Telehealth’s first 90 day refund

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.

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  1. I am writing to clarify the AMC Health money back guarantee. This offer, as noted in the MedCityNews article, was designed for our outbound post-discharge IVR program with case management. We chose this from among several other programs because it has proven, robust results and is easy to implement and to track outcomes. We would welcome discussions with potential partners to share risk in other pilot programs that include biometric remote patient monitoring.

    It is not clear why Ms. Cusano finds that the actual offer is different from that described in the MedCityNews article. In paragraphs that precede the quote, the article describes the IVR with case management program used in the Geisinger study. We agree that IVR is not cutting edge, but it is low-cost and effective, and can generate an attractive ROI. As Ms. Cusano notes, AMC Health is careful to differentiate between the 44% reduction in risk of readmission, which was the statistic that the study conducted by the Geisinger Center for Health Research highlighted, and the actual percentage of readmission reduction. I am confident that the mis-statement in the article was unintentional.

    John Holland
    Senior Vice-President for Research & Business Development
    AMC Health

  2. Sam

    It is interesting to see AMC user IVR and promise 10% reduction!

    IVR has been promoted by various companies over time – Lifemasters (bankrupt/sold), Pharos Innovations (ref. Iowa project, Yale study), Touchpoint care etc. VA picked device-based biometric monitoring over IVR even though they had internal support for IVR.

    10% reduction means a hospital goes from 25% readmission rate to 23% readmission rate!! Most hospitals get more reduction by improving discharge planning, ensuring followup visit with PCP, improved patient education and medication reconciliation. They can get this by following Project RED guidelines – available free. Some have achieved up to 50% reduction going from 25% to 12-13% readmission rate without IVR or biometric monitoring.