The Florida Hospitals in Volusia and Flagler counties are taking a unique approach to helping patients manage their chronic diseases, helping them avoid unnecessary hospital admissions. With a focus on the top 5 percent of “high utilizers” that use nearly 50 percent of healthcare resources, Florida Hospital Community Care is an initiative that aims to fill in health care gaps, such as access to primary care physicians and specialists, managing multiple medications, and more. The program takes a collaborative, interdisciplinary approach to coordinating care for patients outside of the hospital, in the community, and more importantly, in their normal home environment. The goal is to improve care, outcomes and the patient experience, thus reducing unnecessary hospital admissions and emergency room visits.
Irene de Jesus, JD, RN, MBA, Director of the Florida Hospital Community Care Program in Volusia and Flagler counties, is overseeing the teams of clinicians in this effort. And they’re doing a great job. One essential tool they use is MedMinder, an automated, wireless medication dispensing, cuing and monitoring system designed to improve patient compliance and medication adherence, as well as increase patient independence. For one patient who has used MedMinder for a year, the hospital has seen a reduction in annual costs of $16,535. Moreover, the patient’s “Vulnerability” score improved by 73%, and she reported a satisfaction with the program at 5/5.
Overview
In 2013, the Florida Hospital East Florida Region – consisting of Florida Hospital DeLand, Florida Hospital Fish Memorial, Florida Hospital Flagler, Florida Hospital Memorial Medical Center, and Florida Hospital Oceanside – began examining the skyrocketing costs of inpatient care and saw a pattern: certain individuals with multiple chronic illnesses, who required numerous prescription medications to manage these illnesses, were returning to the hospital for readmission at alarming rates. For example, in the 12 months prior to enrolling in Florida Hospital Community Care, four patients in this high utilizer group collectively had more than 40 encounters with the hospital, accounting for more than $175,000 in direct costs to the hospital. In an effort to assist patients like this, the hospital developed a system of coordinated care for patients in their homes, which includes a team of nurses, licensed clinical social workers (LCSWs), and registered dietitians to coordinate their post-‐discharge care, all free of charge to the patient.
According to de Jesus, after a year of care coordination interventions, including the use of MedMinder, the direct costs to the hospital went down by $119,000, to $58,000. The total number of encounters for all four patients dropped to a total of 32, a reduction of 23.8%, including emergency department and inpatients visits, as well as observation costs.
For those patients using MedMinder, medication compliance and adherence soared to an unprecedented 84%.
Irene de Jesus, JD, RN, MBA
Director of the Florida Hospital Community Care Program
From Frequent Readmissions and Hopelessness to Independence and Wellness
When Hannah Boldrey, RN, Florida Hospital Community Care nurse manager in DeLand, went to visit her patient, an 84-‐year-‐old woman living at home, she quickly saw how hopeless the patient was feeling about her life. In fact, the patient seemed to have given up on taking care of herself. In the past year, she had six hospital admissions, due to a worsening of her chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and atrial fibrillation. When Boldrey talked to her, she discovered that she was overwhelmed with the number of medications she was supposed to take, and therefore had just stopped taking them. Even though the patient lives in an apartment that contracts with a nursing service to give medications to residents who sign up for the service, she found the $400 per month prohibitive, and thought she could manage her medications by herself. She couldn’t. Without assistance with taking her medications, she ended up in the hospital every other month.
“She was very disgruntled,” says Boldrey. “There were days where she would forget to take her medications, or couldn’t remember whether or not she had taken them. So she would just throw her hands up in disgust, and walk away.”
“I brought out the MedMinder and asked her if she would be interested in having the medicine box in her home. She was open to it, so we set it up together, and I worked with her so she could eventually be in charge of all her refills,” Boldrey added.
Boldrey explained to the patient how the MedMinder works – that at certain times, according to when she needed to take a specific medication, the box would begin to flash to remind her to take her medications. And there could even be a personalized message to her, if she wanted. This way, she knew exactly what to expect.
It worked like a charm.
“Once she started, she loved it,” said Boldrey. “She keeps telling me how it keeps her on her toes!”
Most importantly, because of MedMinder, the patient started keeping her doctor appointments, which led to increased adherence to her medications, Boldrey said. And equally important, once the patient learned how to place all her medications in the right slots, she could see immediately when she needed to request refills. “Before she started using MedMinder, she would wait until she got down to her last pill before even thinking of reordering, so she was constantly running out of her prescriptions,” added Boldrey. “She made a tremendous turnaround with MedMinder.”
