Since 2006, Dallas-based CareCycle Solutions has been quietly working on the daunting problem of hospital readmissions. And the home healthcare company may well have cracked the code.
Although the 30-day readmission rate for Medicare patients nationwide is about 19 percent, CCS’s clocks in at 7.3 percent. The difference? Telehealth. And the company traditionally has not been paid a dime to provide it.
“Telehealth creates its own efficiencies,” said CEO Wayne Bazzle. “That makes it fully affordable.”
When the company began providing telehealth in 2006, less than 30 percent of its patients were chronically ill. Now 85 percent of its clients fit that profile. Because of that rise, CCS seeks to employ a dynamic — rather than static — approach to patient care. That means it attempts to provide targeted, non-scheduled interventions based on patient needs. As a result, CCS officials say better patient outcomes can be achieved with fewer nursing visits than originally believed.
Bazzle said that is different from a triage telehealth service that sends patients to the hospital or doctor when there is a medical setback. He said about 40 percent of deteriorating patient conditions can be attributed to medication error—overuse, underuse, or misuse. CCS is equipped to handle those.
“We’ve turned the [home health] model upside down,” Bazzle said. “Telehealth takes the place of home visits. It is more cost effective to monitor the patient’s condition and intervene when necessary. A traditional home health model involved one to two visits by nurses a week. But all kinds of mischief can take place in between those visits.”
The heart of CCS’s success is a clinical-support engine that tracks changes in a patient’s condition daily and helps point clinicians to the optimum patient support in real time.
CCS’s telehealth monitoring system—called VitalPartners 365—tracks patients’ clinic conditions daily, monitored by registered nurses or registered therapists with at least two years of experience in a hospital critical care unit.
The monitoring system includes a device placed in the patient’s home that transmits clinical data at the same time every day. The device tracks blood pressure, heart rate, body weight, and oxygen saturation levels. If the patient fails to check their vital signs, they are contacted by CCS personnel to find out why and to troubleshoot any problems.
The company has created what it calls the “Navigator,” which it developed in partnership with University of North Texas Health Science Center researchers. CCS plans to field-test the patent-pending system in August and September.
Researchers analyzed 7,700 patient records to determine which factors best predicted a change in a patient’s status, then identified and ranked 19 factors that were the most predictive. That allowed CCS to stratify patients according to risk, and the algorithm was used to create the Navigator.
CCS has 36 Medicare-certified offices in Texas and Louisiana, employs more than 900 people, and pulls in annual revenue of about $60 million. Bazzle and his wife Cheryl have been in the home healthcare industry since the early 1980s, and started CCS in 2003.
The bulk of CCS’s revenue is from Medicare fee-for-service for home healthcare. However, the company is ideally positioned to be reimbursed directly for telehealth because of emerging value-based payment models. CCS has a managed-care contract with Amerigroup, and is negotiating with a second managed-care company to be paid per-patient, per-day and for home health visits. CCS’s low hospital readmission rate also is attractive to accountable care organizations. CCS is a preferred provider for Seton Healthcare’s ACO in Austin, and Bazzle is negotiating with six other health systems.
Those negotiations have picked up “materially” in the past year because hospitals are reacting to the newly implemented Medicare penalties for readmissions, but hospitals are quite slow to make changes.
“Moving from fee-for-service to being paid for patient outcomes is a slow activity,” Bazzle said. “Hospitals have to educate discharge planners and physicians because telehealth is not well-understood.”
Texas is one of about a dozen states that have or will use telehealth to treat Medicaid patients. Bazzle said the regulations are being written regarding eligibility and reimbursement. He said other states pay about $10 a day.
CCS is collaborating with UNTHSC on a Medicaid innovation grant to determine whether telehealth can reduce hospitalizations and emergency-department visits. The 300-patient, two-year pilot will begin October 2014.
Bazzle expects to begin monitoring patients in states other than Texas and Louisiana, and to license the Navigator to healthcare systems responsible for managing populations.
Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected]