Provider
Hoag Memorial Hospital Presbyterian
California
Carmella
Cassetta
Interim CIO
949-764-3284
carmella.cassetta@hoag.org
Yes
Vocera
The challenge was there were silos of information; disparate communication pathways; high volume of alarming systems; and an inability to measure volume of alarms, alerts, calls and interruptions. These challenges created several safety concerns surrounding the chaos of alarming devices. The Clinical Communications Program work was led by a multi-disciplinary team that included Nursing, IT, Bio-Med, Medical Staff and Ancillary Departments. Project leads include Michelle McNamara (Nursing - Project Champion), Carmella Cassetta (IT) and Dr. Martin Fee (Chief Clinical Officer). The Program focused on integrating and upgrading technology; utilizing a single communication platform; standardizing event communications; and implementing smart alarms and routing rules to reduce alarm fatigue and improve patient safety. The end result was going mobile. We replaced mobile devices with smart phones with several applications that allowed for workflow efficiencies and improved care team communications. Although it was a multi-year project leading up to implementation, once launched the results were realized immediately. This includes an 88% reduction in high heart rate alarms, a 93% reduction in low heart rate alarms, and a 99% reduction in sensor off alarms. This allows the care team to focus on true actionable alarms and patient needs without cognitive overload. This project has also brought together various care teams in a unified, single platform - facilitating efficient and prompt collaboration, which was not possible prior to implementing these tools.
Improved the life of healthcare providers
Provider
Hansen Family Hospital
Iowa
Obstetrics ShareCare
Doug Morse
CEO, Hansen Family Hospital
641-430-7012
Doug.Morse@mercyhealth.com
No
The challenge: physician shortages and economic losses made it impossible to continue delivering babies in this rural Iowa hospital. Physicians, nurses, and staff from Hansen Family Hospital and its larger referral center partner MercyOne North Iowa worked together to create a care delivery system for obstetrical services. The result: more than $700,000 saved per year, , patients still have access to rural OB services, and 80% of babies remain in the local community for care after the delivery.
Reduced healthcare costs
Provider
Ellenville Regional Hospital
New York
Ashima
Butler
VP & COO
8452103037
abutler@erhny.org
Yes
KPMG
The opiate epidemic has claimed more than 72,000 lives in 2017. The epidemic has evolved over several years. Currently, almost all the opioid related deaths are caused by heroin and fentanyl overdoses. 75% of heroin/fentanyl users started on prescription drugs. Ellenville Regional Hospital, a 25-bed Critical Access Hospital, and the Institute for Family Health, a federally qualified health care center, collaborated to develop a model of care to address the opioid crisis by reducing the administration of opioids in the hospital’s Emergency Department and transitioning care of chronic pain patients, many exhibiting addiction symptoms, to care at IFH. This community-wide initiative is a new model of care to decrease the administration of opioids while also connecting patients to primary care and specialty services. The two partnering organizations assembled a multidisciplinary team to improve the management of chronic pain without opioids and to address underlying drivers of utilization such as mental health and substance abuse issues. Care Navigation provided a warm patient handoff from the ED coordinating the patient’s appointments with the primary care provider and with other community-based services. Care Navigation successfully linked patients to services such as; housing, primary care, behavioral and mental health and referrals to the Home Health Program.
A new model of care was developed, which decreased the administration of opioids in the Emergency Department (ED) especially to chronic pain patients who were Super Utilizers of the ED. Following the adoption of a hospital Chronic Pain Policy that emphasized the use of alternative non-addictive medications in the ED and the implementation of a system that flagged Super Utilizers of the ED with a chronic pain diagnosis, the ED was able to reduce the administration of opioids to these chronic pain patients and to ED patients in general.
ERH’s efforts affected both the patient population as well as the surrounding community. The team’s efforts increased provider awareness and provided a forum to communicate leading practices, increased provider and community collaboration, and boosted staff morale. The immediate impact of this project on community health has been to assist a population of chronic pain patients who have previously utilized the Hospital Emergency Department excessively, to take non-addictive pain medications rather than opiates and to utilize the ED much less frequently. The potential long-term impact is to provide an ongoing effective model of collaborative care for chronic pain patients that works to ensure continuity of care for these patients, while also reducing excessive ED utilization by these patients.
In January 2019, ERH launched Phase II of the project offering Medication Assisted Treatment to patients presenting to the ED after an overdose event or in active withdrawal. These patients are assessed, stabilized, and evaluated for participation in the three day Medication Assisted Treatment (MAT) program that utilizes buprenorphine right through the Emergency Department. The project generates a warm handoff to a peer navigator immediately post event, evaluates whether the patient meets the criteria to participate in MAT, begins MAT management in the ED and establishes follow up care with a community-based substance abuse treatment program.
A new model of care was developed, which decreased the administration of opioids in the Emergency Department (ED) especially to chronic pain patients who were Super Utilizers of the ED. Following the adoption of a hospital Chronic Pain Policy that emphasized the use of alternative non-addictive medications in the ED and the implementation of a system that flagged Super Utilizers of the ED with a chronic pain diagnosis, the ED was able to reduce the administration of opioids to these chronic pain patients and to ED patients in general.
ERH’s efforts affected both the patient population as well as the surrounding community. The team’s efforts increased provider awareness and provided a forum to communicate leading practices, increased provider and community collaboration, and boosted staff morale. The immediate impact of this project on community health has been to assist a population of chronic pain patients who have previously utilized the Hospital Emergency Department excessively, to take non-addictive pain medications rather than opiates and to utilize the ED much less frequently. The potential long-term impact is to provide an ongoing effective model of collaborative care for chronic pain patients that works to ensure continuity of care for these patients, while also reducing excessive ED utilization by these patients.
In January 2019, ERH launched Phase II of the project offering Medication Assisted Treatment to patients presenting to the ED after an overdose event or in active withdrawal. These patients are assessed, stabilized, and evaluated for participation in the three day Medication Assisted Treatment (MAT) program that utilizes buprenorphine right through the Emergency Department. The project generates a warm handoff to a peer navigator immediately post event, evaluates whether the patient meets the criteria to participate in MAT, begins MAT management in the ED and establishes follow up care with a community-based substance abuse treatment program.
