The care of the musculoskeletal system is an important service area in the healthcare system. More than 50% of the U.S. adult population suffers from some form of MSK disease, and the impact on people’s lives is significant.
THE PROBLEM
Pain and mobility problems impact daily life and independence. Quality of life changes dramatically and the impact on mental health increases. comorbidities such as cardiovascular disease, diabetes or obesity; the ability to work; and financial security.
It’s clear why these diseases are so costly – both in terms of the impact on people’s lives and the cost to the U.S. health care system. UConn Health sought to further improve access to orthopedic care and health equity for Connecticut residents, particularly those in rural and underserved communities.
“In addition, we sought a solution that would facilitate standardization of our evidence-based care pathways across our healthcare system while incorporating flexible, virtual options for our patients for education, physical therapy, communication with the care team and more,” said Dr. Isaac L. Moss, chairman of the Department of Orthopedic Surgery, co-director of the Comprehensive Spine Center and program director of the UConn Spine Surgery Fellowship at UConn Health.
“Especially for patients in rural areas, the digital care management approach is a proven means of improving access,” he continued. “For example, this eliminates the time, cost and stress that patients have with traveling to their pre-operative course and in-person follow-up visits for joint replacement surgery.”
And no matter where patients are located, they should have access to the same high-quality, evidence-based care to achieve the best possible outcomes, he added. This project has become even more important in the wake of the COVID-19 pandemic as many patients look for virtual options to supplement their in-person care, he said.
SUGGESTION
Moss said Force Therapeutics’ proposed digital care management platform has proven successful in engaging patients in the care prescribed by their own providers, using interactive educational content, tailored goal setting and direct messaging tools to engage patients to support adherence to postoperative or non-surgical recovery care pathways.
“The platform also overcomes common access barriers such as internet access, language, learning styles, travel and schedules to improve patient outcomes and satisfaction while increasing efficiency and reducing costs,” he said.
“The platform also overcomes common access barriers such as internet access, language, learning styles, travel and schedules to improve patient outcomes and satisfaction while increasing efficiency and reducing costs.”
Dr. Isaac L. Moss, UConn Health
“The platform further improves care by enabling our care teams to standardize patient education and care pathways for each condition and to consistently collect patient-reported outcomes and other data across our spine, joint and sports medicine service areas,” he noted.
“While care is standardized, the care team can easily customize the care pathway for each patient based on their individual needs. Patient interactions with the platform reliably monitor progress and capture key metrics such as PROs, medication adherence, pain and response to therapy, physical activity and more.”
STAND UP TO THE CHALLENGE
UConn Health went live on the platform in early August 2023 and is actively used by patients and more than 60 MSK surgeons, care team members and clinical practice leaders for spine, arthroplasty, sports and foot/ankle care.
Direct integration with UConn Health’s Epic electronic medical record system creates a seamless process from surgical planning to pre-operative care and post-operative recovery at home.
“Standardized, digitalized care management gives our care teams a holistic view of patients and their entire care episodes,” said Moss. “Providers can individualize diagnostic, surgical and follow-up information based on each patient’s needs, comorbidities and support structures at home.”
“When patients use the platform, they have access to educational content tailored to different learning styles instead of disjointed, paper-based patient education,” he explained. “They set their own care goals. For example, patients have set themselves the goal of being able to play with their grandchildren or go mountain biking again. Gamification helps patients absorb important information and stay committed to the best possible outcomes.”
UConn Health care teams actively monitor PROs to assess utilization, pain, function, clinical benefit, mental health, well-being and patient experience. Care teams are immediately alerted and can intervene quickly if a patient is concerned or not developing as expected.
Such early intervention prevents the escalation of potential complications and avoids unnecessary emergency department visits and readmissions. At the same time, it helps patients feel reassured and confident in the care they are receiving, Moss said.
“Providing care at home improves access to care in our communities and helps patients manage their conditions or recover from surgery without the additional costs of in-person care,” he continued. “In addition, we find that some patients require very little in-person assistance, which frees up our care teams to focus on those who need more assistance.”
“Throughout the process, the digital care management approach captures holistic, contextual data, creating a more meaningful, measurable and even predictive view for better patient care and outcomes,” he added.
Another aspect of this approach is reimbursement. In 2022, the Centers for Medicare & Medicaid Services introduced new CPT codes for remote care delivered through a digital care management platform qualified as Software as a Medical Device (SaMD) with the Federal Drug Administration.
“Our platform meets patient engagement and data collection needs. For example, patients must submit PROs for 16 days in each 30-day period, and we need a measurable, defensible audit trail for reimbursable activities,” Moss explained.
RESULTS
Although the go-live was recent, UConn Health is encouraged by the results so far.
The data shows that 87% of the approximately 200 patients who have interacted with the platform so far are complying with PROs – such as reporting pain, completing activities, completing HOOS or KOOS forms, etc.
“Other key performance indicators such as length of stay, readmissions and patient safety will give UConn Health insight into macrotrends at the procedural, clinical, facility and population levels to continually improve quality,” Moss said. “We will monitor these trends as more data is collected over time.
“The wealth of data we collect will also prepare UConn Health to meet increasingly stringent CMS reporting requirements,” he continued. “For example, the Hospital Inpatient Quality Reporting (IQR) program will require hospitals to collect and report PROs, risk variables, matching variables, and PROs-related variables for at least half of eligible hip and knee patients .” “
ADVICE FOR OTHERS
“Digital care management technology has proven effective in improving patient engagement, satisfaction, quality of care and outcomes, and reducing costs for both patients and providers,” noted Moss. “Furthermore, these technologies meet patients where they are (both literally and figuratively), eliminating many of the barriers to quality care that patients across the country face.”
“As organizations evaluate these technologies, it is important to involve both leadership and practical care teams for key MSK service lines in all aspects of the process,” he concluded. “Through this level of collaboration, organizations gain acceptance and buy-in while ensuring they standardize the best evidence-based care plans for their patient populations.”
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