A notable first for telehealth (certainly for this Editor) is the 90-day, 100 percent refund guarantee made by New York-based AMC Health at HIMSS13. As reported in MedCityNews and other sources, AMC “would refund 100 percent of all costs incurred during the first 90 days of the program if the 30-day readmission rate doesn’t decline by at least 10 percent compared to a risk-matched reference population receiving the usual care.” For our international readers, US hospitals are now being penalized for same-cause readmissions by the Centers for Medicare and Medicaid Services, and key to reduction are post-discharge programs integrating home care.
But the actual guarantee is a little different. In the words of their press release (Editor emphasis):
This guarantee offers a full refund if readmissions don’t decline by at least 10 percent within 90 days of deployment using a proven interactive voice response (IVR) program with case management initially deployed by the Geisinger Health Plan (GHP) and AMC Health.
IVR is not exactly cutting edge, but when handled as GHP did, combining case management with outbound IVR, outcomes can be improved. When handled poorly–the infamous Yale heart failure study that used patient-initiated inbound IVR only [TA 14 Jan 11]–compliance and results are poor.
The emphasis on IVR+case management on the GHP model also seems to omit AMC Health’s multiple telehealth monitoring devices (blood glucose, pulse oximetry, blood pressure) tracked by a web portal for home health agencies, so it’s not clear if the results and the guarantee are applicable to device-driven monitoring with or without case management. One last misinterpretation: the ’44 percent reduction’ claim applies to risk of readmissions; actual readmissions over the two-year tracking period is a far lower 19.5 percent. This is helpfully clarified in the AMC Health press release.
Update 7 Mar pm: Neil Versel at HIMSS13 gets all the above right and then some: John Holland of AMC Health explains how IVR is highly time-saving in case management. For GHS, their model indicated that it took an average of 2.9 attempts to get a patient on the phone, three-fifths of calls were unnecessary because they found no gaps in care, and as few as 15 percent of calls required a medical intervention. Also they are developing a ‘smart inhaler’ for asthma and COPD patients which can indicate a missed dosage or, importantly, alert to over-use as an indicator of diminished lung function.