In a notable leap forward for the management of chronic diseases and overall public health, Sentara Health, a Virginia-based healthcare system, has introduced a pioneering remote patient monitoring and chronic care management program. The program was established in collaboration with HealthSnap, a provider of scalable health metrics solutions. Initially, the initiative will be launched across a network of 12 primary care sites, but it has the potential to be expanded to incorporate 389 providers and service over 85,000 eligible patients.
Sentara Health expects that this initiative will significantly bolster the control of chronic conditions such as hypertension, diabetes, and heart failure. At its core, the program aims to address an increasing challenge associated with managing chronic diseases in healthcare. As articulated by Carol Hawkins, commonly used care models fail to adequately cater to the needs of patients with chronic diseases. To supplement these models, Sentara Health intends to provide real-time health monitoring to augment patient health outcomes and satisfaction with their care.
Throughout their healthcare journey, patients with chronic diseases typically need more care than just the services they receive during office visits. Therefore, the newly introduced HealthSnap program will extend support to these patients between their visits, thus connecting the missing links in their care journeys. It will also manage and monitor devices and escalate care when necessary.
Sentara has strategically decided to centralize its remote patient monitoring team to support traditional primary care providers, alleviating any additional strain on their workload. Billing and clinical oversight will be performed by the RPM team along with the review of eligibility, interventions, and escalations. To ensure a smooth transition, Hawkins, along with her team, is in continuous communication with the clinicians involved. She asserts that effective and continuous communication is crucial.
To manage the transition process efficiently, Sentara has formed an RPM advisory council comprising primary care physicians and operational directors. Notably, Sentara Health is an integrated non-profit health system operating 12 hospitals and employing 34,000 individuals. The role of the RPM and CCM platform is set to be integrated into Sentara’s care model to bolster clinical teams between visits and thus improve patient outcomes. Dr. Hawkins and her team plan to broaden the range of conditions addressed by the program in the upcoming years.
By utilizing HealthSnap’s virtual care tools, Sentara stands alongside over 150 health systems and provider organizations. According to HealthSnap, the company has remotely monitored over 100,000 patients across 33 states. As for other health systems planning to adopt a similar model, Dr. Hawkins advises conducting a thorough assessment of existing capabilities and scaling up based on that assessment. She also recommends seeking insights from other large health systems which have successfully scaled up programs and financial models. Feedback from partners with previous successful collaborations can also provide valuable learnings. In conclusion, Sentara’s health initiative serves as a beacon of innovation in managing chronic diseases and population health.