At Providence, RPM improves patient health and reduces caregiver workload
Providence, a 52-hospital health system based in Renton, Washington, sees digital innovation as a key tool to overcome industry-wide challenges and transform healthcare delivery for the benefit of the communities it serves.
Many of the virtual care and digital health systems under development, as well as those developed in recent years, are aimed at addressing three macro challenges that healthcare currently faces: workforce shortages and burnout; catering capacity and throughput; and fragmentation of care or access for patients.
The expansion of the health care system to Remote patient monitoring is intended to directly address two of these issues.
THE PROBLEM
“Scheduling in-person appointments with primary care providers, as often as necessary for proper monitoring and follow-ups, can be a real challenge for patients with chronic conditions,” said Dr. Eve Cunningham, chief of virtual care and digital health at Providence. “RPM provides a viable solution to improve patient care and outcomes, leverage team-based care, and maintain a neutral workload for primary care physicians and care teams.
“It significantly eases the path for our patients by expanding our clinical team directly into the home, improving the quality of care we provide to patients with chronic conditions while streamlining the patient experience,” she continued. “RPM has been a game-changer for both our providers and patients, and our work with (RPM vendor) Cadence is a great example of how our commitment to embracing this virtual care modality has translated into better patient outcomes.”
PROPOSAL
For large-scale adoption, Providence took a public health approach and looked at how many patients might qualify for this type of program, the clinical benefits, increased access, and the ability to care for patients in a better way.
“What we found was that there was a lot of interest in RPM from both a provider and patient perspective, and therefore a huge opportunity to implement this technology at scale,” Cunningham said. “For years we had experimented with RPM in smaller pilots, but for various reasons never scaled it up.
“With technology, it is very important to develop simple and hassle-free tools that do not increase physician burnout, but instead reduce administrative burdens and make the care delivery process more efficient and energetic.”
Dr. Kenneth W. Kooser, Providence Medical Group Family Medicine-Lacey
“When we connected with Cadence, we saw an opportunity to implement RPM across our entire footprint,” she added. “Together we were able to identify a site where we could prove the concept, demonstrate success and socialize it internally at scale.”
When beginning this work, Providence had four fundamental goals: to increase patient engagement, strengthen the patient-provider relationship, improve the quality of care, and ultimately shift the delivery of care from reactive to proactive.
“We knew this would lead to better clinical outcomes and lower overall healthcare spending for patients – and we were right,” Cunningham noted.
“The program has since helped us keep chronically ill patients safely at home the fivefold goal of healthcare improvement: to improve the patient experience by tailoring treatments and interventions to patient data; addressing public health through proactive, preventive care delivery; lower costs by connecting patients to the most appropriate healthcare intervention and reducing avoidable hospital admissions; improve the well-being of caregivers by expanding their reach through a virtual care team; and providing equitable care by reaching all patients, regardless of their ability to personally present for treatment.”
MEETING THE CHALLENGE
At Providence, patients suffering from congestive heart failure, hypertension and/or type 2 diabetes are provided with equipment that allows Cadence’s virtual care team to proactively monitor a patient’s condition from home.
“If there are any concerns, the Cadence team will contact the patient to assess their well-being, manage their medications and, if necessary, connect them to their Providence doctor to hopefully avoid a trip to the emergency room “, said Dr. Kenneth W. Kooser, a family medicine physician at Providence Medical Group Family Medicine-Lacey in Lacey, Washington.
“This team-based approach allows for additional touchpoints with chronically ill patients from the comfort of their home, between patient visits,” he continued. “Cadence’s services are accessible 24/7 and help assess emergent, urgent and non-urgent issues, reducing the burden on Providence physicians.”
For team-based care to succeed, it’s critical to establish mutually agreed-upon clinical guidelines so that everyone on the care team is rowing in the same direction, he added.
“For example, with remote monitoring, this meant establishing clear and effective clinical guidelines for patients in advance so that everyone on a patient’s care team understands when and how to intervene if necessary,” he explained. “We regularly review and update these clinical guidelines with the latest evidence-based practices.
“We will then communicate these new guidelines to everyone on the patient team in an effort to standardize care and ensure that every patient receives the best care at every clinical touchpoint,” he continued.
