Meadville Medical Center: Novel Deployment of MedMinder for High-Risk Patients

January 14, 2014

 

Meadville Medical Center chose MedMinder pill dispenser to help them reduce ER visits and preventable readmissions, and have succeeded in meeting these goals and many others in the time they have deployed MedMinder.

Meadville’s care coordination team deploys MedMinder in three novel ways: as one tool in reducing preventable readmissions; as a device to help individuals of all ages manage chronic conditions and polypharmacy issues; and as a way to encourage and enhance intergenerational relationships, where student coaches work with older adults on medication adherence.

Meadville chose MedMinder because it looked easy-to-use and because of its ability to remotely track and report information, qualities they could not find with any other product. If they see a problem arising for a patient, they can look back at the data MedMinder generates, get in touch with the patient if need be, and work with that person to prevent problems before serious complications arise. As for compliance, Meadville Medical Center has seen compliance levels rise to nearly 100% — some 55 – 60% higher than they were prior to using MedMinder as part of its care coordination efforts.

 

Aligning Quality Care and Preventable Readmissions via Care Coordination

With the advent of the Patient Protection and Affordable Care Act (PPACA or ACA), health care entities have seen an increase in accountability. The ACA, also called “Obamacare,” and “health care reform,” focuses on changing how services are paid for by the Centers for Medicare and Medicaid Services (CMS) by increasingly rewarding better outcomes (quality care) instead of volume (quantity of care). One of the key measurements for reimbursement rates for hospitals is its readmission rate, especially within the first 30 days of discharge. The lower the readmission rate, the higher the hospital’s marks on quality care.

Meadville Medical Center’s (MMC) Mission and Vision align perfectly with ACA and CMS initiatives; MMC’s Core Objectives focus on: Service, People, Quality and Safety, Innovation and Growth, and Fiscal Responsibilities. As one means of honoring these Core Objectives, MMC created the Community Care Network – to provide care coordination for patients at high risk of readmissions. The Community Care Network provides a multidisciplinary, team-based approach to care coordination that includes managing chronic conditions, and providing services to help people maintain optimal physical, social, and emotional health and wellness. The team includes physicians, registered nurses, dietitians, social workers, counselors and health coaches; all services are provided at no cost to the patient or family.

At MMC, they use MedMinder in three novel ways: As one tool in reducing preventable readmissions; as a device to help individuals of all ages manage chronic conditions and polypharmacy issues (multiple medications); and as a way to encourage and enhance intergenerational relationships, where “student coaches” work with older adults on medication adherence.

Ms. Meuré, the program’s Director, and Dr. Barry Bittman, Chief Innovation Officer of Meadville Medical Center, have a great deal of experience in tracking compliance and adherence, and make constant use of the charting available from MedMinder to keep an eye on patient status; this enables them to catch abnormalities regarding medication before they become a larger problem.

Reducing Preventable Hospital Readmissions

As one essential key to reducing preventable readmissions is medication adherence and compliance, MMC’s Community Care Network chose MedMinder to help them reduce ER visits and preventable readmissions; taking the right medications at the right time is a keystone of health and wellness.

When the care coordination teams at MMC saw compliance rates running on average around 40%, they knew that level of adherence would very soon translate to complications – that are avoidable and preventable — for their patients. They chose MedMinder because it looked so easy to use – it looks like a large pill box — and because of its ability to remotely track and report information, qualities they could not find with any other product. And they have been deploying MedMinder in novel ways ever since 2012. MedMinder is especially useful in community-based settings, which is the bailiwick of Tracy Meuré, RN, Director of Meadville Medical Center’s Community Care Network. “If an issue arises with a patient, we can look back at the data and see what’s going on,” says Ms. Meuré. “The data from MedMinder gives us a chance to auto- correct the problem and intervene if there is an issue. If we can’t correct the problem and we see the person is starting to decline, we give them a call,” says Ms. Meuré.

“That way, we can often work closely with the individual before serious complications arise.”

With the use of MedMinder, Ms. Meuré has seen compliance levels rise to 95 -100%, some 55 – 60% higher than they were prior to using MedMinder as part of her team’s care coordination tools.

