Philips National Chronic Disease Expert Design Project

A National Effort to Develop Best Practice Telehealth
Clinical Protocols in Home Care

The home care industry faces a significant challenge. With over 9,000 certified agencies, 4,500 hospice agencies and countless private duty agencies serving over four million seniors each year, nearly every agency faces the same clinical challenge - how to successfully (from a quality and financial perspective) deal with their most difficult patients, those with chronic disease.

The numbers and financial implications are staggering. Johns Hopkins University reported that 90% of Americans over the age of 65 have one or more chronic diseases, 70% have two or more. When you couple this fact with a May 2008 AHRQ Report (Health Care Expenses for Adults with Chronic Conditions, 2005) that found that those with one or more chronic conditions accounted for the overwhelming majority of total medical expenses for all conditions, 95.8% for the near elderly (ages 55–64), and 98.8% for the elderly age 65 and over, the significance of these numbers becomes clear.

They represent 2.8 billion dollars in direct home care costs and double to triple that figure when co-morbidities are included. They traditionally lead to the greatest number of re-hospitalizations and emergent care visits. For the certified agencies, they have the most negative effect on quality outcomes and have serious implications to the financial viability of home care agencies given CMS’s new Pay for Performance initiatives. The question that everyone is asking, “Is there a more effective way to better serve patients dealing with chronic illness?”

The Potential of Telehealth

The option that has generated the greatest interest is telehealth. Since its inception, telehealth has always been seen as having the potential to impact the delivery of chronic disease services in home care. Unfortunately, there have been few studies that have explored the impact of telehealth on both quality outcomes and profitability in home care.

The 2007 Philips National Study on the Future of Technology and Telehealth in Home Care did, however, generate some valuable insights and one very critical question. Nearly 89% of the agencies that used telehealth services (approximately 21% of home care agencies with Medicare budgets in excess of one million dollars have telehealth services) reported that telehealth led to an increase in overall quality, while 42.8% reported that it led to a reduction in costs.

Although self-reported, it was clear that a significant number of agency directors felt that telehealth led to better quality and financial outcomes. What wasn’t clear nor was it explored in the initial study, was the obvious question: “What were the practices and protocols that led those agencies to have such successful financial and quality outcomes? How did they do it?” The need to answer this question is imperative and is the catalyst that leads to the initiation of the Philips National Chronic Disease Expert Design Project.

A National Approach to a National Problem
The Philips National Chronic Disease Expert Design Project

On one side there is the growth in the Medicare population, the growth in the number of patients with one or more chronic diseases, the corresponding growth in national costs, and the obvious growing threat to the viability and credibility of home care agencies who are desperately searching for better ways to serve these patients. On the other side is the fact that there are a substantial number of agencies who report that they have established a protocol that has led to better financial and quality outcomes.

In the middle is a national effort sponsored by Philips Telehealth Solutions and co-sponsored by two of our country’s leading health care associations and home care’s leading national research and consulting firm. It is a national effort designed to answer the single, most important question being asked by home care agencies throughout the country: “What are the proven and best home care telehealth clinical protocols and practices for optimally (financially and quality-wise) serving home care patients experiencing one or more of the four major chronic diseases most often addressed by home care agencies: CHF, COPD, hypertension, and diabetes?"

An Overview of the National Chronic Disease Project

In response to these questions and realities, Philips Telehealth Solutions, a division of Royal Philips Electronics of the Netherlands, initiated the National Chronic Disease Expert Design Project. The Project began in January 2008 with the first phase expected to be completed in time for the NAHC Annual Meeting in October 2008. Additional study and refinement are at the discretion of the sponsor and are expected to take place over the following years. The following is a brief summary:

Project Sponsor: Philips Telehealth Solutions

Project Co-Sponsors: National Association for Home Care and Hospice, DMAA: The Care Continuum Alliance, and Fazzi Associates

Project Managers: Fazzi Associates

Expert Design Model: The Philips National Chronic Disease Expert Design Project will bring together a national panel of chronic disease medical experts and home care clinical telehealth experts from nearly every state. The National Expert Panel will review the medical realities of those with chronic diseases as well as all available telehealth protocol from national groups such as AHRQ, the QIOs, etc. and from the proven experience and protocol of agencies who have demonstrated success in using telehealth with one or more of these patient populations. Based on these insights, the National Expert Panel will go through a systematic exercise designed to collectively develop the best practice parameters and protocol for addressing each of the four major chronic diseases.

