In 2018, Scottsdale Physician Group in Scottsdale, Arizona, saw a need that simply was not being met.

THE PROBLEM

Some patients were not getting the medical care they needed, when they needed, because of a variety of issues. These patients could be bed-bound, homebound, have little to no support structure, have an inability to access transportation to medical appointments, have infirmities, have high fall risks or other concerns.

These patients were getting care, but unfortunately the care they received was in high-cost environments such as hospitals – and discharged to post-acute facilities. In other words, because of the aforementioned issues, or most likely a combination of those issues, they ended up calling 911 when the medical conditions inevitably worsened, which further increases costs and is horrible for them clinically and emotionally.

“No matter how close the nearest primary care physician office is, if they can’t get out of bed or leave their home, they simply are not going to get care before their conditions worsen,” said Blue Beckham, chief strategy officer at Scottsdale Physician Group. “It is precisely these patients who are consuming the healthcare dollar at an increasing rate.

“If we look at a typical acute episode for this type of patient, it looks like this: Call 911, get evaluated, transported to the hospital ER, evaluated again, seen by ER physician who calls for consults, multiple consults, run blood work, get some imaging, review findings, admit the patient,” he explained.

“Daily consults with the hospitalist and appropriate specialists, try to improve clinical status,” he continued. “Patient may be eligible to be discharged home, but the hospitalist is concerned there is no support structure, so the patient is discharged to a skilled nursing facility, more rounding by an SNFist, finally discharged home with home health and instructions to follow up with the PCP that the patient couldn’t get to in the first place, and then the cycle repeats.”

This episodic cycle is expensive, and the patient still does not get the care they actually need, which is frequent visits with high-quality providers that prevent the acute episodes. Scottsdale Physician Group believed there had to be a better way of taking care of the patients that was scalable and effective.

PROPOSAL

The nearly perfect clinical solution is to send physicians to patient homes, and Scottsdale Physician Group did just that.

“The results were very encouraging clinically, but the cost was very high and physician satisfaction was extremely low,” Beckham recalled. “Because of drive times, even the most efficient doctor could only see eight patients a day, and after years of education, training and hard work, having a physician spend hours driving around further reduced physician satisfaction and was terribly inefficient.

“We did learn, however, that going to the patient’s home worked, so we searched for a solution that allowed us to do a real exam without sending a doctor to do it,” he continued. “Having the ability to do a physical exam was at the heart of the challenge.”

"Yes, the cost savings are important, but the improvement in patient lives is just as important."

Blue Beckham, Scottsdale Physician Group

Traditional telemedicine has its place as a scalable and cost-efficient tool in a physician’s armamentarium, but it has limits, he contended. A simple cough or cold can be treated with traditional telemedicine. But what about an elderly homebound patient with COPD, CHF, diabetes and zero comfort with technology?

Scottsdale Physician Group turned to vendor AMD Global Telemedicine. It needed a technology that allowed the group to do a physical exam. It needed to see in the eyes, ears, nose and throat. It needed to see all of the vitals. It needed to have the ability to see in high-definition wounds, sores and other skin conditions. It needed the ability to do an EKG.

“In the end, AMD’s solution allowed us to actually do a better job of gathering and trending important clinical data for each patient than we had when we sent physicians to the home,” Beckham said. “For example, the technology allowed us to take and store images of wounds so our providers could see changes over time.

“We simply did not have that available to our mobile physicians,” he added. “In short, the technology allowed us to do more than a typical brick-and-mortar physician office could do.”

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MEETING THE CHALLENGE

Scottsdale Physician Group combined three elements to meet the challenge: Remote physicians, in-home EMTs and the vendor technology.

“This allowed us to scale quickly, centralize our physicians, yet still do physical exams and do it all without any technological savvy on the part of our patients,” Beckham said. “Today we see hundreds of patients a day in their homes. Our providers and in-home technicians work together to deliver incredible care for our patients.

“Our technicians are the hands of the providers utilizing the AGNES Connect platform with integrated medical devices, yet at the same time providing a human touch that traditional telemedicine can’t do,” he continued. “All patients must do is be home for their appointment. They do not need to use or understand any of the technology. Our technicians do it all for them.”

RESULTS

“The results have been extraordinary both on an individual and population level,” Beckham noted. “At the aggregate level, for example, we were able to reduce total medical spend over a year by 22% for a large population, and have been able to continue to lower that spend. We have dropped inpatient admissions and ER visits by a similar percentage.

“What is just as exciting for us, however, is the patient experience,” he stressed. “On a daily basis, we are positively impacting the lives of patients who simply didn’t have any other options. Again, if they can’t leave the house, they are not going to their PCP.”

In one case, Scottsdale Physician Group dropped a patient’s ER visits from nearly twice a month to zero.

“Yes, the cost savings are important, but the improvement in patient lives is just as important,” he said. “In our industry, we have talked about the Triple Aim for a long time. And as an industry, we have made huge improvements. The key for us, however, was to deliver on the Triple Aim for patients who historically were underserved.”

ADVICE FOR OTHERS

The key for other healthcare organizations looking to adopt technology to further their model of care is to truly define what they are trying to solve, Beckham advised.

“In our case it was threefold – deliver clinical excellence, maintain or improve physician efficiency, and provide a great experience for vulnerable populations,” he said. “Since we knew we wanted to do all three in the home, we could truly identify what we needed.

“If we started with reduce cost, for example, that could mean a million different things in a variety of situations,” he continued. “Because of our previous experience in hospitals and post-acute facilities and the knowledge we gained from our mobile physician program, we knew treating patients at home would reduce costs.”

So instead, the group solved for the logistical challenges – it needed to solve the how, not the why, he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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