This document discusses tele-home monitoring programs for patients with conditions like heart failure and diabetes. It provides examples of programs that have used daily video visits and monitoring of vitals to save costs on long-term care for an elderly diabetic woman and reduce heart failure readmission rates. Research studies are summarized that found tele-home monitoring reduced hospitalizations and emergency room visits while improving outcomes when combined with care coordination. The document concludes by outlining the financial benefits to counties from keeping patients healthy at home and reducing long-term care costs through remote monitoring programs.

1. Tele-Home Monitoring
Blandin Foundation Web- X
December 14, 2017
Maureen Ideker, RN, BSN, MBA
Senior Advisor for Telehealth
Essentia Health, Duluth

2. Objectives
• Provide basics on Tele-Home monitoring with
examples of use in heart failure & diabetes.
• Describe the equipment needed at home,
broadband & resources needed for services.
• Describe potential savings to counties and
citizens.

5. Example 1: Elderly Diabetic
Lady
• Maintained at home over 3 years
• Daily video visit for insulin injections
• Saved 36 months at $6,000/Month to the county for
LTC MA - $216,000

6. Example 2: A common
Disease - Heart Failure?
Prevalence
– Affects 5.8 million in the U.S.
– Over 650,000 new patients annually
– The lifetime risk of developing HF is 20% for
Americans ≥40 years of age.
– HF is the most frequent cause of hospitalization
in elderly (> 65 y/o)
Prognosis
– 1/2 of people who develop HF die within 5 years
of their diagnosis
– Less than 25% are alive at 10 years

7. • HF is not always treated correctly
• Patients do not adhere to diet and medication
regime
• Projections show the prevalence of HF will
increase 46% from 2012 to 2030, resulting in >8
million people ≥18 years of age with HF
Heart Failure
Progression is Inevitable
AHA Heart Disease & Stroke Statistics 2014 Update

8. What will it Cost?
• Estimated lifetime cost per each individual HF patient
is $110,000/year
• In 2012, total cost for HF was estimated to be $30.7
million
• Projections show that by 2030, the total cost of HF
will increase almost 127% to $69.7 billion from 2012

9. Summary % Readmissions for
Heart Failure Within 30 Days
• National – 24%
• Essentia Health – Duluth – 9%
• Essentia Health with Tele-Home Monitoring
Scales – 2%

10. Tele-Home Monitoring Research
• Kaiser-Permanente- conducted the foundational
research in mid-1990s(4)
• University of MN replicated it with similar results
in 1998
• VA in Florida experienced greater impact in
2004 by adding care coordination
• Ascension Health conducts research under
Beacon Grant in 2012 with similar results and
adds self management education

11. U of MN Research:
1998 & 2004
• The impact of using home monitoring devices on
transfers to higher levels of care….1998
• Patients ability to use and acceptance of tele-home
monitoring equipment………2004

12. MN Telehealth Network Research
1998 – Telehomemonitoring
N = 150
U of MN

13. Research Patient Groups limited
to CHF, COPD & Diabetes
Daily recording of:
- Weight
- Blood Pressure
- Pulse
- Oxygen Saturation, Spirometry or glucose
readings
- Video visits at least weekly
13

14. 14

15. Beacon Case Study
• 53 y.o. female with more than 6 chronic
conditions
• 13 hospital admits in 2011, $156,000
• Remote Monitoring and self management
conducted resulting in:
• 1 ED visit and 1 brief hospitalization in 2012:
$2500

16. Veteran’s Administration Study in
Florida-2004
• Remote home monitoring along with care
coordination, including diabetes, resulted in:
• 50% reduction in hospitalizations
• 11% reduction in ED visits

17. Essentia Health Using Tele-Home
Monitoring (MN Example – Duluth)
• Over 300 home monitoring devices out for heart failure
hospital discharges, health care home pts, and
homecare/hospice uses.
• Heart Failure program started using devices in 2002.
Named a best practice example by AHRQ.
Readmission rate in this group1-2%. National average
is over 23%. Huge ACO impact.
• Mostly scales deployed,(some Bp units short term

18. HF Program Model
• Consult 5-7 days after hospital discharge
• Patients managed by APP in ambulatory setting
• Seen by cardiologist initially, annually and as needed
• Registered nurses provide continuous case management:
– Phone triage
– Follow-up on labs/ test results
– Utilize protocols
– Manage telescale data
– ONGOING PATIENT EDUCATION

19. Monitoring & Exception Review
• Patient alerts at Central Station
– Nurse reviews data in both Cardiocom and EPIC
– Makes decision if patient needs to be contacted
• If assessment is needed the nurse considers the following:
– Nursing assessment and education needs
– Review medication list
– Dietary compliance
– Follows diuretic protocol as indicated/or talks with
provider
– Initiate office visits or primary care referrals as needed
– Care plan monitoring; hospitalization initiation
– Communication with team members (other specialties)

20. Advantages to Tele-Home Monitoring
• Facilitates early intervention and prevents ER visits
and hospitalizations
• Improved patient adherence with care plan
• Patients get immediate feedback on life style
choices
• High patient satisfaction
• Healthier!
• Improved quality of life
• Decreased LTC stays

21. Financial Considerations
• County costs for MA support – LTC
• Decrease tax-base when leave home
• Decrease local spending
• Increased county costs for MA with disability

22. References
• Chumber NR, Neurgaard B, Koob R, Qin H, Joo Y. Evaluation of a
care-coordination/home-telehealth program for veterans with
diabetes. Eval health professions 2005;28:464-478.
• Erickson C, Ideker M, Fauchald S. Integrating Telehealth Into the
Graduate Nursing Curriculum. The Journal for Nurse Practitioners
2015; e1-5.
• Finkelstein S, Speedie S, Potthoff, . Home telehealth Improves
Clinical Outcomes at Lower Cost for Home Healthcare.
Telemedicine and e-Health Vol 12, N0 2, 2006: 128-136.
• Finkelstein S, Speedie S, Zhou X, Ratner E, LeMire T, Valley K,
Dahle L. Virtual assisted-Living Umbrella for the Elderly (VALUE):
What the community thinks.

23. References Continued…
• Johns Hopkins Medicine. A Typical Hospital at Home Program
Follows these Steps. http://www.hospitalathome.org/about-us/how-
it-works.php.
• Johnston B, Wheeler L, Deuser J, Sousa KH. Outcomes of the
Kaiser-Permanente Tele-Home health research project. Arch Fam
Med 2000;9:40-45.
• Klapper B, Kuhne H. Patient self-management by telehealth using
the Bosch model of care. Journal of Telemedicine and Telecare
2010;16:193-195.
• Snell, A. Reducing Hospital Readmissions Using Remote Patient
Monitoring and Patient Engagement Tools. Beacon Research
Study, Ascension Health Presentation, Indianapolis, 2013.

24. Contact Information
• Maureen.ideker@essentiahealth.org
• 218-371-0596