Improved the care of patient populations
Provider
University of Maryland Medical Center/Baltimore City Fire Department
Maryland
David
Marcozzi
Medical Director
6672142172
nbaehr@som.umaryland.edu
No
The University of Maryland Medical Center and the Baltimore City Fire Department partnered to develop and implement two mobile integrated health community paramedicine (MIH-CP) programs in West Baltimore, Maryland. West Baltimore citizens are faced with numerous challenges that impact their health including lack of access to health care, poor individual health literacy, high unemployment, a low median income, and lack of transportation. To address these challenges and enhance the wellness of the community, the West Baltimore MIH-CP program provides a broad range of health services to patients where and when they need them to fill gaps in healthcare delivery, mitigate emergency department overcrowding, and reduce patient readmissions. The two integrated, patient-centered, public-private MIH-CP programs are: Transitional Health Support (THS) and Minor Definitive Care Now (MDCN). THS is designed to help patients with multiple social, environmental, and healthcare challenges to improve the successful transition from hospital to home. The THS multidisciplinary team is comprised of community paramedics (CP), nurses (RN), community health workers (CHW), emergency medical technicians (EMT), social workers, pharmacists, nurse practitioners (NP) and physicians (MD). This team uses a holistic, evidence-based, and modern approach to provide robust, patient- centered support to individuals and their families at home, after discharge from hospital. The THS field two-member team, consisting of BCFD CPs or RNs, visit the patient in their home multiple times over the next 30 days. The field team communicates with the remainder of the team to identify solutions to the patient’s health challenges. Minor Definitive Care Now (MDCN) is a program that supports low acuity patients who call 911 for EMS evaluation and transport. Within the MIH-CP catchment area, the MDCN team, consisting of an advanced level provider (ALP) and a CP, monitors and responds to these calls in a dedicated, medically equipped vehicle at the same time as emergency BCFD providers. The patient is screened by the MDCN team, and if appropriate and agreeable to the patient, then treated at scene. The 911 unit is released back in service, available for the next emergency in West Baltimore. By providing these services, the MIH-CP programs identify and address the needs of the community where and when they are needed, providing the patient the support and appropriate resources needed to maintain their own health. These programs have generated positive impacts on the quality of patient care, risk-adjusted readmission rates, and EMS utilization.
Improved the care of patient populations
Provider
Methodist Le Bonheur Healthcare
Tennessee
Paula
Jacobs
VP/Process Improvement & Innovation
9014781044
paula.jacobs@mlh.org
No
Since the adoption of electronic health records, care teams now have far more information than can be effectively managed. As one intensivist lamented, 'I can see that my patient was turned every two hours, but I have no idea why her condition so drastically worsened overnight.' The department of Process Improvement & Innovation rose to this challenge of “too much data, not enough information” by creating an interactive quality tool, IQ Dashboard. This tool retrieves data from the EHR and display real-time, graphical visualization of every patient's clinical status and risk factors. Quality leaders and Outcome Coordinators use IQ Dashboard for surveillance of conditions like sepsis or sickle cell, review for appropriate preventive care of surgical patients, identify those who are readmitted or are at high risk for readmission, or assess for unreimbursed observation hours. Information is pulled directly from the EHR every few minutes, replacing hundreds of custom reports that basically become obsolete within moments of printing. Using the pull technology of IQ Dashboard has proven much more effective than the dozens of push alerts that were often ignored due to the sheer volume. Per the attached presentation, results include a reduction in sepsis mortality that is now saving approximately 15 lives every single week, an 85% reduction in hospital onset clostridium difficile, and improvement in the PSI-90 patient safety indicator composite from far below national average to top decile. IQ Dashboard has been further enhanced to efficiently manage bed reservation requests, schedule terminal room cleanings, coordinate transporter requests, and capture the voice of the customer via patient rounding. It is difficult to select a single category of benefit from this solution. Based on patient flow efficiencies now possible with IQ Dashboard, we have been able to increase bed placement capacity by 11 beds a day. Considering revenue of approximately $2200 per patient day, the value of increased capacity through improved efficiency is significant. From a patient care perspective, reduction of hospital acquired infections and surgical complications has transitioned Pay 4 Performance penalties of nearly $2.9M into an actual incentive payment in 2020. Patient experience is enhanced by shortening the time awaiting bed placement. IQ Dashboard has now become our comprehensive care management and patient flow platform. Incredibly robust, the custom view feature in IQ Dashboard allows users to quickly reach into the 45,000+ fields of patient data to retrieve the information needed to ensure continual surveillance of high risk conditions to keep our patients safe. That’s priceless.
Improved the care of patient populations
Provider
Washington Department of Heatlh
Washington
Scott
Hamstra
Pediatrician
480-745-8500
scott_hamstra@stchome.com
Yes
STC
During the outbreak the burden on the state to provide residents their immunization information was tremendous and they needed a way to provide information to their residents in a timely and less burdensome way on the state. MyIR™.Net, a free, online portal that allows consumers to access their own and their dependents immunization information, as well as a state sealed certificate. MyIR was designed and developed by STChealth, an Arizona based organization Provide innovative technology and service solutions to eradicate preventable disease and empower individuals to take control of their health providing innovative technology and service solutions to eradicate preventable disease and empower consumers to take control of their health. The first version of MyIR was successfully rolled out in the state of Washington, connecting over 100,000 consumers with their family immunization records. These consumers who have pulled their records online instead of calling the health department has saved the state $200,000 and the savings go up as more consumers get connected. The DOH estimates each consumer connected to MyIR saves them $5. In addition to saving money for the state, results have shown that consumers with a MyIR account are more likely to be up to date on their vaccinations that WA state residents wtihout a MyIR account.
Improved the care of patient populations
Provider
Avera eCARE
South Dakota
Deanna
Larson
eCARE CEO
6053224723
deanna.larson@avera.org
No
Disparities in access to quality health care services exist in rural America. Residents of rural counties often must drive hundreds of miles for specialty care or forgo care altogether. Twenty-five years ago, Avera Health, based in Sioux Falls, S.D., recognized this disparity between its urban tertiary center in Sioux Falls and the numerous rural communities across its footprint, which now spans 72,000 square miles.
In 1993, Avera began piloting telehealth as a way to connect specialists in the city of Sioux Falls to rural community partner facilities. Over the span of 25 years, Avera eCARE has developed an innovative virtual care network to meet its own needs as a health system, and has expanded beyond its traditional geographical borders to serve 400+ sites in 30 states.
Today, as the world’s most extensive and diversified virtual care network, Avera eCARE® is a leader in virtual care delivery – making a difference in how health care is delivered.
