Scaling a pandemic-era RPM program into a virtual continuum of care

Four years after the onset of the COVID-19 pandemic, health systems are working to integrate virtual care capabilities more effectively into traditional healthcare delivery. Organizations are taking the telehealth and remote patient monitoring (RPM) services rapidly implemented to meet pandemic-era needs and growing them into more thoughtfully designed, comprehensive virtual care models. Georgia-based Wellstar MCG Health, formerly Augusta University Health, is one example of an organization that has achieved this, growing an early discharge program for COVID-19 patients into a wide-ranging virtual continuum of care.  

According to Lauren Hopkins, MPH, assistant vice president of virtual care and community engagement at Wellstar MCG Health, the early discharge program began, like many others did, to mitigate capacity problems during the COVID-19 pandemic.

“The purpose of this program was to identify patients who could be discharged early from the hospital and were provided a remote monitoring kit with a blood pressure cuff, pulse ox, and thermometer so a 24/7 virtual RN could monitor patients virtually,” she said in an interview with mHealthIntelligence. “This program was designed to improve bed capacity and throughput while providing continued clinical support to these high-risk patients.”

Launched in February 2021, the program helped improve patient outcomes and patient satisfaction, she noted. However, organization leaders soon noticed gaps in program operations, including the need for broader in-home care capabilities, enhanced remote monitoring equipment, and added resources, including diabetes education and social worker support. Thus, Wellstar MCG Health decided to expand its Virtual Care at Home program to provide at-home care services for patients with differing clinical needs.

The program encompasses various workflows to support a virtual continuum of care that targets varying acuity levels, including hospital-at-home care, at-home patient observation, early discharge management, pre- and postsurgical monitoring, pre- and postpartum monitoring, and chronic disease remote monitoring.

While the Virtual Care at Home program’s initial goals included building capacity to reduce inpatient lengths of stay and unnecessary ED visits by virtually supporting patients during COVID-19 disease progression and recovery, they have since evolved, Hopkins said.

The health system has added more disease-specific goals to the program, such as reducing postpartum preeclampsia or heart failure, lowering readmissions and ED visits, reducing the length of stay for targeted diagnosis-related groups (DRGs), and improving health equity.

Hopkins noted that selecting a new technology vendor was critical in growing the program beyond pandemic-era needs. The health system wanted a flexible vendor with a scalable platform to support a growing patient volume and condition mix.

“We eventually selected Biofourmis for several reasons, including that the solution helps our patients overcome technology resource obstacles for video encounters and data entry,” Hopkins said. “The solution also offers continuous monitoring devices and data sharing, which has enabled us to continue increasing the acuity of patients we manage. Real-time analytics of vital signs and other biometrics help our clinicians anticipate potential clinical problems before they occur.” 

However, Wellstar MCG Health had to overcome various hurdles during program implementation, including clinician concerns related to referring patients to the program.

“While the concept of telemedicine is one that has been around for quite some time, delivering high-quality care through telemedicine or virtual means can be challenging,” Hopkins said. “The concept of ensuring the care provided through the virtual care-at-home program is on par with the care the patient receives in the hospital can be concerning for our physicians and healthcare clinicians.”

To address this issue, health system leaders involved the clinicians in designing the program's care plans and protocols so that they could be sure that the care patients received at home would be of the same clinical quality as the care they received in the hospital. These protocols have since become the standard of care for high-risk patients discharged to home across the health system, Hopkins said.

The health system also involved a multidisciplinary team in implementing the remote monitoring equipment program and creating patient eligibility criteria.

Further, Wellstar MCG Health recognized the need for specialized training for clinicians involved in the Virtual Care at Home program.

Hopkins emphasized that providing high-quality virtual care is not as simple as conducting a Facetime visit. Clinical teams must receive training in completing physical assessments virtually and identifying social determinants of health (SDOH) indicators in the home through motivational interviewing or pointed questions, among other skills.

“Virtual care is a tool that providers and the healthcare system can leverage to improve access and outcomes, but to achieve those results, a training plan must be developed to accompany the operational plan and design,” Hopkins said.

Delving into patients' SDOH needs helps clinicians understand gaps in patient knowledge or resources. They then work with the patients and their caregivers to close those gaps, she added.

To date, Wellstar MCG Health has treated 1,606 patients through the program. The clinical outcomes have been positive, with the program boasting a readmission rate of 9.34 percent, which is lower than the national average of 14.56 percent, Hopkins said. The program also reduces a patient’s inpatient length of stay by 1.49 days compared to those not discharged into the program.

According to Hopkins, one of the program’s most significant drivers of success is its flexible model, designed to support patients with varying acuity levels and SDOH needs. She emphasized that creating this flexible model required a multidisciplinary approach to ensure engagement and care parity from one setting to another and clear communication channels across all team members.

Not only that, but Hopkins also said that closed-loop communication with the patient’s primary care or specialty care provider is critical for success. This communication is necessary to ensure the provider understands the care plan to avoid confusion or care disruption.

For health systems looking to grow their own pandemic-era virtual care programs to meet needs beyond the public health emergency, Hopkins suggests embracing the disruptive nature of virtual care and RPM models.

“Be prepared to be disruptive in a positive way,” Hopkins said. “Creating new models of care within your health system is never easy, but collaboration and full transparency along the way will go a long way towards your success.”