This month, a pilot program called Hospital Care at Home began identifying patients from the Ann Arbor area who could safely go home from Michigan Medicine’s adult emergency department, instead of being admitted to the hospital. These admissions are covered benefits and reimbursable by Blue Cross Blue Shield of Michigan.
It joined a program available to hospitalized Michigan Medicine patients called Patient Monitoring at Home, which launched recently with funding from a grant from the Federal Communications Commission’s COVID-19 Telehealth Program.
“Both of these programs offer patients more flexibility about where they receive their care, while ensuring that they are connected to a health care team that understands their needs while remaining in familiar surroundings, with uninterrupted sleep.” says Grace Jenq, M.D., a geriatrics specialist and associate chief clinical officer for post-acute care at Michigan Medicine. “Especially in this time of pandemic, we are proud to offer this option to our patient, and appreciate the support of BCBSM and the FCC.”
Hospital Care at Home Pilot
The HCAH program is the first test of the ‘hospital at home’ concept in Michigan, and is patterned after a successful program in another state that was originally funded by Medicare.
It involves Michigan Medicine’s Home Care Services division, including Michigan Visiting Nurses and the HomeMed Infusion Pharmacy program, as well as partnerships with the Huron Valley Ambulance service of Emergent Health Partners and Binson’s Medical Equipment.
The program focuses on evaluating patients with specific conditions – heart failure, pneumonia, COPD, urinary tract infection and cellulitis — while they’re still in the emergency department.
Patients must qualify for an inpatient stay, and must live in Washtenaw County or nearby Belleville. They must have BCBSM or Blue Care Network insurance, and must either be able to care for themselves or have a caregiver at home.
If they qualify for the pilot program, they’ll receive transportation via HVA to their home. There, they will receive a range of home-based care — including blood draws, X-rays and medication infusions – through visits from trained staff including a physician, nurses and nurse practitioner, a home health aide and a physical therapist if needed. They will also be loaned a digital tablet and a kit of electronic devices that can monitor their vital signs and transmit the data to nurses who can coach them and act on changes. A physician and paramedics are on call for urgent needs.
After three to five days of care, they’ll be transitioned back to their primary care provider.
Past research on similar program has shown that they reduce readmissions to the hospital, and improve patient satisfaction, says Jenq.
Patient Monitoring at Home program
Meanwhile, some inpatients at Michigan Medicine, the University of Michigan’s academic medical center, could be eligible to go home earlier than they once would have, or to get extra support once they are home.
Through the new Patient Monitoring at Home Program, they’ll be loaned a wireless digital tablet and the suite of devices that connect to it. They’ll monitor their vital signs, connect with nurses remotely and have access to on-call help.
The program aims to improve patients’ experience, reduce their risk of readmission and maintain their quality of care, while allowing Michigan Medicine to make the best use of the inpatient beds it currently has. Patients can remain in the program for several weeks, as needed. Some patients may start in the program as they transition from the nursing home they were discharged to after a hospital stay.
The company providing the remote monitoring equipment and service is Health Recovery Solutions, which has worked with other hospitals to provide similar services.
Each patient receives a box containing a tablet that connects via wireless Bluetooth technology to a blood pressure cuff, scale, blood sugar monitor, thermometer and blood-oxygen sensor. Before they leave the hospital, or soon after arriving home, they’ll receive training in how to use the devices and how to check in with the team that will monitor their results. Each kit is cleaned and recalibrated between patients.
If any of the devices give readings outside expected ranges, an automatic alert will go to the HRS command center’s nurses, who will connect with the patient and their Michigan Medicine post-acute care provider. That provider can also work to proactively coordinate care the patient might need to avoid a new hospitalization.
“In just our first months of using this program, we’ve had many ‘saves’ where patients received needed adjustments to their medications, or scheduled for diagnostic tests,” says Jenq. She notes that patients with a wide range of conditions – from type 1 diabetes and kidney disease to COVID-19 and heart failure — have already used the program successfully.
Patients scheduled for major surgery can also pre-enroll in the program to ensure that they’ll have help after leaving the hospital.
“When we send someone home from the hospital, they go from constant monitoring to nothing, and they and their families are expected to manage everything,” says Jenq. “The approach we’re taking with both of these programs tries to find a new way, especially for patients with short hospital stays. It also gives the patient’s regular physician a way to see trends in their vital signs before they come in for an office or telehealth visit, and provides recommendations.”
Jenq notes that some of those vital signs, especially blood pressure, may be more accurate if measured in the patient’s home than in the clinic. “This is the wave of the future, and could change the way we do medicine so that it’s more accurate and more patient-centric.”