parent company of HIMSS Media, which attributes the ROI to the “cost difference between expensive hospital admissions and the low-cost health coaches that contributed to the reduction in readmissions.”
The HIMSS report also states that, among many contributing factors, an ROI of that magnitude can only be achieved when there are “significantly large” reductions in readmissions.
With hospitals, payers and area agencies on aging (AAAs) incentivized to lower readmission rates, alongside growing investment dollars in the more than 50 apps and services bazaar, a new class of mHealth assistance is emerging that combines community-based care transitions with care coordination technology; Care at Hand and Caremerge are two such offerings.
Care at Hand
Elder Services of Merrimack Valley reaped its savings by using, alongside other technologies, Care at Hand’s care coordination services.
What makes this unique is the fact that all three participants - seller, hospital and payers - share the same motivation: reducing hospital readmissions to the benefit of the patient.
Care at Hand is designed for non-clinical healthcare providers at the point of care. The application also has a clinical supervisory component for a nurse care manager who may be overseeing a fleet of non-clinical staff. 
While most care transition services involve a clinically-trained caregiver (a social worker or nurse, for example, who interacts with the patient when he or she leaves the hospital), Care at Hand technology allows for less expensive caregivers to be used. It's estimated that a non-clinical healthcare provider costs about 40 percent less than a nurse caregiver.
The Care at Hand approach differs from past transition thinking in which clinicians were trained to identify as soon as possible what is likely to make the patient sick.
“Clinicians like myself are hard-wired to interrupt the patient,” said Andrey Ostrovsky, CEO, MD, a co-founder of Care at Hand.
In a major change of focus, Ostrovsky and his partners believe that unlike clinical practitioners, non-clinical caregivers are hard-wired to listen, absorb and empathize, making the interaction qualitatively different by creating a unique bond between the caregiver and patient. Oftentimes, he said, these workers are from the same community and share analogous cultural backgrounds.
The technology itself has two major components. The application at the point of care prompts the worker to answer about 15 questions driven by a set of algorithms that anticipate and identify the issues and medical and non-medical problems. The questions change after each interaction. The results of the Q&A, along with the algorithms, become a resource or behavior model of what issue is most likely to land the patient back in the hospital. Next, on the back end, the technology processes and sends an alert to a supervising manager who, in turn, reviews the results and sends a text message or secure e-mail to the local manage,r prompting him or her to take any necessary action.
About 60 percent of the questions focus on organic medical causes of a health decline. In the case of heart failure, for instance, other questions home in on upstream determiners of poor health, such as too much salt in the diet. Co-morbidity issues, such as COPD or diabetes, are also considered. Beyond-the-clinical-diagnosis issues are also brought into play, such as lack of access to financial resources or no support at home.
“We look at that as contributors to readmission,” Ostrovsky said.
Caremerge also has its startup roots in the growing demand for senior care coordination and transition services. Caremerge is a cloud-based communication and care coordination platform that connects providers, payers, families and seniors. The device-agnostic mobile application offers each user type - Certified Nurse Assistants (CNAs), nurses, physicians, family members and seniors - their own view based on the relevancy of their workflows.
The CNA view offers an easy-to-use interface with a picture of the patient and room number displayed upon launch. When the CNA clicks on the patient under his or her care, a list of things to do appears on the screen and tasks are logged upon completion. A single icon displays what medications are needed and when they should be given. Caremerge does not allow the CNA to see the remainder of the clinical data. The iPhone version of Caremerge also can use speech-to-text input.
Daily input collected on the device from the CNA, such as whether the patient is dressing him or herself, bathing, was found confused or fell, is analyzed by algorithms developed by Caremerge. Based on the results of the analysis, other members of the care team, such as the director of nursing, may be alerted.
For the family the application offers daily activity feeds, indicating when the senior under care is attending breakfast, lunch or dinner or pursuing a favorite pastime, like Scrabble. If the family member notices the senior is not playing Scrabble or needs more help with dressing, he or she might ask for an extra caregiver visit to encourage the senior.
In addition, family members see in real time which CNA is caring for their loved one, and they're given the ability to communicate freely with staff via a HIPAA-compliant secure messaging solution that's built within the family application.
From a facility level, the application tracks whether certain routine tests were taken, like the A1c for diabetic patients, with popup alerts for the caregiver to confirm. Analytics for multiple facility administrators include tracking performance statistics across various facilities and reporting on the percentage of quality measures complied with as well as readmission rates.
Various patient activities are weighted and quantified into categories like physical, cognitive, social and even spiritual well-being. A morning walk might be 60 percent physical, 30 percent cognitive and 10 percent spiritual. Caremerge transforms these stats into a pie chart and makes recommendations accordingly.
“These numbers are evaluated at the end of each day as a way of looking at a patient's dimensions of wellness,” said Asif Khan, a co-founder and CEO.
Senior market on the upswing
Care at Hand and Caremerge appear to be simple tools from a user perspective. Both will help AAAs and other community-based senior transition facilities organize information and communicate among hundreds of staff over multiple shifts, providing services for hundreds of residents. And both are among early stage companies in the Startup Health incubator.
Startup Health recently surveyed the top 12 VC firms funding the over-50 market and found investments in preventive medicine rose 59 percent, from $93 million in 2012 to $1.48 billion in 2013, representing 53 percent of all digital health investments. Startup Health also found most VCs investing in companies relevant to the over 50 market are funding early-stage innovation.
With Medicaid already reimbursing home care workers to help vulnerable elderly patients with activities of daily living, it makes sense to use those same workers to prevent or reduce admissions to skilled nursing facilities and hospitals. And since many seniors qualify for Medicaid payments and many health centers are receiving state funding, providing and tracking effective care has a direct impact on a facility’s income.
One thing is for certain: When care transition for seniors is evaluated from a strictly financial perspective, the combination of a huge and growing market and the potential for a sizeable ROI spurred in part by innovative technology means transitions-in-care will see an influx of many more competitors - which, in turn, should engender ever more innovation and better care.