Background: Reduction of 30-day hospital readmissions has been challenging to all hospitals in the paradigm shift from volume-based to value-based new healthcare in the US. It is even more difficult to reduce all unnecessary hospital admissions beyond readmissions due to intensive clinical care needs outside the hospital. Although telemedicine has been proposed as a new approach to reduce hospital readmissions, the current technology and clinical support are insufficient to provide care for high risk populations.
Methods: In addition to Conventional Care (CC: hospital/clinic), an Interreality Care (IRC) service was created for patients outside of the hospital with integration of: 1. CC; 2. On-Site Care using mid-level providers and testing (vitals, labs, imaging) at patients' residency; and 3. On-Line Care using 24/7 monitoring and specialty intervention (cardiology and pulmonology). A group of 112 Medicare patients with multiple hospitalizations enrolled in the service over 16 months. The duration of each hospitalization (General wards and ICU) and costs for the hospital stays for healthcare were compared between CC and IRC.
Results: The average number of hospitalizations per patient was 4.2 in CC and 0.8 in IRC. The average healthcare cost per patient was $59,980 for CC and $11,850 for IRC. The overall net cost savings between CC and IRC was $4.9M for healthcare.
Conclusion: To our knowledge, this is the first study to test the model of reduction of both unnecessary hospital admissions and readmissions using the integration of IRC. The preliminary results demonstrated that IRC with integrated Hospital, Clinic, On-Site, and On-Line care for patients at home can improve both quality and the cost of care, not only for 30-day readmissions, but for all healthcare admissions. Further study is warranted to examine implementation and scalability of the new model in a variety of healthcare settings, such as ACO, HMO and public health worldwide.