One ACO's High-Tech Approach to Care Coordination
HackensackAlliance ACO uses 4G tablets to better coordinate and manage patient care.
No one accountable care organization looks the same as any other, though some strategies have proven successful for many ACOs, especially the use of care coordinators or navigators.
Usually, care coordination in ACOs is fairly low-tech, involving face-to-face visits in the office or the home and the occasional phone call. However, Hackensack (N.J.) Physician Hospital Alliance ACO, a Medicare Shared Savings Program participant, has taken care coordination to the next, high-tech level by giving patients their own 4G tablets to help manage their care.
The tablet program is one of the many initiatives that helped HackensackAlliance ACO become the seventh ACO overall and first in New Jersey to receive accreditation from the National Committee for Quality Assurance.
How it works
The ACO gives 4G tablets to patients with chronic heart failure, chronic obstructive pulmonary disease and/or diabetes, since those are the three leading causes of readmissions in the HackensackAlliance ACO, according to Noreen Hartnett, BSN, RN, patient care navigator with HackensackAlliance ACO. "Those are disease processes that are changing for the patient day-to-day, so they need to manage their symptoms at home as well as have physicians managing in the office," Ms. Hartnett says.
Patients take the tablet home and nurse care navigators help them set the tablet up with a daily plan, including when they should eat, take medications, measure blood sugar or weigh themselves.
When the tablet is programmed, it will alert the patient to take medications or weigh themselves, for example, and the patient will document it in the tablet, according to Morey Menacker, DO, president and CEO of HackensackAlliance ACO. If patients do not document something when they are supposed to, care navigators receive a notification so they can contact the patient and identify the problem.
In addition to notifying patients and providers, the tablets are also loaded with educational resources, such as medications' possible side effects or diet tips specific to patients' illnesses. They are locked to only display software relevant to managing the patient's regimen.
"It's almost like having an electronic nurse with the patient at all times in order to maximize compliance with various recommended treatments," Dr. Menacker says.
Patients are eligible for a tablet if they have the dexterity to use one and are alert and oriented, she says. Currently, 16 patients are in the program.
Per patient, the tablet program costs HackensackAlliance ACO about $150 each month, aside from the initial investment of the tablets. However, the average cost of a readmission is $13,200, according to statistics from the Healthcare Cost and Utilization Project. "If it prevents enough readmissions, the program pays for itself," Rohan Udeshi, COO of Health Recovery Solutions, the company that provides the tablets for the program, explains.
Additionally, Medicare ACOs are measured on 33 quality metrics, which include readmission rates as well as disease-specific outcomes for COPD, diabetes and CHF. If the tablet program helps improve outcomes and prevent readmissions, ACOs can be rewarded financially for improving on those quality metrics as well, which would increase the return on investment.
The tablet program is proving to help reduce readmissions in the HackensackAlliance ACO. In a pilot study of the program, a group of Medicare patients who used the tablets had a readmission rate of just 8 percent, while a control group had a 28 percent readmission rate.
More anecdotally, Dr. Menacker brought up a patient who was hospitalized every two months for his chronic heart failure in 2012 — but hasn't been hospitalized once in 2013 after being put on the tablet program. "It's a dramatic change to a patient's quality of life," says Dr. Menacker. "You can't put a cost on that. The cost is miniscule compared to the benefit."
The program doesn't just help reduce readmissions, however. It also helps patients get healthier and become more confident in their health management, especially when they leave their physician's office or hospital. "It empowers the patient," Ms. Hartnett says.
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