WELLBE PLATFORM FOR PATIENT ENGAGEMENTWith an aging population and increase in chronic conditions including obesity, the demand for hip and knee operation is increasing dramatically. A study in the Journal of Bone & Joint Surgery estimates by 2030 “demand for total hip arthroplasties to grow by 174% to 572,000 and demand for primary total knee arthroplasties by 673% to 3.48 million procedures”.
Responding to this strong demand and high procedure expense, CMS launched the Comprehensive Care for Joint Replacement (CJR) payment bundle April 1st, focusing on cost and quality over a 90-day period beginning with the hospital admission. The CMS CJR Payment bundle is initially for about 800 selected hospitals across the country.
Although Virtua, one of New Jersey’s largest health systems with hospitals, surgical and rehabilitation centers, is voluntarily participating in the BPCI payment bundle, their investment in the orthopedic patient experience at their Joint Replacement Institute (JRI) started long before the payment model changes.
Virtua Health’s Orthopedic Patient Care Journey
Back in 2000, Virtua adopted the Six Sigma methodology and launched the STAR initiative to deliver an "outstanding patient experience”.
“When we look at how we can change and improve a process, we focus on the patient and understand what they need, not what we think they need,” explains Kate Gillespie, AVP of Virtua’s Orthopedic Service Line.
With a commitment to enhancing the orthopedic (hip, knee) surgery experience, Virtua listened to patients discuss their challenges and needs. Through focus group research (Spring 2015), Virtua learned:
• Orthopedic patients need a lot of information to get ready for their surgery but are overwhelmed when inundated with too much at one time.
• Patients place a high value on their doctor’s suggestions to achieve best results.
• Patients that are prepared are more confident and will participate in the process leading to improved outcomes.
“We learned that as patients prepared for surgery, they were asked many of the same questions by different members of our care team,” said Gillespie. “We needed to improve the patient experience and ensure the consistency of information shared along the patient journey. We also wanted to engage the family to support the patient before and after surgery and decided to require that each patient has a ‘care partner’.”
The Virtua JRI team looked for technology to continuously engage patients and families, from on-boarding before surgery, to educating and guiding them from discharge through recovery. The tool needed to be actionable, collecting essential information from the patient (i.e. concerns, pain levels) and informing Nurse Navigators when patients fall off track.
Virtua JRI chose to implement a Connected CarePath for Total Joint Replacement from Wellbe, a solution provider in Madison, Wisconsin. Working closely with Wellbe, Virtua customized their CarePath with their own health history and sleep apnea surveys, scheduling and care plan content (delivered via “CareCards”).
PATIENT CREATES CARECIRCLE ON WELLBEDuring the initial visit to the surgeon’s office, patient Patty is given information about Wellbe, a personalized care plan for her pre-and post-surgical journey. She signs up with the Nurse Navigator and receives a Welcome email. Patty shares this information and invites her family ‘Care Partner’ to join her CareCircle to access her resources.
Pre- Surgery: Beginning 4-6 weeks prior to surgery, Patty views a care plan with a personalized set of “CareCards” explaining the operation and process to successfully prepare including preadmissions testing and health clearance forms. She receives a “CareCard” introduction to her Nurse Navigator. Every CareCard is delivered “from” her doctor or another member of her care team to motivate compliance. Patty receives reminder messages and checklist items leading up to the surgery and can refer to any completed CareCards in the “library” such as “How to prepare for the day of surgery.”
“Our patients really like the library feature. Before we launched the Wellbe platform, patients were given a Joint Replacement booklet. Now patients and families have all the surgery information at their fingertips. Patients traveling to our Institute can prepare for their surgery by viewing videos instead of attending an in-person class,” adds Gillespie.
Post –Surgery: Within Wellbe, Patty views discharge information such as symptoms to watch for and completes surveys so that her care team can manage her recovery. Patty’s Nurse Navigator monitors her “Progress Report” with required actions and contacts her with any concerns.
“We believe this post-surgery engagement is important to prevent readmissions by ensuring the patient understands how to take medications, manage pain and follow outpatient physical therapy,” Gillespie shares.
Patient Engagement Results
Since launching the Wellbe platform in December 2015, Virtua JRI has enrolled 700 patients. Patients span every socio-economic level and range from 40- 90 years old, with the majority in their 70s.
“We are signing up 86% of our surgery patients which is much higher than we expected. The remaining patients either did not have an email address or didn’t have a friend or family member to help them,” explains Gillespie.
Virtua is evaluating success based on a few factors. Through a Wellbe survey, they are measuring how prepared the patient feels using the platform. With Wellbe reporting, Virtua is also measuring the patient’s engagement and compliance with required CareCards.
Patients have shared positive comments about their experience using the tool - “grateful for the support received”. Nurse Navigators have also provided feedback - the Wellbe platform has helped them be more efficient in their patient care. Through “one tool”, nurses are able to “organize and track patient progress and communicate with the rest of the team” (i.e. physician office, pre-admission testing department).
Virtua has received suggested enhancements such as “defining an end time for a patient to be on the platform” and removing the medication form since patients “already gave the medication list to my surgeon.” Virtua has also added a link to the “Virtua Orthopedic Endowment”, giving patients an opportunity to give back.
Virtua initially launched the Wellbe platform without tying it into their Electronic Medical Record. “We are considering integrating Wellbe into our EMR so that the patient’s surgical chart will be easily available on one site for our Nurse Navigator.”
“Wellbe provides a key to patient engagement by keeping them engaged and participating towards a successful surgical journey. Virtua is determining where we can use this tool in other service lines such as Spine, Bariatric, Oncology and Maternity, which are all education-intensive clinical episodes.”
“This program aligns with our vision in keeping our focus on the patient /family experience, and provides us with an opportunities to participate in their surgical journey”, Gillespie concludes.