“Jackson,” a A 76 year old member of the Network, had been readmitted multiple times to the hospital, all within 30 days of discharge. Since MedMinder was deployed for Jackson, he has not had any additional readmissions. Ms. Meuré credits both MedMinder, along with the full care coordination efforts of her team in supporting the health and well-being of patients like Jackson.

In addition to reduced hospital readmissions, Ms. Meuré notes, The Network has also seen an improvement in various clinical metrics such as lowered blood pressure, lowered A1Cs (blood tests that show glucose levels over time); and overall lowered scores on risk profiles for patients using MedMinder.

Not surprisingly, given these outcomes of improved health for this populations, MMC’s Community Care Network has also achieved substantial reductions in overall costs in caring for these patients.

 

Helping Patients Live Autonomously: MedMinder as a Way to Manage Chronic Conditions and Polypharmacy Issues

MMC’s Community Care Network makes use of MedMinder’s smart technology for patients managing one or more chronic conditions, often requiring multiple medications for their treatment. In instances where patients have polypharmacy issues (the concurrent use of multiple medications), MedMinder has proven to be a tremendous help in managing the often complex web of medications and timing involved in taking them. MedMinder’s tracking and reporting are especially useful here as clinicians need to carefully monitor potential adverse events.

MMC also uses MedMinder for patients who show early signs of dementia. “The individuals can often manage their medications, but need reminding about when to take them,” says Ms. Meuré. “We are looking to keep individuals as healthy as possible, and prevent avoidable readmissions,” she says. Although no specific data is available, results have been excellent in the MMC care coordination program where MedMinder is deployed. “We work with psychiatrists and coordinate the use of medications to address emotional or mental health issues,” says Ms. Meuré, “to ensure the best outcomes for our patients and make sure there are no contraindications for co-existing chronic conditions.”

The MMC Community Care Network also deploys MedMinder as a training tool. “For patients who need assistance in remembering to take their medications, we start them on MedMinder with a goal to transition them off the device, so they can be fully autonomous if that is appropriate,” says Ms. Meuré. “We use MedMinder to help them get on a regular schedule, which in some cases they can then maintain without the device,” says Ms. Meuré; the device is then passed along to the next person for their use.

While the majority of patients in MMC’s Community Care Network are adults, they also work with children with diabetes, a chronic condition, who need to remember to take their medication on time. “Kids love electronics,” says Ms. Meuré, and they enjoy using MedMinder, with its interactive features, its flashing lights and audible sounds, to remind them.

Chief Innovation Officer: “Work with Students as Health Coaches”

Dr. Barry Bittman, Chief Innovation Officer at MMMC, conceived of and began a program of hiring students from nearby Allegheny College as “health coaches” for individual patients in the care coordination program – the sickest and most frail patients. Student health coaches visit the patients where they live, on a one-to-one basis, and help encourage them to reach the goals they have set for themselves in their care plan. Dr. Bittman’s vision for the program was that the student health coaches could function as they eyes and ears of the care coordination team, enriching both the patient and coaches, and playing a role in preventing avoidable readmissions.

“As medication adherence and compliance are essential to good health outcomes,” notes Ms. Meuré, RN, “the health coaches will stay with patients as they fill their MedMinder. While the student coaches may not touch the medications, they watch carefully to ensure that the patient neither misses a dosage slot, nor places too many in one dispenser,” she adds. Ms. Meuré relates that the program has been a great success. The students, who interact with the patients one-on-one on an ongoing basis, can often spot changes in the individual’s usual appearance or behavior and alert the other members of the Community Care Network team. The students, many of whom are thinking about careers in healthcare, get college credit for their work, and a sense of having helped someone in their community. “In situations when a patient doesn’t need a nurse, having the health coaches there has been extremely beneficial for the patients, while giving these students a chance to get some life experience,” says Ms. Meuré.

With a service area covering 75,000 individuals in Crawford County as well as an additional 150,000 persons from northwestern Pennsylvania, the Meadville Medical Center has annual inpatient admissions of approximately 7,617 and more than 215,742 outpatient visits. The Emergency Department alone reports 37,690 visits yearly and approximately 650 babies are born here each year.

MedMinder is an automated, wireless, dispensing, cuing and monitoring system designed to improve patient compliance and medication adherence, as well as increase patient independence and overall health. 

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