Avera eCARE offers specialized services that include Emergency, Pharmacy, ICU, Senior Care, Specialty Clinic/Consult, Hospitalist, Behavioral Health, Correctional Health, School Health and more.
Although a pioneer in rural health care, eCARE serves many urban sites too, driven to improve access to quality care wherever people are in need of that access.
Via secure, interactive and real-time audio-visual technology, participating sites can access specialty support and face-to-face consultations 24/7 at the touch of a button.
eCARE offers 24/7 access to specialty care through innovative ways, for example, using critical care specialists who are based on the other side of the world, in Israel, to cover nights.
On a national and world level, Avera eCARE is a model of how telehealth presents effective solutions to some of today’s most daunting challenges: Workforce shortages, escalating costs, and access to life-saving care for everyone, no matter where they live. Here are key examples:
Ambulatory Telemedicine – The hardship of taking time off work or school, or requiring an escort to travel across the state for one or multiple appointments is more than many patients can absorb. eCARE allows patients to see physicians in many medical specialties—including infectious disease, pulmonology, cardiology, nephrology and others—without having to leave their community. Up to 30% of eCARE Consult patients indicate that without telemedicine, they would have forgone specialty care.
Community Care – The advent of high quality, secure telemedicine applications allows eCARE to extend this care model into patient homes; to truly meet patients where they are, on their terms. For example, Avera uses telehealth tools to reach moms with gestational diabetes, delivering timely education, clinical support, and ongoing monitoring. Enrolled moms can have an appointment from their office or during a lunch break via their smartphone. Knowing that their care team is monitoring their daily glucose levels keeps them motivated to track their progress, watch what they eat, and work with the team if insulin is prescribed. The results are impressive – healthier deliveries, reduced birth complications and fewer C-sections, not to mention thousands of miles saved by patients.
Post-Acute – The elderly population living in skilled nursing homes and long-term care facilities are frail, medically complex, and manage multiple chronic conditions. Unnecessary hospitalization and emergency room visits are harmful, costly, and represent a major opportunity to improve health outcomes and quality of life for a vulnerable population. Avera has implemented telehealth access to geriatric services to prevent avoidable escalation of illness for residents, resulting in better quality, better patient experience and lower costs. eCARE data suggests geriatric telemedicine can improve unplanned transfers by 62% and saved an estimated $342 per beneficiary per month on Medicare costs.
Avera eCARE has received national coverage in the Washington Post, Wall Street Journal and soon will be featured on a major television network.
In 1993, Avera began piloting telehealth as a way to connect specialists in the city of Sioux Falls to rural community partner facilities. Over the span of 25 years, Avera eCARE has developed an innovative virtual care network to meet its own needs as a health system, and has expanded beyond its traditional geographical borders to serve 400+ sites in 30 states.
Today, as the world’s most extensive and diversified virtual care network, Avera eCARE® is a leader in virtual care delivery – making a difference in how health care is delivered.
Avera eCARE offers specialized services that include Emergency, Pharmacy, ICU, Senior Care, Specialty Clinic/Consult, Hospitalist, Behavioral Health, Correctional Health, School Health and more.
Although a pioneer in rural health care, eCARE serves many urban sites too, driven to improve access to quality care wherever people are in need of that access.
Via secure, interactive and real-time audio-visual technology, participating sites can access specialty support and face-to-face consultations 24/7 at the touch of a button.
eCARE offers 24/7 access to specialty care through innovative ways, for example, using critical care specialists who are based on the other side of the world, in Israel, to cover nights.
On a national and world level, Avera eCARE is a model of how telehealth presents effective solutions to some of today’s most daunting challenges: Workforce shortages, escalating costs, and access to life-saving care for everyone, no matter where they live. Here are key examples:
Ambulatory Telemedicine – The hardship of taking time off work or school, or requiring an escort to travel across the state for one or multiple appointments is more than many patients can absorb. eCARE allows patients to see physicians in many medical specialties—including infectious disease, pulmonology, cardiology, nephrology and others—without having to leave their community. Up to 30% of eCARE Consult patients indicate that without telemedicine, they would have forgone specialty care.
Community Care – The advent of high quality, secure telemedicine applications allows eCARE to extend this care model into patient homes; to truly meet patients where they are, on their terms. For example, Avera uses telehealth tools to reach moms with gestational diabetes, delivering timely education, clinical support, and ongoing monitoring. Enrolled moms can have an appointment from their office or during a lunch break via their smartphone. Knowing that their care team is monitoring their daily glucose levels keeps them motivated to track their progress, watch what they eat, and work with the team if insulin is prescribed. The results are impressive – healthier deliveries, reduced birth complications and fewer C-sections, not to mention thousands of miles saved by patients.
Post-Acute – The elderly population living in skilled nursing homes and long-term care facilities are frail, medically complex, and manage multiple chronic conditions. Unnecessary hospitalization and emergency room visits are harmful, costly, and represent a major opportunity to improve health outcomes and quality of life for a vulnerable population. Avera has implemented telehealth access to geriatric services to prevent avoidable escalation of illness for residents, resulting in better quality, better patient experience and lower costs. eCARE data suggests geriatric telemedicine can improve unplanned transfers by 62% and saved an estimated $342 per beneficiary per month on Medicare costs.
Avera eCARE has received national coverage in the Washington Post, Wall Street Journal and soon will be featured on a major television network.
Improved the care of patient populations
Provider
Iora Health
Massachusetts
Andrew
Schutzbank MD, MPH
Senior Vice President, Development
617-396-4672
andrew@iorahealth.com
No
Challenge: Relieving Physician Burnout by Reducing "Work after Work"
Who: Whole company effort led by CEO including: Physicians, Care Teams, Clinical & Executive Leadership, Technology and Continuous improvement teams
What: Focused coaching and global improvements to primary care physician and care team workflow (including technology) to allow providers to finish work during the clinical day.
How: Directly measured work completed during/after hours while holding quality of care constant (or improving)
Who: Whole company effort led by CEO including: Physicians, Care Teams, Clinical & Executive Leadership, Technology and Continuous improvement teams
What: Focused coaching and global improvements to primary care physician and care team workflow (including technology) to allow providers to finish work during the clinical day.