Criteria for Home Care Agency Participation: The home care experts need to be real experts in telehealth and chronic disease. There will be one expert from each state. To help recruit highly experienced and successful agencies, regardless of what telehealth system they use, Fazzi Associates is working with the National Association for Home Care and Hospice and all state home care associations to identify and recruit optimal agencies that meet five key criteria:

• Minimum two years experience using telehealth preferred.
• 25 units or more in the agency program with an average of 75% of units in use.
• Agency telehealth program must include the use of disease specific pathways or disease state management protocols.
• Telehealth program outcomes include at least one of the following measurable success points:
  • Reduction in visits per episode of greater than or equal to 10%.
  • Reduction in Acute Care Hospitalization rates to better than 50% of your state average.
  • Reduction in Emergent Care rates to better than 50% of your state average.
• Agency has a clinical leader who is knowledgeable and who oversees their service.

Project Timelines: The project began shortly before January 2008. The first six months of the project focused on project design, eligibility requirements and expected outcomes. The following is the remainder of timelines:

July 2008: Project is announced and technicalities and schedules confirmed. Efforts made to identify and collect all available protocol on the use of telehealth with specific chronic diseases. Additional research initiated on the financial, clinical and medical realities of each of the chronic diseases.

August 2008: Agencies and national chronic disease medical experts recruited and confirmed.

September 2008: Final design of the Expert Forum is approved.

September 22: All participants receive briefing report.

October 2 and 3: Expert Design Forum is held in Chicago, IL.

October 14: Formal presentation of the Executive Summary, Major Findings and Financial and Quality Implications are presented at the National Association for Home Care’s Annual Meeting in Fort Lauderdale, FL.

November 1: National Report issued of Executive Findings.

November 2008 – December 2009: Specific findings are field tested and refined.

For More Information: Please contact the Project Manager, Lynn Harlow (lharlow @ fazzi.com).

NAHC Report Article

NAHC Announces National Chronic Disease/Telehealth Project
Effort to Bolster Best Practices for Four Major Diseases

Calling it a “critically important project that addresses two of home care’s most important issues, chronic diseases and telehealth,” Val Halamandaris, President of the National Association of Home Care & Hospice (NAHC), announced the Philips National Chronic Disease/ Telehealth Best Practice Project.

The project will be sponsored by Philips Telehealth Solutions and co-sponsored by NAHC and Fazzi Associates, one of home care’s leading consulting, benchmarking and best practice research firms. This unique project will bring together leading telehealth/chronic disease home care practitioners from every state and national medical experts in the four major chronic diseases. Their goal will be to jointly develop best telehealth practices for dealing with patients with these diseases.

The four diseases to be addressed by the project are chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension and diabetes. “There is no surprise why this project is focusing on these four diseases,” says Halamandaris. “According to a November 2007 study by Johns Hopkins University, 90% of Americans over the age of 65 have one or more chronic diseases, 70% have two or more. These four diseases represent the most prevalent diseases addressed by home care agencies.”

“There is another reason,” added Michael Lemnitzer, Senior Director, Philips Telehealth Solutions. “During Philips National Study on the Future of Technology and Telehealth in Home Care, we discovered that agencies that used telehealth with a disease management program had better financial outcomes and better quality outcomes. What we didn’t explore was what the best telehealth practices were for serving these populations. The goal of this study is to find the answers to that question.”

The Philips National Chronic Disease/Telehealth Best Practice Project will use a unique expert design process to explore this issue. “Home care practitioners who have extensive chronic disease and telehealth experience will join leading medical experts on the four chronic diseases,” says Dr. Robert Fazzi, Project Co-Director. “Their goal will be to systematically develop a series of best practice telehealth protocols that will help agencies more successfully serve patients with one or more of these diseases.”

The project was designed over the first half of the year and is now moving to the process of recruiting practitioners to participate in the national expert design forum, which will take place sometime in September 2008. Results and implications of the findings are expected to be presented for the first time at NAHC’s 27th Annual Meeting and Exposition in Fort Lauderdale, FL in October.

Participant Selection Criteria

NAHC Report Article

National Chronic Disease/Telehealth Project Names Expert Panel Criteria
Findings, Implications, Strategies to Be Presented at NAHC's Annual Meeting