Telemed pilot for complex patients
A new telemedicine offering gives palliative care’s most medically complex patients access to specialty care from the comfort of their homes. The program is a collaboration between Cook Children’s Health Care System (CCHCS), Cook Children’s Physician Network (CCPN) and Cook Children’s Health Plan (CCHP).
For many of the most complex palliative care patients, a trip to see their primary care or specialty physician requires them to mobilize a ventilator, monitor, feeding pump, medication and wheelchair. It’s cumbersome, time consuming, exhausting for caregivers and can be dangerous for these medically fragile patients.
“It's really burdensome for families to access the bricks and mortar medical center when they have medically complex children, especially if they have lots of technology,” said Jason Reynolds, MD, a pediatric palliative care physician on the medical staff at Cook Children’s Medical Center. “Many of our families will spend four, six or eight hours, just a better part of their day, accessing a 15 or 20 minute visit. It's very taxing for them, and many of these children run the risk of picking up whatever virus is going around, which can have profound consequences in the medically fragile population.”
Dr. Reynolds has been interested in virtual care for years, asserting that it’s important for the medical community to embrace this type of technology to stay at the forefront of what current and future generations expect for medical care.
"Otherwise, we're just going to get left behind because, socially and culturally, the adults in the community that have children are of a generation that this is what they expect and will continue to demand in terms of access to care,” Dr. Reynolds said. “Personally, I like the idea of being able to access my patients from anywhere in the state of Texas, wherever they are and wherever I am. I think that's an interesting and innovative model of care.”
The concept developed into a collaborative pilot when Dr. Reynolds and his team reached out to CCHP about success they had in providing virtual monitoring and intervention with some of their patients, and they had a hunch that the patient benefits also translated to cost savings for the health plan. A review of the data proved that to be true.
“We got super excited about it because, of course, it's quality of life for the members not to have to traipse into the medical center,” said Karen Love, CCHP president. “And we found that there were some savings in terms of reduced hospitalizations and reduced trips to the emergency room.”
The health plan agreed to join CCPN palliative care physicians and CCHCS in a larger pilot by supporting the cost of telemed technology for their members.
“The more we can keep our medically complex members getting the care they need in their home, the better it is for these kids from a health standpoint and the less stressful it is for their families,” Love said. “We're looking for a way to make the lives of these families that are already so incredibly complex as easy as possible. We want to be the insurance company that makes life easier for them.”
The goals of the program are to improve the patient care experience, decrease preventable inpatient admissions and ED visits and reduce the total cost of care. These objectives will be measured through metrics such as increased virtual outpatient visits, and a reduction in missed follow-up visits, ED visits, inpatient and ICU admissions and total cost of care.
“Our hope is that this will keep physicians better connected with their medically complex patients and families and, by having access to these tools, we can intervene earlier, before these kids get so sick they require hospitalization,” Dr. Reynolds said.
It also has the potential to increase efficiency, productivity and growth within physician practices. Dr. Reynolds said telemedicine has been a huge boost to their practice, which has grown 300% over the past 18 months as they transitioned to 95% virtual visits.
Up to 40 CCHP members primarily under the care of CCPN’s palliative care physicians will be enrolled in the year-long pilot. They must meet the ACE Kids Act definition of a child with medically complex conditions.
The program will employ technology that will allow a provider to listen to heart and lung sounds, see inside a patient’s ears and throat, capture pulse oxygenation, take blood pressure, and overall have a more thorough physical exam via a virtual visit. Families will need WIFI or a personal hotspot and smartphone in order to download the monitoring software application via the MyCookChildren’s patient portal. Physicians can access the software via Epic.
“We’ve found that some of the sub-specialists are feeling uncomfortable and unsure of doing virtual visits, especially when it comes to billing for them,” Dr. Reynolds said. “Providers want to offer an equivalent level of care in a virtual setting, and the ability to do a full exam by capturing vital signs along with the ability to look into patients’ ears and mouth and listen to heart and lung sounds opens up a lot of possibilities for virtual visits.”
The technology allows the physician to do all of that and more while the patient remains in the comfort of their own home. In some aspects, the high quality digital picture generated from the exam camera provides a better view than what can be seen with a traditional scope, according to Dr. Reynolds. It’s user friendly for parents and in-home caregivers who will be trained by the palliative care team on how to use the equipment.
The pilot launched in June with six palliative care families who are helping troubleshoot any issues with technology and connectivity. Once this initial review process is complete, the offering will expand to other CCPN physicians and eligible CCHP members.
To learn more about how you and your practice can participate in the palliative care telemedicine offering, email virtual.health@cookchildrens.org or call Jeanette Aguilar, virtual health coordinator, at 682-885-3426.