Prehabilitation

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T2 Telehealth aka ATA 2017 aka ATA 23: Part 2, How Did We Get Here and Where Are We Going?

This was my second trip to Orange County Convention Center this year, so it was hard not to compare and contrast the annual American Telemedicine conference to HIMSS, the biggest health IT conference. As well, it was my third time at the ATA conference, back after skipping in 2016, and the gap made it easier to reflect on previous years as well.

The ATA annual is almost 10 times smaller than HIMSS, which makes it a lot less exhausting and easier to focus. There’s not a feeling that for every second you’re talking to someone you’re missing out on talking to someone else equally as interesting and valuable. (There is no shortage of interesting people, just a more manageable group.) The size also makes it a bit easier to talk to people as they’re not rushing off to walk a few miles across the convention center to the next session.

The first year I attended, 2014, the tradeshow floor was full of integrated hardware and software solutions, and Rubbermaid was even a vendor selling telemedicine carts. It was almost as though the iPad hadn’t been invented.  It was the year that Mercy Virtual launched their services as a provider of telestroke and telemonitoring for other health systems. A provider as a vendor caused a bit of a stir on the tradeshow floor.

By the next year, the integrated hardware and software vendors were dwindling, but talks were largely still given by academics and were focused on pilot projects that while showed success, talks often ended with a plea for thoughts on how to scale the program.

ATA evolved out of an academic conference and that’s still quite prevalent in the presenters who are often from academic medical centers, and reporting on studies rather than implementation. Data was important in all sessions, but measurement of value was inconsistent. In addition to academic medical centers, most leaders in telehealth seemed to be faith-based not-for-profits, like Mercy and Dignity, and as well as rural organizations where the value was clear.

That said, a welcome addition to this year’s content was two new tracks on Transformation and Value. I spoke in the Value track at ATA, along with Reflexion Health and Hartford Healthcare about the value of telerehab in total joint replacement, and we were able to share data points from real patient implementations, in addition to clinical studies. (If you’re interested, in the Wellpepper segment, get in touch.)

Although, harkening back to the day 1 keynote, the definition of value depended on the business model of the telemedicine platform being implemented. There’s no question that telestroke and neurology programs, and telebehavior programs deliver value especially in rural areas without direct access. At Wellpepper, we’ve seen definite results in post-acute care, both in recovery speed and readmissions.

In other sessions the value was not as clear and no one was able to fully refute the study that when offered the choice, patients used telemedicine in addition to in-person visits, thus driving up costs. In fact, the director of telemedicine for a prominent healthcare organization confirmed that patients were using televisits for surgical prep when they could have just read the instructions given to them. (Or interacted with a digital care plan like Wellpepper.)

As with every technology conference the voice of the patient was absent, with the exception of head of Mercy Virtual Randall Moore, MD who started all his presentations by introducing us to patient Naomi who was able to live out her life at home, attend bingo, and enjoy herself due to the benefits of the wrap-around telemedicine program that Mercy put In place. Oh, and it cost a lot less than the path of hospital admissions she’d been on previously. Sounds like triple aim, and what we all need to aspire to.

So, based on the keynotes, the sessions, and the show floor, I’d characterize this year’s conference as a world in flux, like what’s going on elsewhere. There was a sense of relief that the ACA had not been repealed. HIMSS took place before the proposed repeal and replace plan died, and there was a lot more fear and uncertainty. Vendors and providers alike are looking to strengthen the value chain. Unlike HIMSS, there was a lot less hype. Machine learning and AI were barely mentioned except in keynotes possibly because telemedicine is still largely a world of real-time visits, and extracting meaning from video is a lot harder than from records. We see promise, people want to do the right thing, but it’s not clear which direction will help us ride out the storm.

 

Still trying to figure out what this has to do with Telemedicine. Look better on realtime visits?

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Healthcare Technology, M-health, Prehabilitation, Rehabilitation Business, Telemedicine

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Our Picks for APTA CSM 2016

APTA CSM 2016Wellpepper CTO Mike Van Snellenberg will be at APTA CSM in Anaheim this year, and here are a few of the sessions you might see him at. If you want to be sure to see him, book a meeting.

As usual we’re following sessions about healthcare transformation, patient experience and patient centered care, patient reported outcomes, and interventions that include technology. With the conservative care and physical therapy being an important part of new bundles like CMS’s Comprehensive Care for Total Joint Replacement, these are hot topics as well.

Here are a few session picks from Wellpepper.

Patient-Centered Care

Exercise and Diabetes: Tools for Integrating Patient-Directed Practice

The Customer Experience in Health Care: The Game Changer, Part 1

Words Mean Things: How Language Impacts Clinical Results

Acute Care Productivity Measurement, “What about the Patient?” The Time has Come to Shift to a Value Based Measurement System

Technology

Wearable Technology Meets Physical Therapy

Virtual Reality and Serious Game-Based Rehabilitation for Injured Service Members

Tracking Outcomes

Changing Behavior Through Physical Therapy: Improving Patient Outcomes

Functional Reconciliation: Implementing Outcomes Across the Continuum

Using Outcomes Data to Improve Provider, Patient and Payer Engagement and Demonstrate the Value of Your Services

Healthcare Transformation and New Models of Care

Exceptional Care and Profitability in Light of Health Care Reform for Patients with Chronic Musculoskeletal Pain

The Complicated Hip: A New Debate

Emerging Issues in Medicare and Health Care Reform, Part 2

Bundled Payment Implementation for Primary Total Joint Patients

Managing Patient-Centered Care in a Changing Reimbursement World

Health System PT’s Leading the Transition to Value-Based Health Care

Posted in: Adherence, Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare Policy, Healthcare Research, Physical Therapy, Prehabilitation, Rehabilitation Business

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EvergreenHealth Selects Wellpepper as Mobile Patient Engagement Solution for Total Joint Replacement

SEATTLEJan. 20, 2016 /PRNewswire/ — Wellpepper, Inc., a clinically validated platform for patient engagement, today announced that EvergreenHealth, an integrated health care system that serves nearly 850,000 residents in northern King and southern Snohomishcounties in Washington State, has selected Wellpepper as the mobile engagement solution for all total joint replacement and musculoskeletal care plans. The project was made possible at EvergreenHealth with a generous donation from The Schultz Family Foundation, a private not-for-profit foundation founded by Howard Schultz, CEO of Starbucks Corporation, and his wife Sheri.

Patients with musculoskeletal issues that require surgery or rehabilitation will use Wellpepper on their mobile devices to track their outcomes and adhere to their care plans. This information will enable patients, physicians, and other healthcare providers to track progress and patient-reported outcomes in real-time to improve care. Wellpepper enables health systems to implement their own care instructions on its task-based platform and makes it easy for patients to understand and adhere to their care instructions.

“Across our organization, we strive to be a trusted source for innovative care solutions for our patients and families, and our partnership with Wellpepper helps us deliver on that commitment,” said EvergreenHealth CEO Bob Malte. “Since we began using Wellpepper in 2014, we’ve seen how the solution enhances the interaction between patients and providers and ultimately leads to optimal recovery and the best possible outcomes for our patients.”

The Wellpepper remote care management solution is designed to be easy-to-use and highly engaging for patients while being flexible and easily customizable for use in clinical practice. It is clinically-proven to improve patient adherence and outcomes with over 70 percent patient engagement.

Health systems are increasingly looking for solutions to enhance patient care while reducing costs, and this is particularly true in total joint and musculoskeletal scenarios. The new Comprehensive Care Model for Total Joint replacement announced by the Centers for Medicare and Medicaid aims to reduce the cost and quality variability of procedures.

“We are seeing a lot of interest in using the Wellpepper platform in orthopedic and total joint replacement scenarios,” said Anne Weiler, co-founder and CEO of Wellpepper. “Interest and adoption are largely being driven by our ability to customize the care plans based on the health system’s own protocols, personalize the plans for each patient and collect the standardized outcomes required as part of the new Center for Medicare and Medicaid requirements.”

The Wellpepper platform doesn’t dictate care plans; instead it provides a set of task-based building blocks that health systems and providers can customize to reflect their own methodologies and practices. The patient interface is simple and straightforward, so patients get only the tasks and questions they need on a given day.

For more information about Wellpepper or to find out how the Wellpepper patient engagement solution can support value-based payment models, please visit wellpepper.wpengine.com or email info@wellpepper.com.

About EvergreenHealth
EvergreenHealth is an integrated health care system that serves nearly 850,000 residents in King and Snohomish counties and offers a breadth of services and programs that is among the most comprehensive in the region. More than 950 physicians provide clinical excellence in over 80 specialties, including heart and vascular care, oncology, surgical care, orthopedics, neurosciences, women’s and children’s services, pulmonary care and home care and hospice services. Formed as a public hospital district in 1972, EvergreenHealth includes a 318-bed acute care medical center in Kirkland, a network of 10 primary care practices, two urgent care centers, over two dozen specialty care practices and 24/7 emergency care at its Kirkland campus, Monroe campus and at a freestanding center in Redmond. In 2015, the system expanded to include EvergreenHealth Monroe – an accredited, full-service 72-bed public hospital district, established in 1960 in Monroe, Washington. EvergreenHealth has clinical and strategic partnerships with several health care entities, including Virginia Mason, Seattle Cancer Care Alliance and dozens of independent practices that are part of the clinically integrated EvergreenHealth Partners network. In addition to clinical care, EvergreenHealth offers extensive community health outreach and education programs, anchored by the 24/7 EvergreenHealth Nurse Navigator & Healthline. For more information, visit www.evergreenhealth.com.

