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Voice Response Technology Slashes Hospital Readmissions

Geisinger Health Plan reports discharged Medicare patients monitored by an interactive phone response system are less likely to be readmitted.

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Combining an interactive voice response (IVR) system with additional telemonitoring tools reduced 30-day readmissions by 44%, when compared to a control group of patients that did not use the technology, according to a study that followed Medicare patients who are members of the Geisinger Health Plan (GHP). The technology also increased case manager efficiency in monitoring patients transitioning from hospital to home.

The recently published study bolsters the claim that hospitals wishing to invest in a IVR system--which makes automated phone calls to patients--to monitor them after discharge is a worthwhile investment and that a unified communications strategy can yield positive results, said Janet Tomcavage, Geisinger Health Plan's vice president and chief clinical transformation officer.

"Patients coming home from the hospital are tired, often still weak, and at times overwhelmed with the recovery," Tomcavage told InformationWeek Healthcare. "Families helping patients also struggle with the directions for recovery, medications, follow-up appointments, and the complexity of post-discharge care of their loved one. IVR serves as a way to reach out and assess how patients are recovering and identify those who may need help sooner."

The Geisinger Health Plan, which is part of the Geisinger Health System (GHS), serves 217,000 commercial and 52,000 Medicare Advantage members in central and northeastern Pennsylvania. GHP has been tracking patients through the Geisinger Monitoring Program (GMP) interactive voice response protocol since 2008 when it established the post-hospital discharge telemonitoring system. The GMP program uses AMC Health's Telemonitoring platform.

[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]

The study followed 875 Medicare patients who were enrolled in the combined case-management and GMP program. This group was compared with 2,420 matched control patients who were only case managed.

Under the program, patients use their phone keypad to answer a series of yes or no questions relating to the most common issues they might encounter after hospitalization. Those include eating and drinking habits, breathing, wound healing for surgical patients, and taking medications. If, for example, a patient indicates that he is having difficulty breathing, the IVR triggers an alert to the nurse case manager who then contacts the patient to better understand the issue. After an evaluation, the nurse case manager can arrange for a physician appointment if needed or reinforce the current treatment plan.

"Patients range in age from 30 to 80 and have many different conditions including post-surgical cases to diabetes, pneumonia, kidney disease, cancer, or trauma," Tomcavage said. "IVR is one easy tool that allows us to reach out to all patients and perform high-level assessment."

The survey of Geisinger case managers showed that 96% believe telehealth technologies allow them to monitor heart failure patients more efficiently. Eighty-five percent say the telehealth tool, in combination with close monitoring from the healthcare team, helps to keep their patients out of the hospital.

Approximately 1,000 heart-failure patients are monitored remotely at any given time by the program, which also uses weight and blood-pressure devices that transmit patient data via Bluetooth technology. When the patient steps on a scale, for example, her weight is transmitted to a secure server. The nurse programs a profile of the patient into the system and can have the system alert the case manager if the patient's weight goes up or down beyond a specified amount.

According to Tomcavage, weight gains of more than three pounds in a day or five pounds in a week can often signal heart failure. The scale helps the case manager keep in front of heart-failure exacerbations and allows for prompt intervention in the form of additional diuretic medication or scheduling a primary-care office visit.

"Providing case managers and providers with earlier evidence of weight gain prompts earlier treatment of excess fluid. We believe this has reduced emergency department visits and hospitalizations for heart failure in this population," Tomcavage said.

Geisinger officials said patient compliance with the program has been greater than 85%.

"This collaboration will help to enhance the logic that identifies which technologies are most effective in the management of chronic conditions in the home and how clinical data can be embedded in day-to-day workflows to improve care coordination and outcomes," Maria Lopes, AMC Health's chief medical officer, said in a statement.

"The essence of telehealth is to drive efficiency with clinically meaningful and actionable information, identify pre-acute trends, improve quality metrics, and bridge any communication gaps between patients and their care teams, leading to reduced hospitalizations and costs."

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)

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