Evara Health is tackling chronic conditions and saving lives with RPM
Some time ago, Evara Health had briefly considered remote patient monitoring as a service, but the federally qualified health center never had the necessary funding.
THE PROBLEM
Because so many patients are elderly or have transportation issues, the organization recognized the need to better monitor patients with chronic diseases who could not come to the clinic regularly.
Evara also needed a way to better monitor patients being discharged from the ER to reduce the chance that they will have to return. Unfortunately, Medicaid does not provide reimbursement for this RPM services. As an FQHC, Evara was not eligible for Medicare reimbursement.
“With more than half of our patients on Medicaid and another quarter uninsured, we had no way to fund the initial start-up costs or ongoing service costs,” said Howard Rubin, CIO at Evara Health. “We had applied for a number of grants to start a program. In late 2021, we were fortunate to receive one of the FCC's telehealth grants, which gave us the funding to start an RPM program. “
PROPOSAL
Evara Health has selected Health Recovery Solutions as its RPM supplier.
“Our plan was to initially connect our RPM program to our Medical Home@Home (MH@H) service,” Rubin recalls. “We have teams of two medical assistants who visit our patients who are having difficulty getting into one of our clinics. These patients are typically homebound and have multiple chronic illnesses or have recently been discharged from hospital and need extra attention.”
MARKETPLACE
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MEETING THE CHALLENGE
Evara has the MH@H team take the RPM kit to the patient's home, help the patient set it up, take the first set of measurements, and answer any questions.
“Our value-based nursing team then monitors these patients between MH@H visits,” Rubin noted. “We have worked closely with our clinical leadership to develop acceptable ranges for the various metrics, so if a metric falls outside of that range, nurses are alerted on the portal they are monitoring.
“One of the The benefits of the RPM product we use are that we can adjust the alert values on a patient-by-patient basis as needed, so if a particular patient tends to have higher than normal blood pressure, the system is not constantly sending alerts,” he continued.
When a nurse sees an alert, she contacts the patient directly to see what is going on. Then, if necessary, the nurse alerts a healthcare provider who can view the measurements, talk to the patient, place orders if necessary and request a MH@H team to visit if necessary.
“Since the initial rollout, we have now expanded to enrolling patients in our clinics when referred by their provider,” Rubin said. “The nurse in the clinic helps the patient become familiar with the kit, or with the mobile version: an app on a smartphone that is connected via Bluetooth to the appropriate devices.
“These are not necessarily patients with transportation issues, but they may have a single or unique condition that the provider wants to monitor over a period of time,” he continued. “We also recently introduced a new patient cohort where we are enrolling pregnant and postpartum patients for the service to monitor for gestational diabetes or hypertension.”
Evara Health migrated to a new EHR when it began the RPM project, from Greenway Intergy to Epic. That's why it initially decided to just use the Health Recovery Solutions physician portal to monitor patients, rather than trying to integrate the system with Epic during the transition.
“Our nurses can cut and paste relevant information from the portal into the patient record in Epic, alongside any relevant notes,” he explained. “We are now working with our partner, Health Choice Network, to implement an interface between Health Recovery Solutions and Epic to automatically flow the information from the portal to the patient record in Epic.”
RESULTS
Rubin said the organization has had good results overall, but it took a while.
“In our enrolled patient population, we have seen anywhere from 5% to as much as 20% improvements in high blood pressure and high A1c (glucose) levels,” he reported. “We have also seen a significant increase in testing as patients become more comfortable with the technology, which helps us identify any trends that could be concerning.
'We have also seen some very specific cases where the RPM technology has had a life-saving impact on our patients,” he added.
There are two such cases that Rubin can highlight.
“In the first case, one of our nurses received an alert that a patient's blood pressure was high and called the patient,” he said. “After a brief conversation, she determined the patient was having a heart attack and called 911 to take him to the hospital, where he received a stent that saved his life.
“In the second case, we had an expectant mother who was diagnosed with RPM and the nurse diagnosed her with elevated blood pressure,” he said. “Again, after speaking with the patient, she advised the patient to go to the hospital immediately. It turned out that she was experiencing the early stages of eclampsia, which could have endangered both her life and the life of her baby. “
ADVICE FOR OTHERS
“The first thing to consider is what problem you are trying to solve and what patient cohort you want to enroll,” Rubin advised. “It is critical to be clear about how this technology will be used and what will be considered successful.
“The second thing is to have a well thought out and documented rollout plan, with a detailed marketing plan,” he continued. “It is important that whoever registers patients has a script to address any issues quickly and clearly.”
It is imperative that a clinical champion is identified in advance to help clinical teams refer and enroll patients in the program, he added.
“Sometimes staff will see this as extra work and not necessarily see the value in it, so it is imperative that there is someone from the clinical team speaking to them and encouraging them,” he said.
“You also need to identify the financing path,” he concluded. “Often the initial purchase of the equipment is covered by a grant or other source, but ongoing monthly service costs can quickly add up. In addition, depending on the organization's structure and insurance coverage, they should consider whether there is any possible reimbursement for the RPM services and what documentation would be required to receive it.”
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