Delivering Value Through Virtual Care in Home Health: A Q&A with Spectrum Health

In 2020, Spectrum Health’s home health division implemented a virtual care program in response to the recent rollout of PDGM. By integrating virtual visits with in-person care, Spectrum has not only been able to achieve its initial objective of reducing costs but has also seen significantly improved outcomes for home health patients, from better recovery rates to reduced readmissions.

We sat down with Joshua Douglas, OTR/L, Virtual Therapist at Spectrum Health, and Julie Liebknecht, MS, OTR/L, CAPS, Field Clinician at Spectrum Health to talk about how the virtual program is structured, how it has helped drive value while reducing costs, and what’s next for the program.

In this recap of the conversation, find out how Spectrum’s home health department has leveraged virtual care to:

• Reduce in-person visits by an average of 1 across all episodes.
• Improve functional outcomes by 25 percent.
• Maintain continuity of care and patient engagement despite a reduction in therapy utilization due to PDGM.

Q: Spectrum Health has been a proponent of using virtual care across the full continuum, but today we’re going to talk about the virtual care program within your Home Health Division specifically. I believe you began this program a little over a year ago following the transition to the PDGM payment model. So just to begin with, can you provide an overview of the program and how it was set up?

Josh: Certainly. In the fall of 2019, as most home health agencies were looking at their utilization practices to see how they would fit into the new payment model, we did our own analysis and saw a potential reduction in therapy utilization in in-home care. To keep that from negatively impacting our patients, we wondered if we could offset it using virtual components. So I was tasked with trying to develop this program as an adjunct to our in-home care to ensure that our patients weren’t suffering or having a decline in their potential outcomes.

We started by experimenting with phone call follow-ups with patients, and very quickly found that it went from one phone call to three phone calls through their whole course of treatment all the way to discharge. We discovered that this was an exciting avenue for continuing the education piece that the therapists were working on in the home. With virtual care between visits, our clinicians weren’t having to spend time going over things again from a previous visit. It left the clinicians open to move on to a new or novel treatment with each in-home visit, which we found was really maximizing the patient’s experience and moving their outcomes forward.

From the phone calls, we moved into doing face-to-face video visits with our patients. With the flexibility that we have in home health, because we’re not trying to bill for these sessions individually, we set up virtual appointments ahead of time but could play around with how we delivered them to a patient. We found that the phone calls worked well in certain instances, while in others our patients really wanted a face-to-face virtual visit. And then we also found that face-to-face virtual visits were nice for us as well sometimes, like when we needed to inspect a wound or review placement of equipment in a patient’s home. Also, as a system we started using the MedBridge patient app. We combined that with providing additional exercises for our patients, follow-up, and assistance with navigating the app, and tied it all into our clinician’s plan of care so that we could move that patient forward.

Great. Thanks Josh. And Julie, you’re a practicing field clinician. So can you describe the difference between working in person with an end clinician versus performing virtual visits, and how virtual care has changed your practice in the field?

Julie: Absolutely. With PDGM rolling out I wasn’t available to make as many face-to-face and in-home visits with my clients. But with the virtual care capability, I could look at it from a different perspective and project how many in-person visits I might need if I could supplement with virtual visits for a lot of the educational pieces that didn’t require me to be there in person delivering hands-on care.
From there I could then refer to Josh and provide him with the plan of care so that we could positively impact that patient and allow them to get the services they need without always seeing them in person. A lot of these referrals that I’m making are for things that don’t necessarily need to be in person, like energy conservation, home safety recommendations, pain management after a surgery, or with chronic pain looking at a home exercise program.

In these cases, we look at how virtual visits can supplement in-person visits to help progress the patient. Josh has been able to progress home exercise programs by following up with a phone call or video visit to assess how they’re tolerating it and if they can possibly tolerate more repetitions, maybe increased resistance and things of that nature.

Great. Thanks so much, Julie. And Josh, early on you talked about virtual care being a tool to help offset costs versus drive additional value. But in the process of building the program you found that you could drive value as well as demonstrate cost reduction. Could you talk about how you’re measuring whether value is created for your patients and your organization as the result of implementing virtual care?

Josh: Yes. Going into PDGM we weren’t a high utilization agency to begin with, but we knew that it was potentially going to impact us cost-wise.

But over the course of this program, we’ve found that we’ve actually been able to reduce our therapy utilization by one visit per episode. It doesn’t sound like much, but when you’re looking at all of your episodes, that’s a significant amount. By reducing that cost, our initial concern was whether we were going to shortchange our patients and limit their progress. So to gauge our progress we looked at OASIS functional measures over the course of most of the year for about 200 patients and saw that they experienced a 25 percent functional improvement on average.

I’m not going to say that that’s strictly because of our virtual programming, but it does contribute. And it does show that you’re able to increase the quality of the services you provide without as much hands-on contact with patients. One of the biggest bits of feedback that I get from patients is that they really appreciate having someone following up with them and keeping them on task, which is a huge thing with home health since we’re an intermittent service and not there with the patient daily.

So it really helps anytime we can add in that extra contact point to coach them through their disease process, talk them through their home programs, or respond to needs we might be missing or little things that come up. We’ve really shown that it’s made a significant impact with these patients.

To find out more about Spectrum Health’s virtual care program for home health, including how it has helped improve readmission rates and outcomes for COVID patients, plus plans for the future of the program, watch the full presentation here.