Overview
Midland Care Deploys Telehealth to PACE Patients
Midland Care offers integrated community care to address the social, physical, and spiritual needs of the aging Kansas population, assisting seniors at home to live more independent lives.
In 2007, Midland launched the nation’s 37th Program of All-inclusive Care for the Elderly (PACE), providing over 250 patients per year with preventative care, physical therapy, speech therapy, medication management, and a range of other services to ensure their comfort and health.
Challenge
PACE patients are among the most high-risk for hospitalization, with an average of seven medical conditions per patient. Due to their heightened risk level, PACE patients require numerous visits with healthcare providers each week.
A majority of Midland’s high-risk, PACE patients live over an hour from their care facilities. These intensive care requirements, combined with the rural landscape of Northeast Kansas, place a strain on healthcare resources. These challenges prompted Midland to implement a telehealth program aimed at reducing visits, lessening windshield time, and facilitating the expansion of population health programs.
Solution
In 2018, Midland launched a telehealth program in partnership with HRS to expand access to healthcare services and increase touches between PACE patients and their clinicians. Midland’s team, utilizing telehealth and remote monitoring, continuously tracks patients’ health status, collecting vital signs, symptom surveys, and tracking medication adherence – all critical elements to prevent hospitalizations.
The nursing team at Midland monitors patient data for exacerbations or sudden changes and perform virtual visits to further evaluate the patient or to check on the patient if their survey responses indicate they are feeling lonely or isolated. Midland’s team leverages virtual visits to augment in-person visits, allowing them to offer services from multiple providers including social workers, case managers, and physical and occupational therapists, while the patient remains in the comfort of their home. The use of virtual visits helps Midland reduce windshield time and improve clinical workflow.
Telehealth helps provide Midland’s PACE patients with confidence and involvement in their care. Even when isolated in their home, they know that our care is just a touch away.Stephanie Meyers, RN
Telehealth Nurse
Clinical Interventions with PACE Patients Ranging from Voice Calls and Virtual Visits to SN Visits
Average Additional Touches per Patient
Results
In one year, Midland’s team performed over 170 clinical interventions with PACE patients ranging from voice calls and virtual visits to SN visits. These additional interventions prevented further decline in patient health and reduced unnecessary hospitalizations.
Via telehealth, Midland’s team averaged an additional 16.96 touches per patient during each patient’s time in the telehealth program. These additional touches and interventions are imperative to PACE patients who often live with multiple physical and mental health conditions as they enable patients to receive essential care services from Midland without the burden and stress of travel