About The Schultz Family Foundation
The Schultz Family Foundation, established in 1996 by Howard and Sheri Schultz, creates pathways of opportunity for populations facing barriers to success. The Foundation invests in innovative solutions and partnerships that unlock people’s potential, and strengthen our businesses, our communities, and our nation. For more information about the Foundation and its work: schultzfamilyfoundation.org.

About Wellpepper
Wellpepper is a healthcare technology company that provides a clinically validated platform for digital treatment plans delivered via mobile devices. The Wellpepper patient engagement solution improves patient adherence and outcomes with its patent-pending adaptive notification system and just-in-time, task-based instructions and by fostering communication between healthcare providers and patients. Wellpepper is used by major health systems that are moving to an accountable care organization model and need to track and improve patient outcomes while lowering costs. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington.

Media Contact:
Jennifer Allen Newton
Bluehouse Consulting Group, Inc.
503-805-7540
jennifer (at) bluehousecg (dot) com

SOURCE Wellpepper

RELATED LINKS
http://wellpepper.wpengine.com


Posted in: Healthcare Technology, Healthcare transformation, Interoperability, M-health, Outcomes, Physical Therapy, Prehabilitation, Press Release, Rehabilitation Business

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Get Your Engines Ready for CSM 2015 Indianapolis

CSM2015Marquee_960x222I’m not a physical therapist, healthcare professional, nor do I play one on TV, but I can’t wait for my third American Physical Therapy Association conference. While I’ll be spending most of my time at our booth (2114 if you’re looking) on the exhibition floor, I’ve managed to find a shortlist of 46 sessions I’d like to attend, and this is from someone who is not looking for clinical practice sessions.

Screen Shot 2015-01-27 at 11.10.50 AMNext week over 10,000 physical therapists, doctors of physical therapy, PhD researchers, and students will converge on Indianapolis (yes, in winter) for the annual American Physical Therapy Association Combined Sections Meeting. The Combined Sections Meeting or CSM as it’s often referred to (we do love our acronyms in healthcare) combines all the interest groups and professional associations within the association including private practice, oncology, neurology, homecare, acute care, orthopedics, sports medicine, and students and academic researchers. The result is a diversity of topics that represent the major trends in healthcare today including: concussions in youth sports; the impact of the Affordable Care Act on practice; high-intensity interval training; caring for an aging population; managing chronic disease; preventative medicine, health and wellness; healthcare technology; and the psychology of pain.

See for yourself in a selection of some of the 46 sessions we’ve flagged:

Sports Concussions in Youth: The Role of PT for a Surging Population

Transforming Physical Therapy Practice for Healthcare Reform

Exercise Prescription for the Older Adult With Multiple Chronic Conditions

Getting Patients Into Cardiac Rehab and Other Wellness Programs and Keeping Them Exercising After Rehab

Google Glass in Physical Therapy Education and Clinical Practice

High-Intensity Interval Training: Rehab Considerations for Health and Cardiovascular Risk

Practice Issues Forum: Does Medicare Really Cover Maintenance Therapy?

I Have Arthritis. Is My Running Career Over? Evidence-Based Management of the Runner With Osteoarthritis

Called to Care: Integration of Positive Psychology

Integrating Physical Therapy in Emerging Health Care Models

Virtual Reality and Serious Game-Based Rehabilitation for Injured Service Members

Of course, our most anticipated session will be “Use of Mobile Health Technology to Facilitate Long-Term Engagement in Exercise in Persons with Chronic Neurological Conditions” where Dr. Terry Ellis Director of the Center for Neurorehabilitation and a Associate Professor at Boston University will be presenting the results of a study where they used Wellpepper and Fitbit to improve adherence to home exercise programs for people with Parkinson’s disease. For a sneak preview of what she will present, see this article from Inside Sargent Magazine.

As in 2013 and 2014, we will do our best to blog about as many sessions as we can so that if you can’t make it to the conference this year, you can still experience some of the flavor.

If you’re going to CSM, what sessions are you looking forward to most?

