Northern Arizona Healthcare has broadened the scope of its home health monitoring program, Care Beyond Walls and Wires. The trend of expanding the rollouts of telehealth initiatives and remote care management continues to grow.

The successful telehealth program requires a mix of cultural sensitivity, technology savvy, and practical, roll-up-your sleeves ingenuity, its leaders say. In its pilot phase, patients in the program had fewer hospitalizations per patient (1.8 vs. 3.3) and days hospitalized per patient (5.13 vs. 13.98) in the six months following enrollment.

As value-based medicine becomes more the norm, these programs will play an increasing role.

Healthcare IT News recently spoke with Gigi Sorenson, RN, director of telehealth services for NAH and Care Beyond Walls and Wires, about the program, its evolution, and the trajectory of telehealth into the future. Here's what she had to say on the various aspects of the program:

On its governance and funding:
The program at Northern Arizona Healthcare is young, about 4 1/2 old. Since that inception, we developed into a full hub-and-spoke site model, which is fairly unique for a healthcare system to be both.

In north Arizona, many times we don't have enough beds. It's not conducive at this time to be adding inpatients beds. Our challenge thus is to have the right patients in the beds we have. How we build the capability to ensure the right capacity utilization at the right location is our business challenge. We been able to show by using telehealth, by connecting all of these rural clinics in northern and central Arizona, we help to make the best decision about where patients needs to go.

We been able to show to senior leadership that by putting some upfront money in regards to capital expenses for improving the infrastructure of telehealth, the amount of money we are saving on the back end is tremendous. Not only are we saving money, we are improving patient satisfaction, we're improving provider satisfaction, and all of this is built in to the value-based purchasing reimbursement models.

On its multicultural approach:
We have the Anglos (and) Hispanics (and) Native Americans. That's our big mix out of the three cultures that we service. We have found you have to be aware of the culture you are going into, but also not to go in with deep stereotyped thought processes. Even with the Native Americans, the Hopis are different from the Navajos, which are different from the Apache and from the Hualapai. You have to be culturally aware of the tribe itself, not Native Americans as a whole. You don't just work with the individual patient. Ninety-five percent of the time it's the families. You must have distinct awareness of what's going on, not so much with a global entity, but with the patient sitting in front of you.

When you introduce technology into their care delivery process, you have to be very careful. There are some cultures that are very sensitive to the technology's ability to track their location. It can been seen as Big Brother-like. You have to be very careful how you introduce the role of the technology--what is its purpose and why it is important and then letting the patient make those decisions. We have had patients turn us down for in-home monitoring. But they are very willing to do e-visits, so we have to find where their comfort zone is. Some are very willing to upload their data through unintrusive two-net hub, but they don't want to have an in-home video visit. It's looking at that specificity and being really clear why you are introducing that technology piece to their care delivery that makes us successful.

On consumer- vs. medical-grade hardware
Being able to allow a mix of medical-grade and consumer-grade devices is critical. Granted, you don't want off-the-shelf blood pressure machine as the one true source as the blood pressure, so there are certain pieces that need to be medical grade. But I think allowing that flexibility so that more and more patient have improved access to the devices and to their own medical data that's happening in their homes is critical to getting patients engaged in their own healthcare and getting patients engaged with their provider. If only I could just monitor how many steps my 75-year-olds are taking – they really getting out of their chair during the day and to be able to do that with a $30 Fitbit or something better. I see needing a mix for sure to get a pure fill picture.

On IT and vendor management
I have forged a wonderful relationship with IT. We can come and say this is our clinical needs. Specifically, here's a pocket of patients and these are the challenges we are facing and then to be able to sit with them from the IT perspective, "Well, have you thought about this?" or, "Maybe we should do that." Our collaborative brainstorming is great. We even have IT coming in to talk directly to the patient so they can understand from a layperson's perspective what does it mean for me who is able to do this and here are my barriers, and that has been a tremendous help.

Vendors will say, "Oh yes, we have coverage there" or "We can do that" or "No, it's not working." So we actually brought vendors to home visits with us. For example, we took Qualcomm (suppliers of Life's 2net Connectivity Platform and HealthyCircles) out and drove them around.

Northern Arizona is really unique. We have the reservation and other rural areas. But also Flagstaff itself is a huge stem community. We'll be in a homeless shelter here and then do a home visit to a $2 million mansion. Then we'll be out on reservations. How do I make this one system work? We take vendors and have them talk with patients and their families. What they see their marketing ideas for products is not real life. And that has worked out.