A technological approach to patient engagement shows ROI for Providence St. Joseph Health

Tom Burton, director of operations, orthopedics and neurosciences at Providence St. Joseph Health, speaks at the HIMSS21 conference in Las Vegas on Tuesday.

Photo: Jeff Lagasse/Healthcare Finance News

LAS VEGAS - Navigating the waters of Medicare reimbursement can be a tricky proposition for hospitals and healthcare organizations that take on financial risk. There's a business case for increased patient engagement that can help to achieve a return on investment in these kinds of situations, which Tom Burton knows well.

Burton, a licensed physical therapist and director of operations, orthopedics and neurosciences at Providence St. Joseph Health, made that business care at HIMSS21 in Las Vegas in his session, "How Providence is generating patient engagement ROI."

Focusing on patient engagement was a response to a difficult situation at Providence, and the situation was this: Starting in 2016, the Centers for Medicare and Medicaid Services put together a comprehensive total joint bundle for Medicare, in which Providence was automatically enrolled.

The organization took all total hip and knee replacements and examined how much was spent from admission to 90 days post-discharge – every bill that occurred. They came up with a grand total, which was compared to a target that CMS makes. It's a target that changes with some regularity.

"We were getting nervous, because we're on risk," said Burton. "If we go above target, it's a loss. We're going to have to pay that money back to Medicare."

Because of that, Providence knew it had to maximize its return on this type of program. 

One area that leapt out was skilled nursing facilities (SNFs), which bore extraordinary costs and often resulted in patients being readmitted back to Providence. According to Burton, about 30% of patients who went to an SNF had to be readmitted, and the health system wanted more control over that. If Providence had a margin, that margin would begin to vanish the longer a patient stayed in the hospital. But there was no ready way to measure that.

At first, Providence targeted its surgeons, and set expectations for what shared decision-making with patients should look like in an effort to open lines of communication. Being more involved, the system thought, would help to reduce those readmissions, and potentially even identify early cancellations so other patients could be moved into those spots.

But it didn't work. The expectations simply weren't being met. So Providence shifted focus onto the patients, creating an educational program of sorts that would let them know all of the steps they needed to go through. 

This time, the strategy worked. The ROI from simple education was significant: It decreased length of stay and increased discharges straight to the home, bypassing SNFs altogether. Patients were largely happy, but the remaining issue was that patients had to be signed up for the program by their physician's offices, and there wasn't enough compliance among surgeons to make sure patients attended.

The solution? Engage with patients directly and digitally.

"There are all sorts of things you can do to get patients more engaged without having to make them take time off work, attend classes or rely on surgeons," said Burton.

Increased rapport with patients truly made a difference, as the system was able to set expectations more effectively and ensure patients were sticking with the program.

"We focused on the important things: We had to get patients into the hospital, out of the hospital, and home," said Burton. "And we didn't want them coming back."

In investigating patient engagement tools, Providence settled on Twistle, which put together an ROI calculator that allowed the system to gauge whether the approach would work, and whether it would justify the investment in a tech partner. 

"We solved the fact that we couldn't communicate with patients all the way up to their surgery and afterwards when they were at home," said Burton. "We can do that using a patient engagement platform. It allows us to ask questions, get answers and engage the patient."

Providence was able to save $365 per joint replacement, resulting in $283,000 in annual savings, with an opportunity to expand and potentially save as much as $831,000 per year. The length of stay and readmission reductions were significant. Patients report 92% satisfaction.

And while hip and knee replacements were the impetus for pursuing a technological approach to patient engagement, the approach has worked for COVID-19 patients as well.

"We leveraged Twistle into a COVID program," said Burton. "We managed patients while they were at home, decreased admissions, and are able to care for patients at the highest level."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com