Posted in: Adherence, Aging, Exercise Physiology, Health Regulations, Physical Therapy, Prehabilitation, Rehabilitation Business, Sports Medicine

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Pre-habilitation: Effective Preventative Medicine for Rehabilitation

If an apple a day keeps the doctor away, what can a knee bend do? The American Academy of Orthopedic Surgeons recently answered this question with the results of a new study of the impact of physical therapy on surgical outcomes for hip replacement. The answer: “Prehabilitation reduces the need for perioperative care by 30%.” Amazing results, especially considering that total joint replacements will increase by 400% by 2030 according to the academy. Considering that post-acute care costs are the fastest rising and most variable, an investment in pre-habilitation can pay off huge dividends. Based on data from the AMA and CDC we’ve estimated that a 10% decrease in post-acute care costs could help realize $4.3B in savings over this same period. The AAOS study showed that patients who received pre-habilitation saw a decline in up to $1,215 per patient in perioperative care, due to a decrease in costs for skilled nursing and home care. Given that total joint replacement costs vary from a low of $6000 to a high of $30,000, providing pre-habilitation and a means for patients to be adherent is a very easy way to get to this 10% decrease. If you’d like more information on how we calculated these costs contact us.

The theme of pre-habilitation was also prevalent at the recent ACRM annual congress in Toronto, consider it the preventative health of rehabilitation, which literally means the act of restoring something to it’s original state. If you can decrease the amount of damage done in the first place, restoring it to the original state becomes easier or at least if you don’t see complete recovery, you see better outcomes. Two sessions at the conference explored this concept where there was known risk of damage: one focused on pre-habilitation for cancer patients that would need to undergo surgery, and the other a focused study on adults with lower back pain who were at risk of declining.

Effect of Diet on Outcomes for Cancer Surgery PatientsOne session focused on pre-habilitation for patients undergoing cancer surgery, and was striking both for the outcomes and for the collaborative and interdisciplinary team. The session, “Improving Outcomes With Multimodal Prehabilitation in Surgical Cancer Patients” was notable both for the outcomes presented and for the strength of the collaborative and inter-disciplinary team that included led by Dr. Carli from McGill University that included physicians, dieticians, and physical therapists. The team presented the results of their randomized clinical study that showed that a prehab program including strength training, exercise, diet, and nutrition counseling could decrease hospital stays by ½ a day and that the strength training helped patients compensate for surgery-related weakness perioperatively.

Patients were given either just nutrition counseling or nutrition counseling plus a whey supplement or a placebo. Patients with nutrition counseling sustained their levels in the 6 minute walk test before and after surgery. Patients with both nutrition counseling and the whey supplement improved their distances in the 6-minute walk test after surgery.

Together the strength training, nutritional counseling, and protein supplements improved patient surgical outcomes. Ideally, nutrition counseling was recommended to begin at cancer diagnosis, but at the very least pre-surgery. This study proved that there are modifiable patient risk factors before surgery that can improve outcomes.

Exercise for Lower Back Pain in SeniorsA second study outlined by Dr. Gregory Hicks from the University of Delaware  in the session “Novel Ways to Improve Mobility and Physical Function in Older Adults: A Targeted Intervention Approach”, looked at whether stabilizing trunk exercises could prevent decline in high-risk seniors. Interestingly, the presenter X pointed out, any studies involving trunk muscle stabilization had purposely excluded adults over 65 so there was no evidence of the impact. In this study, the control group was given the usual care condition of heat, ultrasound, massage, and stretching. The second group was given trunk muscle training and Neuromuscular Electromagnetic Stimulation. Unfortunately, the second group had low adherence to their programs, and were not happy to miss out on heat and massage. This probably says more about the need for patient education and engagement than anything. In many studies strengthening exercises have proven helpful, but not if you can’t get patients to do them. Regardless, patients in the trunk muscle group had a 17% higher rating on the top 3 functional limitations that they had reported as being most important to them at the outset of the study and their exercise self-efficacy was expected to continue to improve over time.

While the results were positive, Hicks outlined some of the limitations of the study, including the exercise adherence but also pointed out that patients had different outcomes based on the physical therapist delivering the treatment and based on how closely they identified with the pre-defined outcome measures that were used in the standard tools (OSWESTRY). This brings up an interesting point about how to deliver care.

While research has proven that proactive activities, like improving diet or exercise, can improve outcomes, patients, and by that I mean humans, are subject to human nature, which is not always doing what’s in our own best interest.

There are ways to change this within the care delivery system to help patients adhere to their treatment plans:

  • Making sure patients understand what they are being asked to do
  • Making it easy to follow instructions
  • Fostering a positive relationship between patient and healthcare provider

Adapted from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/pdf/tcrm0103-189.pdf

These principles are fundamental to our Wellpepper patient engagement solutions and help us get over 70% patient engagement. We’re pretty excited to see the opportunities for these types of solutions to be used in pre-habilitation scenarios that are proven to improve outcomes.

Posted in: Prehabilitation

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