Photo: Augusta University Health
Augusta University Health launched its Virtual Care at Home program in February 2021 as a direct response to the COVID-19 pandemic. Like hospitals across the nation, it was limited on bed capacity and had throughput issues.
THE PROBLEM
The program was aimed at supporting the inpatient care team by discharging patients (ages 18 and up) from the medical center a few days earlier to help reduce length of stay and free up beds by providing virtual monitoring 24/7 through nurses, episodic monitoring kits, and daily virtual visits with an Augusta University Health provider.
"We would also enroll patients directly from our emergency department to avoid any unnecessary admissions," said Lauren Williams Hopkins, assistant vice president of virtual care and community engagement at Augusta University Health. "The patients were discharged from the medical center and not in an inpatient status once they were enrolled into our program.
"As we began to enroll patients, we found rather quickly the satisfaction of patients and our care teams began to improve," she continued. "We were able to support our medical center in this innovative way, while improving satisfaction and outcomes of the patients we were treating through reduction of readmissions and reduction of ED visits."
When Augusta began the program, it worked with its chronic care management vendor, NavCare, to use the vendor's episodic remote monitoring program.
"We deployed care coordinators from our population health team to monitor patients during the day – including remote monitoring, reviewing new referrals for program enrollment, and prepping the patient for the daily provider visit – while NavCare provided the nurse monitoring at night," Hopkins said. "The Augusta University Health hospitalist team also provided night on-call coverage for when a nightly escalation by a physician was needed.
"After month three, our virtual care service chief, Dr. Matthew Lyon, worked to develop new protocols for additional conditions outside of COVID-19," she continued. "These conditions included COPD, asthma, pneumonia, UTI and DVT/PE.
Staff slowly began expanding the patient population by increasing capabilities to care for patients in their home. The organization worked with a local vendor to provide in-home diagnostics, in-home labs and in-home visits. This allowed staff to enroll more acute-level patients to continue supporting the inpatient care teams.
"As our program grew through capabilities, our hospital grew more comfortable with this new care model; referrals increased and new conditions were added to help improve other focused areas of need at the medical center," Hopkins explained.
"This included post-surgical patient support, closer alignment with our home health agencies for patients enrolled in the program, and focused readmission reduction efforts for heart failure through the Virtual Care at Home program," she added.
As things grew, staff realized the need for improved technology to provide a higher quality of remote monitoring for patients, but also to improve connectivity issues in the rural patients serviced.
"By combining our virtual care and population health operations, we were aiming to create an approach to improve quality outcomes by allowing that to drive the strategy for vendor selection, and not the technology driving the strategy."
Lauren Williams Hopkins, Augusta University Health
"Until we switched to the Biofourmis platform, our VC@H care team was using another vendor for virtual visits," she recalled. "While this technology works well, there are still many patients who have no smartphone, tablet or laptop to allow them to connect to our providers.
"This eliminated patients who could have been enrolled into the program," she continued. "This was a key feature we began to look for in a new remote monitoring vendor. We needed to ensure we provided our patients a way to connect to us through a seamless video connection."
The other main barrier with the previous vendor was the episodic monitoring offering. When Augusta began the program in 2021, the goal was to eventually apply for the CMS Acute Hospital Care at Home waiver, so staff knew they would need to find a vendor that could offer continuous monitoring.
"Biofourmis’s Hospital at Home program offered us the ability to deploy a tablet to patients so we can connect through video, plus continuous monitoring devices to continue increasing the acuity of patients we were servicing," she said.
PROPOSAL
In her role as the director of population health, Hopkins was focused on ways technology can assist Augusta in improving health disparities in the population it serves, so staff began the journey of exploring what vendor would meet the needs for the future.
"The focus we wanted was knowing we could build a relationship with our vendor that was not technology-focused, but outcome-focused," Hopkins noted. "The COVID-19 pandemic increased the digital health space, which is great, but it also clouded the ability to find a sustainable vendor we could grow with as our program expanded and new workflows were needed depending on the needs of our community.
"Augusta University Health is an academic medical center in Augusta, Georgia, affiliated with the Medical College of Georgia," she continued. " Augusta University Health and Medical College of Georgia have a focus around education and research, so while safe, effective patient care is the No. 1 priority, we also were exploring how the vendor could support our education and research missions."
Augusta also needed a vendor that could support the holistic patient, and not just solve one problem, like many digital health platforms do today, she added.
"By combining our virtual care and population health operations, we were aiming to create an approach to improve quality outcomes by allowing that to drive the strategy for vendor selection, and not the technology driving the strategy," she said.
"Another aspect in a vendor we wanted was the use of the equipment for the patient," she continued. "We service a wide range of patients from varying socioeconomic backgrounds. Because of this, we needed to have a tablet that can be used by any patient with ease."
As staff narrowed the vendor review, the vendors provided an answer to two main issues of video capability and continuous monitoring. Hopkins said Biofourmis stood above the rest due to its predictive analytics, which would allow Augusta to be more proactive in managing patients and use this information in research and education missions.
MARKETPLACE
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MEETING THE CHALLENGE
From the start of the program in February 2021 through implementation with Biofourmis in February 2023, Augusta stayed committed with the first vendor, NavCare. NavCare is a local company in Augusta, Georgia, that has become quite valuable to the Augusta University Health care team and patients.
"Because they were local, we were able to have several brainstorming sessions to improve any technology issues we were experiencing," Hopkins said. "They would sit with us and come up with solutions that worked for our problem and did not force us into a solution.
"They value relationships like Augusta University Health, so together, we were able to successfully treat more than 740 patients with more than 4,300 patient days and a readmission rate of 7.43%," she continued. "During the two years of our work with NavCare, we changed out equipment for blood pressure cuffs, pulse oximeters, thermometers and scales."
They were always researching new equipment alternatives that would enable Augusta to continue growing and treat more patients in the program, she added.
RESULTS
Through the Virtual Care at Home program, Augusta has been able to show a reduced readmission rate of 7.43% (through January 31, 2023). The program itself was able to maintain a low readmission rate, which also improved the overall readmission rate for Augusta University Health to less than 12%.
"The program is continuing to focus on main areas of readmissions by partnering with those providers and care teams to formulate a plan to support patients through the VC@H program and our other transitional care management programs," Hopkins noted.
"This program has also allowed us to reduce our length of stay in patients who are enrolled in this program," she continued. "We initially demonstrated this in a retrospective study conducted on 100 COVID-19 patients enrolled in Virtual Care @ Home and 100 COVID-19 who were not enrolled in the Virtual Care @ Home program."
From these findings, the patients who were enrolled in the VC@H program had a length of stay of 5.7 compared to 9.4 for those not enrolled. The reduction of the length of stay by 3.7 days equated to a reduction of cost savings for the hospital of $1.13M or $11,304 per patient.
MORE TO COME
With a new agreement with Biofourmis, Augusta is hoping to continue expanding its capabilities of providing safe, effective care for its patient population.
"By adding the continuous monitoring patches along with Biofourmis’ predictive analytics, this will improve our response to patient alerts and issues by being proactive in sending an Augusta University Health community paramedic to the patient’s home or bringing them to the ED if needed," Hopkins said.
"With the change in vendor, Augusta University Health also hired resources to support the virtual monitoring program including registered nurses, community paramedics and social worker support," she continued. "Biofourmis will give us a more seamless way to communicate with our patients all hours of the day by chatting with patients through the tablet, three-way virtual visits to allow for other care team members to be included, and a quick emergent connection button for patients to access in the event of an urgent or emergent medical need."
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