How: Directly measured work completed during/after hours while holding quality of care constant (or improving)
Improved the life of healthcare providers
Provider
Fuller Hospital
Massachusetts
Carrie
Ballou
Community Relations
774-287-4249
carrie.ballou@uhsinc.com
No
Fuller Hospital, a 102 bed inpatient community psychiatric hospital for adults, adolescents ages 12 and older, and adults with special needs. When Fuller CEO, Rachel Legend, first arrived she had already experienced first hand the disparity in healthcare for the LGBTQ community. Rachel Legend, along with her leadership team at Fuller, has developed a training and education program for staff defining and reinforcing best practices for patient care. The first of its kind in Massachusetts, Fuller has set the standard for other healthcare facilities.
Improved the care of patient populations
Provider
The University of Alabama at Birmingham (UAB) Medicine
Alabama
Bart
Kelly
Executive Director, Telehealth
(617) 204-3500
lindsay.sharifipour@americanwell.com
Yes
American Well
As the only certified Comprehensive Stroke Center in Alabama, a state that has the second-highest stroke mortality rate in the country, UAB Medicine sought a more effective and efficient way to treat stroke patients. Perpetuating the stroke epidemic in Alabama is the fact that the state faces a severe shortage of vascular neurologists, especially in rural hospitals, meaning that many stroke patients would be transferred to UAB Medicine, further delaying care.
UAB Medicine decided to partner with American Well to create a state-wide, comprehensive telestroke program in order to give stroke patients care where and when they needed it. To build out the program, the health system formed partnerships with local hospitals throughout the state. Then, using American Well’s telehealth technology, specifically its telemedicine carts, UAB Medicine was able to deliver telestroke services to critical patients at these hospitals, minimizing the need for transfers. Working with partner hospitals, UAB Medicine developed telestroke workflows designed to quickly and effectively treat stroke patients. The telestroke program usually takes only about 4-6 weeks to implement in each hospital and implementation includes, site visits, telemedicine cart delivery and setup, onsite education, mock visits, tech team support and more to ensure a successful program.
Through its telestroke program, UAB Medicine has been able to drastically expand the reach of its vascular neurologists into rural communities across Alabama and neighboring states. To date UAB Medicine has deployed 13 American Well telemedicine care points within emergency departments and intensive care units throughout Alabama.
Specifically, through the telestroke program, UAB Medicine has:
• Conducted more than 430 telestroke consultations
• Expanded telestroke care to 10 rural hospitals in the program’s first year alone
• An average telestroke evaluation time of just six minutes. That means that it only takes six minutes from the time a nurse submits a case in the American Well platform to the time the vascular neurologist is on video seeing the patient.
• Administered tPA 11.6% of the time via telestroke, which is higher than the national average tPA administration rate of 3.8%.
Looking ahead, UAB Medicine plans to scale its telestroke network, and is already working with the Alabama Department of Public Health to provide a more integrated approach to early stroke services. It also plans to utilize a state-wide trauma communications center to help coordinate stroke care and direct stroke patients to the appropriate center depending on stroke severity and hospital capacity.
UAB Medicine decided to partner with American Well to create a state-wide, comprehensive telestroke program in order to give stroke patients care where and when they needed it. To build out the program, the health system formed partnerships with local hospitals throughout the state. Then, using American Well’s telehealth technology, specifically its telemedicine carts, UAB Medicine was able to deliver telestroke services to critical patients at these hospitals, minimizing the need for transfers. Working with partner hospitals, UAB Medicine developed telestroke workflows designed to quickly and effectively treat stroke patients. The telestroke program usually takes only about 4-6 weeks to implement in each hospital and implementation includes, site visits, telemedicine cart delivery and setup, onsite education, mock visits, tech team support and more to ensure a successful program.
Through its telestroke program, UAB Medicine has been able to drastically expand the reach of its vascular neurologists into rural communities across Alabama and neighboring states. To date UAB Medicine has deployed 13 American Well telemedicine care points within emergency departments and intensive care units throughout Alabama.
Specifically, through the telestroke program, UAB Medicine has:
• Conducted more than 430 telestroke consultations
• Expanded telestroke care to 10 rural hospitals in the program’s first year alone
• An average telestroke evaluation time of just six minutes. That means that it only takes six minutes from the time a nurse submits a case in the American Well platform to the time the vascular neurologist is on video seeing the patient.
• Administered tPA 11.6% of the time via telestroke, which is higher than the national average tPA administration rate of 3.8%.
Looking ahead, UAB Medicine plans to scale its telestroke network, and is already working with the Alabama Department of Public Health to provide a more integrated approach to early stroke services. It also plans to utilize a state-wide trauma communications center to help coordinate stroke care and direct stroke patients to the appropriate center depending on stroke severity and hospital capacity.
Improved the care of patient populations
Provider
Augusta Health
Virginia
Penny
Cooper
Data Scientist
(540) 932-5564
PCooper@AugustaHealth.com
No
Augusta Health’s nurses are highly skilled and trained in recognizing sepsis, but the hospital wanted to see if it could use technology to help reduce the incidence of sepsis even further. Toward that end, in 2016 hospital leadership formed the Sepsis Team and Taskforce to study the issue. Its goal was to provide the staff with a resource that would help them identify the symptoms of sepsis sooner and then bring that information directly to the attention of the clinicians working with that patient so they can intervene before the issue reaches any points of danger.
The Sepsis Team and Taskforce, led by the hospital’s Data Scientist, conducted a retrospective study and then developed an automated process called the Early Sepsis Alert System that takes live data from medical systems each hour: a temperature greater than 38°C, heart rate greater than 90, respiratory rate greater than 20, an abnormal white blood cell count, mean arterial pressure, and shock index. The data is analyzed and compiled, and then each patient is assigned a score based on the beta coefficients of the retrospective study. If the score is above a specific threshold, an alert is sent through the Vocera communication system to the staff caring for that patient. The staff then immediately goes to the patient, screens for sepsis, and if identified, begins early intervention.
In practice, the Early Sepsis Alert System acts as a “second pair of eyes.” Many sepsis indications and issues are still caught by clinicians working directly with patients. But this solution helps keep others from slipping through the cracks, especially during busy times at the hospital.
The single most important impact is that Augusta Health has been able to save 282 lives between April 2016 and March 2019 that otherwise would have been lost to sepsis. The hospital’s yearly mortality rate is about one-third that of the Commonwealth of Virginia (4.76% versus 12.7% statewide).