The result? In the six months since the patient began using MedMinder, she has not had a single encounter of any kind with the hospital system. In fact, she even was able to stop using her nebulizer for breathing, as her respiratory symptoms are so well controlled. Moreover, “She loves that she’s in control now,” says Boldrey.
According De Jesus, the Florida Hospital sees three main reasons for these frequent readmissions: missed medications, missed communication, and missed appointments. MedMinder has served as an extraordinary tool to drastically reduce missed medications in an unprecedented way.
All in the Family: Reducing Family Stress and Narcotic Abuse
Another patient in the program, had been battling depression, pain and narcotic abuse ever since a debilitating car accident in 2012 left her with chronic, relentless pain in her neck, right arm and leg. She also has diabetes and is prone to seizures. Since she was so dependent on the medication for pain control, and aware that she might harm herself, she asked her brother and her sister to be in charge of giving her the medication. But soon, everyone was stressed and fighting – the patient was constantly angry and verbally abusive, insisting that her sister and brother were withholding medication from her that she needed. Her brother and sister no longer wanted the responsibility for her medication, but knew that she needed someone to supervise her medication program, as she even admitted she was powerless over the pull of the narcotics, especially as she was in constant pain.
Enter Melinda Marino, Florida Hospital Community Care counselor and licensed clinical social worker.
“The patient’s problem with pain medication was putting tremendous stress on the family. Her brother and sister didn’t want to confront her, but neither did they want the burden of controlling her access to the narcotics. Her brother complained he was in danger of losing his job, since she took so much of his time and attention. Her sister said her husband was tired of hearing about her from his wife, and was angry and sullen. We provided the patient with a locked MedMinder,” said Marino, which immediately put an end to the family stress and the interplay of denial and addiction.
We set up a locked MedMinder with all of her psychiatric medications and her prescription pain pills. We sat down with her to go over the specific times and pills she would take and showed her how her MedMinder would indicate when to take her pills, and would prevent her from taking too many at once,” said Marino.
The change has been lifesaving for the patient. “She has undergone a tremendous transformation in her functional status,” says Marino. “Now she is out and about during the day, going to a friend’s house to help out, and enjoy the friend’s company. Before she would just pass out, and take long naps; she had no social life at all.”
“Now that her medicines are dosed the way they’re supposed to be, she doesn’t sleep during the day; she goes to lunch with her husband, and she is able to have a real life, which is a tremendous difference for her,” she adds.
Empowering Patients: Using MedMinder to Increase Independence, Medication Adherence, and Good Outcomes for a patient Requiring a Kidney Transplant
Valerie Smith, Florida Hospital Community Care registered nurse at Florida Hospital Memorial Medical Center in Daytona Beach, was able to bring life-‐giving care to a patient with end stage renal disease due to hereditary polycystic kidney disease. In order to be eligible to receive a kidney transplant, this particular patient had to demonstrate that she was healthy enough to be an ideal candidate and was not admitted to the hospital for a full six months. Smith knew that by providing the patient with a MedMinder, she was not only making it possible for her to receive the kidney, but she was also setting her up for success after the transplant, when medication compliance could mean the difference between life and death.
“She is loving every minute of using the MedMinder,” said Smith. “She took it with her to her dialysis and showed everyone at the center how wonderful it is. They all asked her how they could get one too.”
“The patient’s goal is to receive the transplant and then make sure she is successful with managing her post-‐transplant medication,” said Smith, “It’s an essential tool for her.”
The patient has used MedMinder as a bargaining chip with her surgeon, proving that she can maintain her medication schedule ahead of the transplant, as surgeons will not transplant organs into people who don’t appear to be compliant with medications, as the likelihood of organ rejection is too high, and live organs are far too precious a resource, Smith added.
“I have seen a giant shift in my patient,” says Smith. “For her, the MedMinder pill box is empowering her to keep a good schedule of taking her medications. Just having that MedMinder as a tool has encouraged her to make other lifestyle changes to become a better transplant candidate.”
About Florida Hospital Volusia/Flagler
Florida Hospital Volusia/Flagler is a member of Adventist Health System, a faith-‐based health care organization with 45 hospital campuses and nearly 8,300 licensed beds in 10 states. With five hospitals in Volusia and Flagler counties, Florida Hospital is the largest hospital system in the area, with 788 beds, 4,800 employees, and 650,000 patients every year. Florida Hospital Volusia/Flagler’s mission is to extend the healing ministry of Christ, and in 2014, the hospitals collectively contributed nearly $101 million in benefits to the underprivileged, the community’s overall health and wellness and spiritual needs, and capital improvements.
