Since its launch in the spring of 2019, VNSNY’s care management organization (CMO), VNSNY Care360° Solutions, has proven its ability to help insurers manage the health of their high-need members in a home setting. Through a blend of telephonic and video-conference check-ins by specialized nurses, remote vital sign monitoring, and nurse practitioners and paramedics who can quickly be sent to a client’s residence as needed, Care360° Solutions has shown it can keep people with multiple chronic conditions safe and out of the hospital in highly cost-effective fashion.
This March, as COVID-19 spread across the New York City region, the model revealed another important advantage: Because Care360° Solutions follows clients remotely for the most part, using only targeted in-person interventions, it’s a perfect fit for a pandemic environment. Non-COVID individuals—who comprised the bulk of the CMO’s 4,500-plus client base this spring—could still receive close attention while avoiding the infection risk associated with trips to the doctor or unnecessary visits to emergency rooms or urgent care centers. At the same time, clients recovering from COVID-19 could be monitored at home with minimal exposure risk to care providers.
“Among our long-term clients, who we follow for 18 months at a time, the use of telehealth monitoring tripled during the pandemic,” says Rose Madden-Baer, VNSNY’s Senior Vice President for Population Health, who heads up Care360° Solutions. “Many of our clients wanted to avoid visiting their doctor because of coronavirus fears, so we managed their health by remotely monitoring their blood oxygenation levels, heart and respiratory rate, blood pressure, and other key variables.”
The CMO’s virtual visits, in which nurses typically confer with clients by video conferencing, also ramped up, says VNSNY’s Joan Cassano, Vice President for Clinical Operations Improvement and Care Coordination, who helps manage Care360° Solutions’ clinical operations. “We use these visits as a form of urgent care—for example, when our telehealth monitoring indicates that something’s wrong,” she notes. “Through video consults with our clinical staff, clients can often resolve problems without going to an actual emergency room or urgent care center and risking exposure to COVID-19.”
Care360° Solutions’ care management teams also helped clients access food pantries and medication refills during the pandemic’s peak, while the unit’s clinical social workers screened clients for depression and anxiety related to social isolation and connected them with appropriate services.
As the pandemic progressed, Care360° Solutions took on a growing number of COVID-19 cases as well, reaching a census of more than 700 COVID-19-positive or presumptive positive individuals at one point. Some of these were long-term clients who developed COVID-19–like symptoms, in which case the unit dispatched a community paramedic to their home to assess the symptoms in person, then alerted the client’s physician and helped arrange a COVID-19 test if needed.
Other COVID-19 patients were admitted into Care360° Solutions following their discharge from the hospital to assist with their recovery. These cases “ran the gamut,” says Madden-Baer, from mild cases that were treatable outside the hospital, to more severe cases where the client had been hospitalized and was now recuperating at home. “In every case, we closely monitored the client’s symptoms through virtual visits and telehealth to watch for exacerbations, based on the clinical protocols VNSNY has put in place,” adds Madden-Baer.
Through this combination of approaches, the vast majority of clients receiving care management services from Care360° Solutions have been able to ride out the pandemic’s peak at home with no serious issues and with minimal risk of exposure to the coronavirus. “We have a lot of tools that we can use for monitoring people’s health from afar,” says Cassano, “and with everyone locked down due to COVID-19 over the past few months, this toolbox has worked extremely well.”