Home Health Remote Patient Monitoring For Heart Failure Background Heart disease is the leading cause of death in the US Statistics: 5 million with CHF – 300,000 deaths Changes to CMS reimbursement 1 in 4 Medicare patients with CHF is readmitted within 30 days of a hospital discharge. Effectively managing the needs of this rapidly growing population requires modification of current health care delivery models. Leading cause of death: about 611,000 deaths & costs of >$100 billion / year Approximately 5 million people in the US have CHF, and it contributes to 300,000 deaths annually. Effective October 1, 2012, CMS began reducing hospital payments for CHF (readmissions within 30 days of discharge)

Home Health Remote Patient Monitoring For Heart Failure Project Goals To improve the quality of patient care Promote self-management Prevent unnecessary hospital visits Improve the overall health of this population

Home Health Remote Patient Monitoring For Heart Failure Provide remote patient monitoring of Home Health’s CHF patients. Selected participants are monitored daily in their home by a designated Home Health nurse. Scale, Blood Pressure Cuff, Health Check Monitor supports daily monitoring of patient’s vital signs, weight and symptoms

How are patients identified for the remote monitoring intervention? Clinical Criteria: Heart Failure Expected length of service 4-6 weeks or more Exclusion Criteria: Unwilling or unable to operate remote monitoring equipment Patient or Caregiver not able to understand and complete health check routine Residence is not conducive/safe/pest infestation Patient weighs >450 lbs Residence does not have electricity Patient requires hemodialysis

Roles User Type Responsibilities Patient Monitor their blood pressure, weight and other symptoms from their home for improved clinical outcomes, avoidance of unnecessary visits to the ED, and increased patient satisfaction. Home Health Nurse Monitor the patient daily and determine the most appropriate care for the patient. Vendor Provide the home monitoring devices to the patient, and work with Home Health and Telehealth throughout the contract to assist with equipment needs or contract changes. Management (Home Health and Telehealth) Manage the project objectives, ensure that patients’ needs are met, and determine whether to expand the program after project completion.

Preparing for Home Health Discharge Field Staff Support of Transition to patient self-monitoring: Plan for transition two weeks prior to HH Discharge Compare and document remote monitoring scale weight versus in-home scale reading Review education materials again Notify Remote Monitoring Nurse Return equipment to office Patient calls Remote Monitoring Nurse daily until discharge to give daily weight

Metrics 15.9% 88% 100% 65% 89% Totals for Program Measurement Metric/Target Measurement Date Tool Reports Decrease in CHF and 30-day hospital readmissions – baseline of 168 patients 10% prevented patient readmissions. Baseline of 25% Q2 2017 Omnivisor 15.9% High staff and provider satisfaction with timeliness and clinical benefit received from the services 85% likelihood to recommend Select Survey 88% High patient satisfaction 85% positive Survey tool 100% Utilization of the Cardiocom units 90% utilization Cardiocom 65% Patient Adherence to following their prescribed measurements: weight and BP. 80% adherence 89% Totals for Program Number of Unique Patients (Oct '15-Current) 163 Patients admitted within 30 Days of discharge 26 % of Patients Readmitted 16.0% % National Average (1 in 4) 25% % of reduction 9.0% Total Reductions Saved 14.7 Average Cost of readmission within 30 days $18,000 Estimated Savings $264,000 Challenges—staffing; since part of large system, many wanting to slice/dice the data, and we have to be careful of data integrity, e.g. patients being counted who never received home health, or who were hospitalized for a planned event

Home Health Remote CHF Patient Monitoring Conclusion and Next Steps Data is still being evaluated on efficacy of program If our results are confirmed, we’ll develop this program for other diagnoses, e.g. COPD We will also need to determine whether there is benefit to expanding this to other services outside of Home Health