With more than 200,000 adult emergency department visits annually, Spectrum Health knows from experience that many patients likely will need help in the weeks after their ED visit. Identifying which patients will need help, what they will need help with, and when they will need it is the challenge.
Solving that challenge is critical to Spectrum Health in building trusted relationships with patients, leveraging care teams, and saving money from unnecessary utilization of high-cost care resources.
In the case of patients released from the ED, the not-for-profit, integrated health system serving 13 counties in West Michigan sees two categories of problems: patients who lack home support to follow through on their care plan and patients who have a change in symptoms during the weeks following the ED visit but are unsure if their experience is cause for concern, says Tricia Baird, MD, Vice President, Care Coordination for Spectrum Health.
“We see a lot of stress and confusion from patients and their families as they’re either spending more time or more money than necessary to solve a problem that is urgent for them,” Baird says.
Delivering outcomes and ROI
Spectrum Health deployed Conversa’s ED follow-up program, which provides patients with a virtual companion that performs frequent, automated, chat-based, empathetic check-ins, to help care teams catch problems earlier and intervene sooner. More than 20,000 patients participated in the program in the first year. Spectrum found that unplanned admissions, ED visits, and other acute-care episodes for those patients were 5 percent lower than the control group, resulting in over $1M of annual total cost of care reductions from patients covered by Spectrum’s risk contracts.
“We want to be the trusted partner for patients, and this Conversa program really advances our ability to do that,” Baird says.
The program also has boosted the satisfaction of the two dozen nurses and social workers that handle transition care, a group within her 500-strong care coordination team that quickly fills any openings despite a tight job market, Baird says.
“There’s just a ton of satisfaction for my nurses and social workers who are working with this program because they feel that they’re being impactful and effective in every hour that they’re working,” she says.
Spectrum Health is one of a growing number of innovative health systems that work with Conversa to integrate in-person, virtual, and automated care into a hybrid care delivery model. Many of these health systems also rely on Conversa to manage capacity during COVID-19 surges.
Helping care managers practice at the top of their licenses
Spectrum offers the program to patients who are 18 years of age or older who were treated in a Spectrum ED and discharged without being admitted as an inpatient. At 10 a.m. each day, the chat program reaches out to qualified patients who were seen over the 24-hour period ending at 2 a.m. that same day.
The chat asks simple questions, such as, “Are you feeling better than when you went to the emergency department? Do you have everything you need to recover: medications, equipment, follow-up appointments? Are there any social barriers getting in the way of you feeling better?” The chat program contacts patients again a few days later, then two more times the following week and once each in weeks three and four after the ED visit.
Previously, a team of six nurses and social workers was calling about 200 patients each day who required follow up, finding about 30 patients each day having an issue the nurse/social worker can solve. The Conversa program identifies those 30 or so patients each day so the care team can use all of its time to work on the problems these patients face, Baird says.
“If we would have just been picking up the phone and calling, we may have raced right past these difficult problems or not had the time to ask a few more curious questions and make some space to decide that today’s the day we’re going to solve this,” she says.
A good example involves a man in his 50s who resides in adult foster care, Baird says. He received IV antibiotics at a Spectrum ED for an infection in his leg, just two months after a six-day inpatient admission with the same diagnosis.
Three days after his ED visit, the man was escalated to a Spectrum nurse care manager by his Conversa automated companion and he reported several barriers to obtaining the pills he needed to finish his course of antibiotics, including that his foster care home was not able to provide the support he needed. The nurse care manager connected him with a community organization that helped him obtain the pills. The care manager also looped in the patient’s sister to help with his housing situation, as his prolonged infection meant he could not stay at the care home any longer. And when the patient’s symptoms continued without improvement, the care manager arranged a next-day primary care appointment.
High patient satisfaction
At the end of each chat, patients are asked whether the chat was helpful in their care, and nearly 90 percent answer “yes.” Baird says she is not surprised at the high level of satisfaction because patients have been eager to text with us rather than receive a phone call that requires them to feel like talking at that exact moment.
“We’re finding that patients appreciate the automated follow ups throughout the month,” Baird said. “If they were feeling okay the first week but by the second or third week things are breaking down, they feel willing to reach out using this modality to ask for help. We typically don’t see that kind of behavior with phone outreach.”
The program is designed to remove barriers and increase access. For example, Baird says, a woman in her 60s who was treated for severe back pain that was shooting down one of her legs reported through the automated companion that her pain had not improved five days after her ED visit. She also expressed her frustration with trying to schedule the follow-up specialist appointment recommended to her: “I’m just ready to give up.”
A case manager secured the patient a referral to a different specialist with available appointments and ensured that her imaging results were shared with the specialist before the appointment. With the appointment secured and the patient’s stress reduced, the woman was better able to discuss her symptoms and the pain management steps recommended to her. As a result, the woman was able to manage her pain during the two weeks leading up to her appointment with no further ED visits.
“I can’t tell you the number of ‘non-compliant patients’ who are not non-compliant, they’re just struggling with an issue that we didn’t ask about and we can’t see,” Baird says.
Ongoing outreach to avoid readmissions
Spectrum Health is also bringing this approach of wrapping automated care around in-person visits to other patient populations, Baird says. For example, Spectrum is using a Conversa program designed to prevent readmissions after inpatient stays. Patients at lower risk of readmission, either upon discharge or after their higher risks have been reduced through care management to a lower level, are eligible for the program.
“We use it to keep in touch with people who may need us three times in the next 30 days, but we’re not sure which of those three days they will need us,” Baird says. “The outreach and ability to have a two-way conversation is very valuable in that setting.”
Like many leading health systems deploying hybrid care delivery, Spectrum Health has achieved better outcomes for patients, higher satisfaction among clinical and support team members, and greater efficiencies through automated care.