The Sepsis Team and Taskforce, led by the hospital’s Data Scientist, conducted a retrospective study and then developed an automated process called the Early Sepsis Alert System that takes live data from medical systems each hour: a temperature greater than 38°C, heart rate greater than 90, respiratory rate greater than 20, an abnormal white blood cell count, mean arterial pressure, and shock index. The data is analyzed and compiled, and then each patient is assigned a score based on the beta coefficients of the retrospective study. If the score is above a specific threshold, an alert is sent through the Vocera communication system to the staff caring for that patient. The staff then immediately goes to the patient, screens for sepsis, and if identified, begins early intervention.
In practice, the Early Sepsis Alert System acts as a “second pair of eyes.” Many sepsis indications and issues are still caught by clinicians working directly with patients. But this solution helps keep others from slipping through the cracks, especially during busy times at the hospital.
The single most important impact is that Augusta Health has been able to save 282 lives between April 2016 and March 2019 that otherwise would have been lost to sepsis. The hospital’s yearly mortality rate is about one-third that of the Commonwealth of Virginia (4.76% versus 12.7% statewide).
Improved the care of patient populations
Provider
Kaiser Permanente
California
Manju
Gangadhar
Executive Director, Digital Architecture & Strategy
925-209-6630
Manjunath.X.Gangadhar@kp.org
Yes
Samsung Electronics
Kaiser Permanente is using technology to create a digital health and wellness ecosystem that enables precision medicine — putting the patient at the center of personalized health care and empowering them to live more healthy years. The medically supervised Virtual Cardiac Rehab program is one such example. Through “wearable” innovation, it enables rehabilitation health for patients who have experienced a cardiac event such as a heart attack, heart failure, angioplasty, or heart surgery.
Previously, cardiac follow-up procedures occurred at a medical facility where clinicians monitored the patient performing a set of activities and exercises. Travel time and distance presented barriers for some cardiac rehab patients, especially minority populations and patients returning to work. Kaiser Permanente took a user-centered approach to digitizing a research-validated intervention, considering patient access and convenience, and bringing together physicians, case managers, patients, and technologists to co-design the digital solution. Kaiser Permanente first tested the program on a small scale over a series of prototypes and pilots, observing its effectiveness and incorporating learnings. The current program launched in April 2018 and was fully deployed in December 2018 to the broader Kaiser Permanente population.
Today, a consumer-grade Smart watch connects to a secure mobile app that monitors the patient’s heart rate, tracks their personalized treatment plan, and uses a digital calendar and checklist for prescribed, home-based care routines. The care team, meanwhile, remotely monitors patient patterns and progress and can adjust the individual treatment plan based on the data. This motivates patient responsibility and enhances patient-clinician engagement. By practicing cardiac rehab at home, patients develop consistent habits to maintain healthy, long-term behaviors after completing the program.
The innovation in the Virtual Cardiac Rehab program has produced successful outcomes over the last year, helping cardiac patients rehabilitate at home. The patient participation and completion rate of 87% is nearly double that of the traditional medical-facility approach, and the hospital readmission rate is less than 2% versus a 10 to 15% market average. Based on research that demonstrates reduction in cardiovascular mortality after completion of cardiac rehab, around 100 lives have been saved through this program. Aggregate data, integrated with remote monitoring, is used to advance preventive medicine and overall cardiac care.
The technology is a key enabler of the patient experience, but Kaiser Permanente’s rigorous operations management and talented case managers and staff are also integral to the patient experience and success.
Previously, cardiac follow-up procedures occurred at a medical facility where clinicians monitored the patient performing a set of activities and exercises. Travel time and distance presented barriers for some cardiac rehab patients, especially minority populations and patients returning to work. Kaiser Permanente took a user-centered approach to digitizing a research-validated intervention, considering patient access and convenience, and bringing together physicians, case managers, patients, and technologists to co-design the digital solution. Kaiser Permanente first tested the program on a small scale over a series of prototypes and pilots, observing its effectiveness and incorporating learnings. The current program launched in April 2018 and was fully deployed in December 2018 to the broader Kaiser Permanente population.
Today, a consumer-grade Smart watch connects to a secure mobile app that monitors the patient’s heart rate, tracks their personalized treatment plan, and uses a digital calendar and checklist for prescribed, home-based care routines. The care team, meanwhile, remotely monitors patient patterns and progress and can adjust the individual treatment plan based on the data. This motivates patient responsibility and enhances patient-clinician engagement. By practicing cardiac rehab at home, patients develop consistent habits to maintain healthy, long-term behaviors after completing the program.
The innovation in the Virtual Cardiac Rehab program has produced successful outcomes over the last year, helping cardiac patients rehabilitate at home. The patient participation and completion rate of 87% is nearly double that of the traditional medical-facility approach, and the hospital readmission rate is less than 2% versus a 10 to 15% market average. Based on research that demonstrates reduction in cardiovascular mortality after completion of cardiac rehab, around 100 lives have been saved through this program. Aggregate data, integrated with remote monitoring, is used to advance preventive medicine and overall cardiac care.
The technology is a key enabler of the patient experience, but Kaiser Permanente’s rigorous operations management and talented case managers and staff are also integral to the patient experience and success.
Improved the care of patient populations
Provider
St. Joseph's Health
New Jersey
David
Adinaro
VP&CMO
973.754.2397
adinarod@sjhmc.org
Yes
Cerner Corp.
WHAT:
St. Joseph's Health (SJH) is a mission driven organization sponsored by the Sisters of Charity of St. Elizabeth based in Paterson NJ. We provide care to a largely underserved population with significant challenges in the social determinants of health (SDoH). In order to fulfill our mission financial resources must be secured and used wisely.
WHO:
A highly collaborative and motivated team of VPs, physician leaders, directors and managers representing medicine, finance (revenue cycle, denials management, etc.), IT, compliance, HIM, care management and operations (acute and ambulatory).
HOW:
In 2018 SJH created a Physician\Revenue Cycle Collaborative to defragment our efforts across the system and develop a true clinically-integrated revenue cycle.
The initial aim was to reduce lost revenue and expenses related to concurrent inpatient denials (see “who” section for participants). At the time (2017) most concurrent denials were handled on appeal by expensive outside consultants who were often time delayed and frequently unsuccessful.
This group (numbering approx. 20) began meeting weekly and by the end of 2018 had recovered $5.8M (in net receivables) using only internal resources and focused on a single payor. In 2019 the group expanded their efforts to include all inpatient denials; increase the use of appropriate observation and outpatient designations; maximize CMI using our compliant documentation team for all payor classes (not just Medicare) and a post discharge review process; and focus on the professional fee billing of our employed physicians both in the ambulatory and acute settings.
