New Chronic Condition Care Approach for Population Health

April 1, 2021
April 1, 2021

Between the demands of demographic change and the precarious state of healthcare finance, it is apparent that some of the ways we currently provide healthcare are unsustainable. How a population health approach to care is one of the solutions for this problem is a focus of the HealthStream webinar, "Treating an Aging Population: An Effective Approach to Addressing Chronic Conditions," from our three-part series, "Managing Opioids, Pain and Chronic Disease: Critical Steps in Addressing Population Health." The webinar was presented by Robin Rose, Vice President of the Healthcare Resource Group, HealthStream, and Robyne Wilcox, Senior Director of Continuum Research, HealthStream.

Innovative Approaches That Improve Care

According to Wilcox, "Providers are looking for creative ways now to realize savings and manage lower cost but still provide quality care." Their goal is to avoid the use of healthcare resources and care providers’ time when not absolutely necessary. Simultaneously, low cost or no cost ways or settings to provide care should be the choice whenever the opportunity allows. Wilcox provided the example of "remote care services, like remote health monitoring and regular check in calls with patients" as ways to maintain care connections while lowering the costs for the healthcare system and patients.

Another Way to Reduce Readmissions

Wilcox explained, "The assumption here is that these regular interactions will make a positive impact on patients’ compliance with treatment plans and that interventions can occur more quickly when problems do come up." As an example of the value represented by telehealth interactions, she told of a provider who sends patients home with an iPad, a scale, and a video camera post discharge. Every day, "These patients have interactions with their physicians and nurses from home—taking their blood pressure, getting on the scale, and talking about how they feel." These providers are able to monitor patients more closely than when relying on office visits. Best of all, "If it looks like someone's running into trouble, the provider can change a dose or have them come into the office." Knowing that letting a healthcare problem go too far for a patient may mean a costly return trip to the hospital, this provider has "figured out it is better to invest the money up front than manage that slow bleed of revenue loss through readmission."

The Importance of Being Guided by Evidence-based Information

For chronic care management delivered through programs like these to be effective, Wilcox advised that the physicians, nurses and aides involved have to be up to date with the latest evidence-based information and the most recent medical based knowledge. These professionals must then "be able to translate and apply that information to optimal care that fits a mostly senior population and is easy to implement in person." Because many physicians are too busy to keep up with the volume of information about care, Wilcox links "the responsibility to keep pace with the latest information more to nurses and aides, who really need a reliable way to keep current with the latest evidence-based approaches and the best practices for care." Rather than a passive approach to learning involving the scholarly literature, journals, seminars, and even Google searches, Wilcox advises that learning needs to occur "within the context of their setting, so that once read and absorbed, the new knowledge is tested through practice that helps them apply that information before it’s used as the basis of care for patients."

Watch the full webinar here. For more information on HealthStream’s Population Health Management Library, please visit this link.