Published on November 18, 2020

Health Care Innovation Award’s Evaluation Highlights Successes of Avera eCARE Senior Care

An evaluation of federal Health Care Innovation Award projects has confirmed Avera eCARE® Senior Care shows successes in reducing health care costs for long-term care residents. Out of 38 programs evaluated, Avera was one of only two programs that was able to show reduction in costs of care.

Avera eCARE was awarded $8.8 million over three years through the Center for Medicare and Medicaid Innovation (CMMI) to improve health care and lower costs for residents at long-term care facilities. The three-year project began in September 2014 and ended in August 2017.

Avera eCARE’s Senior Care program primarily served Medicare beneficiaries, providing geriatric telehealth consults, timely access to a ready clinical team and specialists, as well as training to help partnering long-term care facility nursing staff address complex and/or urgent health care needs of both short-stay- and long-stay residents in nursing facilities, especially in isolated rural areas.

Mathematica, a national research company, contracted by the Centers for Medicare & Medicaid Services (CMS) to formally evaluate the program, just recently released its final evaluation of Round 2 of the Health Care Innovation Awards to CMMI, which had awarded nearly $322 million to 38 organizations as three-year cooperative agreements. The awards were funded to implement models designed to improve the quality of care and health and lower the cost of care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Round 2 focused on service delivery models along with the design of corresponding new payment models.

Mathematica confirmed that Avera’s program reduced Medicare spending and emergency department (ED) service use among the long-term care beneficiary subgroup. This includes a 4% reduction in total Medicare expenditures in long-term care residents, or a reduction of $73 per beneficiary per month. For the 11,000 residents served, that represents a cost savings of over $9.6 million per year.

The report also showed a 9% reduction in ED visits for both long-term care and short stay residents.

“We were honored to take part in this CMMI project, and believe the grant dollars went to good use to expand telehealth services to more nursing home residents and support nurses working in the facilities. The study revealing the cost savings, clinical impact and overall effectiveness of telehealth in the senior care setting is of huge importance at this time when skilled nursing facilities are depending on telehealth services,” said Deanna Larson, CEO of Avera eCARE. “Senior Care delivered via telehealth not only saves dollars, it improves the quality of life and health status of residents.”

One common feature that Mathematica noticed among effective programs was use of telehealth and technology to deliver interventions.

At the completion of the three-year award, eCARE Senior Care services had impacted over 11,000 residents – allowing 90% of them, on average, to receive the care they needed in their long-term care facility rather than being transferred immediately after an urgent care encounter.

By eliminating potentially avoidable transfers, reducing emergency department visits and providing timely access to expert care, the cost of care per beneficiary was reduced.

Avera’s Clinical Intelligence estimates an even higher savings of $342 per beneficiary per month. This was due to different methodology and including both long-term and short-stay residents in the calculation.

The award connected 45 participating long-term care facilities with 24/7 access to eCARE Senior Care’s geriatric-trained team and urgent care professionals. This innovative technology – including high-definition, interactive video and sophisticated computer monitoring equipment – didn’t replace, but instead augmented the care provided by local health care teams.

“Prior to receiving the grant dollars, we had a desire to offer long-term care facilities with more than just virtual urgent care. We wanted to support them with a geriatrician and multidisciplinary team 24/7. The award fueled our ability to create and offer that team and services beyond urgent care,” said Josh Hofmeyer, Avera eCARE Senior Care Officer.

Through the award, eCARE Senior Care built a team with specialized training in how to meet the unique needs of long-term care residents. This includes fellowship-trained geriatricians and certified nurse practitioners who work closely with physicians, pharmacists, registered nurses, a licensed social worker and nurse practitioner of psychiatry.

Since the time of this award, eCARE Senior Care has expanded to serve over 175 facilities in 10 states. Over 10,000 residents are living within those facilities on any given day who may interact with the team.

“COVID-19 presented significant challenges to senior living facilities. Virtually all facilities have all gone through periods of limited and restricted visitors to protect residents. Even visiting physicians could put very vulnerable residents at risk. So telehealth was looked to as a very viable solution,” Hofmeyer said. “Avera eCARE Senior Care added numerous sites during this timeframe.”

Benefits of Senior Care are many, including earlier treatment for acute conditions, assistance with medication questions and other concerns, and avoided transfers to clinics, urgent care and emergency departments.

“For an elderly and/or frail resident, a transfer can be extremely stressful and uncomfortable. Our program can avoid that scenario in more than 90% of cases, simply by wheeling telehealth equipment into the room and connecting to the Senior Care team. It also empowers and takes significant burden off nursing home staff who already have a full list of duties to attend to,” Hofmeyer said.

eCARE Senior Care has expanded to also serve assisted living centers, independent living campuses, home health agencies, and has also partnered with payer groups, including accountable care organizations (ACOs), managed care organizations (MCOs) and institutional special needs plans (I-SNPs).

“Avera eCARE Senior Care has proven to be a gold-standard service that improves the quality of life for senior living residents. It gives them ready access to a provider around the clock and ensures their medical needs are met as quickly as possible after an injury or the onset of symptoms. It’s proven to be an invaluable tool during the COVID pandemic and will continue to be an important service in the future. Telehealth is the future of medicine and so we’re proud to be recognized for the cost savings and effectiveness we’ve been able to demonstrate through the CMMI project and beyond,” said Victoria Walker, MD, Senior Care Medical and Clinical Officer.