The ability to focus on professional fee billing stemmed from a conversion to Cerner Millennium as our single enterprise EMR (including ambulatory clinical and financial systems). We used this conversion in early 2019 to streamline and change our Profee\Ambulatory revenue cycle processes including considerable education for our physicians and other providers.
Through the end of 2019 we are proud to report the following results (attributed to $20M in increased revenue):
• Recoveries from concurrent denials of nearly $14.5M (net receivables) in 2019.
• A nearly 40% increase in observation discharges (driving a decrease in denials) in 2019 compared with 2018 .
• A 6% increase in system-wide CMI from 2017 to 2019.
• Average daily charges from Professional fees (Acute and Ambulatory) increased to $700K a day at the end of 2019 from $558K average in 2018.
• A highly collaborative and experienced team gearing up for more opportunities in 2020!
St. Joseph's Health (SJH) is a mission driven organization sponsored by the Sisters of Charity of St. Elizabeth based in Paterson NJ. We provide care to a largely underserved population with significant challenges in the social determinants of health (SDoH). In order to fulfill our mission financial resources must be secured and used wisely.
WHO:
A highly collaborative and motivated team of VPs, physician leaders, directors and managers representing medicine, finance (revenue cycle, denials management, etc.), IT, compliance, HIM, care management and operations (acute and ambulatory).
HOW:
In 2018 SJH created a Physician\Revenue Cycle Collaborative to defragment our efforts across the system and develop a true clinically-integrated revenue cycle.
The initial aim was to reduce lost revenue and expenses related to concurrent inpatient denials (see “who” section for participants). At the time (2017) most concurrent denials were handled on appeal by expensive outside consultants who were often time delayed and frequently unsuccessful.
This group (numbering approx. 20) began meeting weekly and by the end of 2018 had recovered $5.8M (in net receivables) using only internal resources and focused on a single payor. In 2019 the group expanded their efforts to include all inpatient denials; increase the use of appropriate observation and outpatient designations; maximize CMI using our compliant documentation team for all payor classes (not just Medicare) and a post discharge review process; and focus on the professional fee billing of our employed physicians both in the ambulatory and acute settings.
The ability to focus on professional fee billing stemmed from a conversion to Cerner Millennium as our single enterprise EMR (including ambulatory clinical and financial systems). We used this conversion in early 2019 to streamline and change our Profee\Ambulatory revenue cycle processes including considerable education for our physicians and other providers.
Through the end of 2019 we are proud to report the following results (attributed to $20M in increased revenue):
• Recoveries from concurrent denials of nearly $14.5M (net receivables) in 2019.
• A nearly 40% increase in observation discharges (driving a decrease in denials) in 2019 compared with 2018 .
• A 6% increase in system-wide CMI from 2017 to 2019.
• Average daily charges from Professional fees (Acute and Ambulatory) increased to $700K a day at the end of 2019 from $558K average in 2018.
• A highly collaborative and experienced team gearing up for more opportunities in 2020!
Improved the care of patient populations
Provider
University of MS Medical Center
Mississippi
Kandis
Backus
Assistant Professor of Population Health and Clinical Pharmacist
601-815-3279
kbackus@umc.edu
No
Mississippi has many healthcare deserts. Those deserts have led to a novel HIV prevention strategy, pre-exposure prophylaxis (PrEP), being out of reach to those that need it most. Physicians such as family medicine, internal medicine, and OB/GYN have been reluctant to incorporate PrEP care into their standard practice. The routine health care visits and decreased insurance reimbursements have only made PrEP access more difficult. We sought to reduce the barrier of access to PrEP care by utilizing an often overlooked healthcare professional, Doctor of Pharmacy (pharmacist). Pharmacists are one of the top trusted healthcare professionals and are the medication experts. Some states have granted pharmacists prescriptive authority and view them as providers while other states allow pharmacists to practice as providers under a collaborative practice agreement with a Medical Doctor. During the initial phase of this project we were able to start PrEP on patients the same day they received their negative HIV test results. This lead to an increase in PrEP uptake from 10% to 43%. We created a model that allows people to access both free HIV and STI testing, medication counseling, and medication access.
Reduced healthcare costs
Provider
Houston Methodist The Woodlands Hospital
Texas
Nadia
Taha
Quality Project Specialist
936-270-2752
ntaha@houstonmethodist.org
No
With the unparalleled changes in the healthcare industry, there has been an increase in the complexity of risk and compliance. As the industry evolves, so does the way healthcare organizations audit their hospitals. While many facilities continue to use a paper format to complete their audits, our hospital has leveraged innovative technology through an electronic audit application (App), My Rounding®. This App is easily accessible using an iPad which ensures time efficiency through real-time notifications by the internal surveyors and greater productivity for quality management team. Action plans are then created inside the App for easy access by the hospital leadership and quality team to drive excellent outcomes and address non-conformities. In order to sustain improvement, the accountability of the corrective action plan is reported through our Accreditation Readiness committee.
With the rapid growth of our facility, accountability was a challenge. Our hospital has implemented the International Organization for Standardization (ISO) Internal Audit Program electronically, in order to maintain high levels of patient safety and clinical performance. Interdisciplinary teams are selected through an interview process. The teams undergo a training course that includes the fundamentals of ISO internal audits and how to use the My Rounding App. Electronic audits have led to early intervention and oversight by the Quality Accreditation team.
The ISO internal audit program has sustained measurable success through our DNV-GL survey that was held in June of 2019 with zero nonconformities. The implementation of these audits has shown positive change in our facility through our patient safety scores. The benefits of conducting internal audits on the My Rounding App has enabled us to receive real time feedback, analyze trends and promptly communicate with leadership. A culture of patient safety is achieved through engagement and accountability.
With the rapid growth of our facility, accountability was a challenge. Our hospital has implemented the International Organization for Standardization (ISO) Internal Audit Program electronically, in order to maintain high levels of patient safety and clinical performance. Interdisciplinary teams are selected through an interview process. The teams undergo a training course that includes the fundamentals of ISO internal audits and how to use the My Rounding App. Electronic audits have led to early intervention and oversight by the Quality Accreditation team.
The ISO internal audit program has sustained measurable success through our DNV-GL survey that was held in June of 2019 with zero nonconformities. The implementation of these audits has shown positive change in our facility through our patient safety scores. The benefits of conducting internal audits on the My Rounding App has enabled us to receive real time feedback, analyze trends and promptly communicate with leadership. A culture of patient safety is achieved through engagement and accountability.
