Visiting Nurse Service of New York

Looking forward to 2021 and America’s continued response to the coronavirus pandemic, home health care continues to play a critical role in public health. Ongoing innovations in care delivery, such as telehealth monitoring, clinical support software, and data analytics are the centerpiece for progress.

The COVID-19 pandemic is demonstrating the important role that telemedicine can play in health care, keeping vulnerable people closely connected to care from the safety and comfort of their homes. With new technology, clinicians can remotely monitor a patient’s weight, blood pressure, temperature, heart rate, and blood glucose levels, and even listen to their respiration and heartbeat. This is urgent care being done right in the home—without sending someone to an urgent care facility.

At the Visiting Nurse Service of New York, where I work, we’ve developed a new care management organization (CMO) called VNSNYCare360° Solutions to help insurance companies manage the health of their high-need members in a home setting shows how technology and skilled clinical care are saving lives in this extended time of social distancing during the pandemic.

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.

Because it follows clients remotely, for the most part, using only targeted in-person interventions, it is 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. 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. We use these visits as a form of urgent care—for example, when our telehealth monitoring indicates that something’s wrong. 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.

Using search engine technology, 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 in NYC this past spring, 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 a nurse practitioner evaluated the individual via telemedicine, and if needed, dispatched a community paramedic to their home to treat in person, and to alert the client’s physician and arrange a COVID-19 test. Other COVID-19 patients were admitted into Care360° Solutions following their discharge from the hospital to assist with their recovery. These cases ranged 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.

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. This innovative model blending technology with skilled care management has worked extremely well and proven itself without a doubt during the pandemic. The good news is that when we’re finally on the other side of this COVID-19 public health crisis, the new medtech systems and interventions that became so essential at its peak will have given us an amazing new toolbox for connecting with and caring for homebound patients in need of critical care.