Central Pennsylvania health system WellSpan Health plans to increase post-acute and hospital-level patient volume at home by 75 percent over the next three years. In a recent interview with health innovation, Vipul Bhatia, MD, associate medical director of post-acute and continuing care at WellSpan, discussed these ambitious goals.
The eight-hospital system’s home care ecosystem includes preventive care, acute care, post-acute care and end-of-life care. It just launched a partnership with remote patient monitoring provider Biofourmis to support the expansion and management of its company-wide home care program.
Bhatia described the continuity of home delivery offerings. In the preventive care space, patients record their vital signs at home. Doctors are analyzing that data and telling patients what to do next. “The reason I say it’s preventative care is because without that visibility from the doctor and active management by him, these changes would go unnoticed, and if they go unnoticed, these patients will be admitted to the hospital,” she said. “Therefore, we are avoiding unnecessary and avoidable visits and interactions with emergency departments or urgent care for these patients.”
The second element that is included in the preventive group is primary care. Patients who have traditionally sought primary care in the traditional doctor’s office can now receive that care at home. This may be for patients who are otherwise well, but who prefer to receive primary care virtually through a video visit. But it also involves patients who are unwell but are homebound and there is no other way to get primary care except for a doctor to come to their home.
“We don’t have a big home primary care model yet, but everything is done by WellSpan and not through a third party,” Bhatia said. “The only thing we do through a third party is use Biofourmis devices to monitor patients, but it is our doctors who monitor vital signs.”
Primary care at home is a small pilot at the moment. “We don’t have it fully scaled up, but we have been doing remote patient monitoring since 2017 or 2018. So our partnership with Biofourmis is new, but our ability to do remote patient monitoring is not,” Bhatia said. experience in remote patient monitoring in the hospital at home program.” WellSpan launched the program in 2020 during COVID, but had been planning it for a few years beforehand. Patients who would normally have been admitted to hospital are treated at home. It is for low acuity patients who do not need to be in the ICU.
The program maximizes the availability of beds in its hospital facilities for patients with more serious conditions. and also addresses overcrowding in emergency departments, Bhatia said. “More importantly, it is a great satisfaction for the patient. “We regularly track our patient experience scores for that program, and we also track our results and compare them to national benchmarks and continue to perform very, very well in those areas.”
These programs all have a clinical team of WellSpan at Home nurses, nurse practitioners, and physicians, and can provide care across different programs within that ecosystem.
The third category involves post-acute care, including traditional home health care or VNA services. “Our own VNA has been operating in our communities for over 100 years,” Bhatia said. “Compared to the other programs I mentioned, this is a well-established program with very established reimbursement mechanisms. But we have aligned that existing program on this continuum.”
CMS recognizes VNA as a special level of care in the post-acute space. Skilled nursing facilities are another level of post-acute care created, but SNF at home is probably five to 10 years behind hospital at home as a movement, Bhatia said. “I think in the next five or six years we will see the same kind of momentum there that we see now in the acute hospitals at home. But we’re not doing SNF at home right now.”
Remote patient monitoring is also used in the post-acute category. “Many times patients start PROM when they leave the hospital because it is used as a tactic to prevent readmissions,” she explained. “By having close monitoring of the devices by the nurses caring for the patients, it is possible to detect some complications early and then act early and that can prevent readmissions and visits to the emergency department.”
Bhatia spoke about the reasoning behind home care’s ambitious growth goals. “We are actively maintaining a census of around 400 for remote patient monitoring at this time. We know there is much more potential and demand,” she stated. “We have some calculations in terms of what our potential might be in that space. When we take into account all the programs in the ecosystem, if we combine all of that, that’s where our estimate or growth of 75 percent comes from.”
Since remote patient monitoring is so critical to these home care models, Bhatia discussed why they wanted to partner with Biofourmis. “We launched with Biofourmis last month because the company has the type of technology that is ahead of other offerings on the market. A specific example involves continuous monitoring. They have a patch that continuously sends a single-lead electrocardiogram, blood pressure, and pulseox to doctors. And I think it will be very helpful for our local hospital if more patients have that continuous follow-up.”
WellSpan executives were also interested in connectivity to their electronic health record. “Biofourmis was able to work with us and have that interoperability with our EHR, and it’s two-way,” Bhatia said. “Doctors don’t have to do double entry. And any data that flows from the devices to the Biofourmis platform flows seamlessly to Epic. That way, even if a doctor, nurse or social worker is not part of the remote patient monitoring team, they can see everything that is happening in the EHR.”
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