Improved the care of patient populations
Provider
Memorial Sloan Kettering Cancer Center
New York
Kevin
Shannon
Director Solutions Architect
646-888-5585
shannonk@mskcc.org
Yes
EPAM
MSK Engage is an Informatics solution embedded within our patient portal for the collection and monitoring of patient-reported data. It was launched in 2016 coincident with opening our ambulatory surgery center, and it is now live enterprise-wide for both standard of care and research patients.
The development of MSK Engage began in 2015 with a simple goal: to build a robust, user-friendly, and secure platform to collect patient-reported data for clinical and research purposes. Working with EPAM, as our development partner, the creation of MSK Engage was a joint cross department effort including members from Information Systems, Health Informatics, Nursing, Medical Staff, Biostatistics, Patient Education, and Ambulatory Operations.
MSK Engage automates the distribution and collection of numerous types of survey instruments, including patient-reported outcomes (PROs), medical history, structured family history, patient preferences, and patient experience. It integrates with our scheduling system, our EHR, and portal secure messaging. Instruments and questions are housed in libraries and structured using the emerging FHIR questionnaire standard. Trigger notifications can be set in its rules engine at the question level (e.g., “severe” PRO-CTCAE symptoms), and multi-lingual support is enabled. The design is responsive for desktop and mobile use by patients. Our patient-run advisory council (PFACQ) participates actively in the design and naming of MSK Engage.
Patients and staff are adopting the platform for both standard of care and research, with increasing patient compliance. Patient and clinicians are using all the designed workflow integration tools, including direct import into documentation templates within our EHR, push notifications, and decision support. There is extensive and timely engagement by our nursing staff with MSK Engage data and triggered notifications on alarm symptoms. Opportunities exist to enhance physician engagement with the data. Significant oversight and governance with advanced visualization tools have been created and are required for success. MSK Engage has contributed multiple surveys per patient over time, which augments our clinical and administrative data sets for our ongoing phenotyping efforts. Future directions include enhancing the point-of-care display of this data for the clinical team, introducing tailored education information based on symptoms, and elicitation of patient treatment preferences.
The development of MSK Engage began in 2015 with a simple goal: to build a robust, user-friendly, and secure platform to collect patient-reported data for clinical and research purposes. Working with EPAM, as our development partner, the creation of MSK Engage was a joint cross department effort including members from Information Systems, Health Informatics, Nursing, Medical Staff, Biostatistics, Patient Education, and Ambulatory Operations.
MSK Engage automates the distribution and collection of numerous types of survey instruments, including patient-reported outcomes (PROs), medical history, structured family history, patient preferences, and patient experience. It integrates with our scheduling system, our EHR, and portal secure messaging. Instruments and questions are housed in libraries and structured using the emerging FHIR questionnaire standard. Trigger notifications can be set in its rules engine at the question level (e.g., “severe” PRO-CTCAE symptoms), and multi-lingual support is enabled. The design is responsive for desktop and mobile use by patients. Our patient-run advisory council (PFACQ) participates actively in the design and naming of MSK Engage.
Patients and staff are adopting the platform for both standard of care and research, with increasing patient compliance. Patient and clinicians are using all the designed workflow integration tools, including direct import into documentation templates within our EHR, push notifications, and decision support. There is extensive and timely engagement by our nursing staff with MSK Engage data and triggered notifications on alarm symptoms. Opportunities exist to enhance physician engagement with the data. Significant oversight and governance with advanced visualization tools have been created and are required for success. MSK Engage has contributed multiple surveys per patient over time, which augments our clinical and administrative data sets for our ongoing phenotyping efforts. Future directions include enhancing the point-of-care display of this data for the clinical team, introducing tailored education information based on symptoms, and elicitation of patient treatment preferences.
Improved the care of patient populations
Provider
Houston Methodist Coordinated Care
Texas
Julia
Andrieni, MD
Vice President, Population Health & Primary Care, President & CEO, Houston Methodist Coordinated Care ACO
7134417638
jdandrieni@houstonmethodist.org
No
Houston Methodist Coordinated Care (HMCC) Accountable Care Organization is a Medicare Shared Savings Program with downside financial
risk. In 2019, we had 212 Primary Care Providers with 30,000 Medicare FFS beneficiaries utilizing 9 different EHRs. Our challenge was to engage PCPs and their staff to achieve the 90th percentile nationally on defined CMS Quality metrics for Medicare Shared Savings programs. Initially, we had to identify these MSSP patients in 9 different EHRs and provide timely feedback to individual PCPs on their performance on CMS Quality metrics by designing quality metric dashboards and comparing providers and practices to drive change. The innovation was the CMS Quality Metric Dashboard embedded in Epic to provide real time feedback to PCPs. All other 8 EHRs were utilized to build reports and to provide the same feedback designed within Epic. The innovation was not only the IT tool but also the innovation in how we worked with Primary Care practices to design new work flows to address gaps in quality of care by training staff to be competent in fall risk screening and depression screening at visits. We also trained all of our outreach teams to include nursing, care coordinators, care coaches, and pharmacists to utilize the provider quality metric dashboard to close gaps of care telephonically during their patient outreach. Our health system IT team was integral in designing and piloting our quality dashboard and including PCP feedback to accommodate their needs. Attached, you will find our HMCC Flag and PCP Dashboard within Epic to identify our patients and provide feedback on performance. Attached, you will also find the monthly comparisons shared with practices and physicians on percentile performance to spark discussions of best practices. In addition, we sponsored celebratory lunches for practices who were leading in quality performance. Also attached, HMCC Quality Metric Performance Improvement from 2017-2019 with our innovations in both designing an IT tool as well as operationally implementing and leveraging this tool. In 2018, we had the 2nd highest score nationally for MSSP Track 3 programs like ourselves. Mission accomplished due to the hard work of many teams.