“With technology, it is also very important to develop easily and without friction tools that do not increase physician burnout, but instead reduce administrative burdens and make the care delivery process more efficient and energetic.”
In the case of remote monitoring, the value for patients is clear: Patients gain peace of mind knowing someone is consistently monitoring their health, he added.
“What is less often discussed is how RPM can improve work-life balance and reduce the burden on physicians,” he noted. “An important aspect for us was to ensure that EHR integration was available to our physicians from the start. With EHR integration, all patient information is available to doctors in real time.
“They can easily identify patients who would benefit from remote monitoring, based on personalized eligibility criteria established by our clinical team, and then easily place orders for patients in the EHR,” he continued. “We also prioritized innovative features, such as an advanced alert system and patient communication platform, to make RPM seamless and easy to use for physicians, staff and patients.”
For example, the majority of these alerts are handled efficiently by the RPM team, without ever escalating to the primary care provider, he added.
“In fact, less than 1% of alerts require escalation to Providence’s healthcare team,” he reported. “This results in fewer calls and messages coming into the clinic. This means we can also identify potential patient issues in real time rather than waiting for the patient to come in for a traditional appointment, at which point their medical condition may have deteriorated.
“Not to mention, with remote monitoring data readily available, physicians can better utilize their in-person visits with patients and reduce the need for more frequent visits that could be avoided due to routine issues,” he said.
RESULTS
Providence’s remote patient monitoring program went live in the summer of 2022 with two pilots in Washington state. Since then, the healthcare system has seen high growth and adoption.
“We measure key metrics including utilization, retention, patient and provider satisfaction, and escalations to Providence PCPs, along with clinical metrics such as blood pressure, percentage of patients adhering to guidelines, etc.,” Cunningham explains.
So far, she reported, Providence has now done just that currently, more than 1,500 patients are enrolled in the care model, and “we expect this number to reach 5,000 to 8,000 by the end of 2024.”
Meanwhile, 88% are taking their vital signs daily and 77% are still participating in the program after six months.
Cadence reduces provider workload through its clinical care team and successfully managing and reviewing patient alerts, with only 0.6% of remote encounters escalated to physicians in Providence.
The clinical outcomes for patients with hypertension and type 2 diabetes are even more remarkable: patients starting with a systolic blood pressure >160 achieve a median SBP reduction of 21 mmHg at week 12 (in other words, 12.55% reduction in SBP in week 12); and patients with blood glucose levels above 183 mg/dl achieved a 16.75% reduction in blood glucose at week 12.
With a year of success, Providence is now live with RPM in Washington, Montana and California, greenlighting the program’s expansion to Alaska this year.
ADVICE FOR OTHERS
At the highest levels, Providence prioritizes executive alignment at the outset of any major partnership or large-scale initiative, Cunningham noted.
“Choose your technology projects wisely, with strategic KPIs and implementation plans behind them,” she advised. “Make sure they align with your healthcare system’s key objectives and help solve your biggest challenges.
“This has been very effective in determining whether our approach is working,” she continued. “Be rigorous in bringing stakeholders together, assessing and making sure you’re on the right track so you can continue to make progress or not.”
Testing and developing a proof of concept is critical, she added.
“We strongly believe in testing technology programs before scaling them more widely across the healthcare system,” she explains. “That said, we don’t want to run perpetual pilots, so we always plan the ‘pilot-to-scale’ approach for every solution we bring forward.
“For remote patient monitoring programs, it is important to ensure that the communication flow between patients, physicians and your partner is working properly,” she continued. “Make sure the incoming data is managed appropriately. Where does it go, who reviews it, does it add burden, who acts on this information are important questions to ask.”
And finally, Providence recommends developing a “tiger team” at scale so that there is expertise within the team in change management and workflow redesign, she advised.
“Getting a program like this off the ground is just the beginning – scaling it will only really happen when the rubber hits the road and you need a team, internally, across departments, that can champion adoption at every touchpoint and encourage,” she concluded.
“Assigning project managers to different departments within the organization, including clinical influencers, IT and operations support, and marketing and communications experts, is critical to the success of the program.”
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