Altamonte Springs, Florida-based AdventHealth is a nonprofit health system with more than 80,000 care team members across hospitals, physician practices, outpatient clinics, skilled nursing facilities, home health agencies and hospice centers across nine states.

THE PROBLEM

With the CMS Hospital Readmissions Reduction Program, hospitals can lose up to 3% of their Medicare payments annually due to penalties. But reducing readmissions poses challenges – especially when working with vulnerable populations like Medicare.

AdventHealth is driven by a mission to deliver compassionate care for body, mind and spirit. This includes caring for Medicare populations, who often face unique challenges when it comes to managing their chronic conditions, leading to higher levels of hospitalization and high HRRP penalties for the organization.

Wanting to improve outcomes for these members, AdventHealth needed a way to increase disease control – reducing the need for expensive acute care and readmissions.

PROPOSAL

Significant correlations have been found between low post-discharge medication adherence and 30-day readmissions, said Joey Pineda, a case manager at AdventHealth and designated project manager for implementing a pilot program surrounding these challenges. 

Understanding this, the team decided to pilot a program to reduce readmissions by increasing medication adherence with a digital health platform, Wellth.

"The pilot, which took place at the AdventHealth DeLand, Florida, acute care hospital, engaged Medicare patients with acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease or congestive heart failure who also had recent 30-day readmissions," he explained.

"Participating patients would utilize the Wellth platform daily – completing daily check-ins and submitting photos of them each time they took their medications as prescribed – in exchange for a financial incentive."

The platform itself leverages principles of behavioral economics, as in a study suggesting that, even when educated, people make irrational decisions (i.e. skipping medications), to increase medication adherence. 

"The beauty of this technology is that it worked with what the patients already have – smartphones."

Joey Pineda, AdventHealth

Patients received up to a set amount of reward money at the start of each month and had money deducted each time a prescribed medication check-in was missed. At the end of each month, the patient was free to spend whatever money they had kept.

MEETING THE CHALLENGE

The Wellth platform was designed to minimize barriers to participation for AdventHealth patients – requiring no additional connected devices – and could be accessed via an app on each individual's existing smartphone.

Through the app, enrolled patients received regular reminders to complete their medication check-ins, submitted photos of themselves taking their medications and received personalized bonus incentives in the form of messages of encouragement from family and friends.

"Each picture submitted by the patient was checked using in-app AI to confirm the medications and amounts taken, and Wellth member-support team members were alerted in the event that a picture submitted was out of the ordinary," Pineda explained.

"These support-team members could then reach out to individual patients to see what the issue was, and refer those patients back to us – their hospital care manager – at DeLand for appropriate follow-up."

Having the AI to identify and send alerts for missed check-ins and incorrect dosages allowed the Wellth support team to quickly step in, assess and engage DeLand staff early on, before acute care was needed, he added.

The DeLand team was also able to set specific parameters for alerts and notifications, reducing alert fatigue and ensuring that the data sent was that most valuable and relevant for its needs, he said.

RESULTS

Prior to the Wellth program, the average 30-day readmission rate for AdventHealth DeLand was 19% for patients with the four targeted disease states. 

Within the first 30 days of the program, however, medication adherence for enrolled patients improved significantly, reaching an average of 91% adherence. This not only allowed DeLand to achieve the 80% CMS quality metric for medication adherence, but improved the individual patient outcomes, as well.

"With the pilot, our DeLand location saw a 57% reduction in readmissions for these previously high-risk patients, taking their readmissions from 19% to 8%," Pineda said. "As readmissions dropped, so did the cost of care for these patients, ultimately saving the organization $183,000 in care costs during the length of the pilot."

ADVICE FOR OTHERS

"First, while the program was helpful in achieving adherence across the board, it was most impactful for patients who had a history of poorly or moderately controlled conditions," Pineda advised. "In treating the mind, body and spirit of your patient populations, start with those populations that are struggling the most rather than trying to find a one-size-fits-all solution."

By investing resources into these higher-risk patients with solutions designed specifically for them, AdventHealth saw better health outcomes and an increased return on investment as a whole, he noted.

"Second, the beauty of this technology is that it worked with what the patients already have – smartphones," he said. "This made implementation quicker on our end, with minimal disruption to our workflow, and enrollment easier for our patients. Connected devices, though they have their place, can be expensive and don't have to be your only option for adopting digital health."

Finally, the goal has to be patient-centric, he said.

"Our pilot, while cost-effective, was ultimately about creating healthier patients through fewer readmissions," said  Pineda. "When we focused on improving the health of these individuals, the readmissions, quality metrics and cost savings all just fell into place."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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