risk. In 2019, we had 212 Primary Care Providers with 30,000 Medicare FFS beneficiaries utilizing 9 different EHRs. Our challenge was to engage PCPs and their staff to achieve the 90th percentile nationally on defined CMS Quality metrics for Medicare Shared Savings programs. Initially, we had to identify these MSSP patients in 9 different EHRs and provide timely feedback to individual PCPs on their performance on CMS Quality metrics by designing quality metric dashboards and comparing providers and practices to drive change. The innovation was the CMS Quality Metric Dashboard embedded in Epic to provide real time feedback to PCPs. All other 8 EHRs were utilized to build reports and to provide the same feedback designed within Epic. The innovation was not only the IT tool but also the innovation in how we worked with Primary Care practices to design new work flows to address gaps in quality of care by training staff to be competent in fall risk screening and depression screening at visits. We also trained all of our outreach teams to include nursing, care coordinators, care coaches, and pharmacists to utilize the provider quality metric dashboard to close gaps of care telephonically during their patient outreach. Our health system IT team was integral in designing and piloting our quality dashboard and including PCP feedback to accommodate their needs. Attached, you will find our HMCC Flag and PCP Dashboard within Epic to identify our patients and provide feedback on performance. Attached, you will also find the monthly comparisons shared with practices and physicians on percentile performance to spark discussions of best practices. In addition, we sponsored celebratory lunches for practices who were leading in quality performance. Also attached, HMCC Quality Metric Performance Improvement from 2017-2019 with our innovations in both designing an IT tool as well as operationally implementing and leveraging this tool. In 2018, we had the 2nd highest score nationally for MSSP Track 3 programs like ourselves. Mission accomplished due to the hard work of many teams.
Improved the care of patient populations
Provider
University of Mississippi Medical Center
Mississippi
Jennifer
Reneker
Associate Professor
6019846326
JReneker@umc.edu
No
CHALLENGE: Mississippi is a very poor and rural state with a love for sports and a rich history of excellence in sport at the highest levels. Prevention of injury is a priority for athletes on all sports teams, from youth leagues to the professional level. Concussion has emerged as a serious injury associated with sports participation and managing the effects of concussion are a challenge, often requiring access to specialists. Effective prevention strategies are necessary to ensure that risks are mitigated to the extent possible. Currently, there are no physical training interventions utilizing headset virtual reality (VR) to train athletes as an injury prevention or rehabilitative strategy.
WHO & WHAT: Dr. Jennifer Reneker, a neurologic physical therapist and epidemiologist, developed a patent-pending training intervention, including novel activities/games in virtual reality (VR) targeting the visual, vestibular, and proprioceptive systems to fine-tune eye movement control and visual acuity; balance and posture; movement precision; and reaction time. A local software developer was hired to bring her idea into the virtual space. The first research study of this intervention included four VR exercises and was completed with 75 college soccer athletes in the fall of 2018. The second research study (completed fall 2019) included nine exercises in VR and was completed with 72 collegiate soccer athletes compared to a second group of 52 athletes, who did not complete the training.
HOW: For the research study completed in 2018, significant improvements were obtained in static balance, neck movement control and endurance, and near-point convergence (of the eyes). There was also decrease in the injury rate across the season when compared to the prior soccer season (11.8 injuries/1000 athlete exposures in 2017 and 8.9 injuries/1000 athlete exposures in 2018). The results from the second study are being analyzed and a third study is planned for 2020. Based on the results obtained so far, this intervention holds promise as a preventive strategy for sports-injury, including concussion, as a comprehensive population-based intervention. Additionally, the VR exercises developed for the purposes of injury prevention are being adapted to assist with rehabilitation of injury after concussion. Paired with telehealth, this VR technology and innovative delivery of rehabilitative exercises will permit remote access and specialist care to rural and underserved populations.
WHO & WHAT: Dr. Jennifer Reneker, a neurologic physical therapist and epidemiologist, developed a patent-pending training intervention, including novel activities/games in virtual reality (VR) targeting the visual, vestibular, and proprioceptive systems to fine-tune eye movement control and visual acuity; balance and posture; movement precision; and reaction time. A local software developer was hired to bring her idea into the virtual space. The first research study of this intervention included four VR exercises and was completed with 75 college soccer athletes in the fall of 2018. The second research study (completed fall 2019) included nine exercises in VR and was completed with 72 collegiate soccer athletes compared to a second group of 52 athletes, who did not complete the training.
HOW: For the research study completed in 2018, significant improvements were obtained in static balance, neck movement control and endurance, and near-point convergence (of the eyes). There was also decrease in the injury rate across the season when compared to the prior soccer season (11.8 injuries/1000 athlete exposures in 2017 and 8.9 injuries/1000 athlete exposures in 2018). The results from the second study are being analyzed and a third study is planned for 2020. Based on the results obtained so far, this intervention holds promise as a preventive strategy for sports-injury, including concussion, as a comprehensive population-based intervention. Additionally, the VR exercises developed for the purposes of injury prevention are being adapted to assist with rehabilitation of injury after concussion. Paired with telehealth, this VR technology and innovative delivery of rehabilitative exercises will permit remote access and specialist care to rural and underserved populations.
Improved the care of patient populations
Provider
BRKINS
Indiana
Dr.Rajendrakumar
Bidari
CEO
917204908173
brkins@yahoo.com
No
Safe I
Improved the care of patient populations
Provider
LifeBridge Health
Maryland
Adam
Beck
Director - Digital Health, Innovation Department
410-601-9815
abeck@lifebridgehealth.org
Yes
GetWell Network
To improve the health of the community and patient experience, LifeBridge Health strives to engage patients throughout the continuum of care. Prior to the implementation of our new digital engagement platform, care managers relied solely on manual and telephonic support for high utilizers and at-risk patients for post-discharge engagement. While effective, these efforts miss many patients (due to low pick-up rate), and are resource intensive. As a result, The LifeBridge Health Innovation Department partnered with emergency department and inpatient staff to leverage a digital engagement tool used by our orthopedic department, GetWell Loop (part of GetWell Network’s solution set.) The platform was originally designed for pre and post procedure communication and check-ins for total joint replacement patients. The GetWell Network assisted LifeBridge in designing a platform that would automate check-ins with patients for a short period after discharge and open a digital communication channel between the patient and our clinical call center to provide necessary support. The GetWell Loop platform for our ED and inpatient discharges was implemented in July 2018 and has been a tremendous success. Through the first year, over 8,400 patients have utilized GetWell Loop with multiple check-ins per activation. Our patients have triggered over 2,400 alerts and generated over 1,700 comments and questions. Patient have expressed their satisfaction with the tool (over 90% satisfied) and initial analysis reveals a positive impact on HCAHPS scores. Additionally, we have identified a significant difference in the 30-day revisit rate for those patients that use GetWell Loop compared to those that do not use the platform; indicating that patients are better receiving the support they need as they transition to community care.
Enhanced the patient experience