ACOs, MSOs, Health Insurance & Health Share Organizations
MONITORING & ASSESSMENT OF PATIENTS AT HOME
Providing Access to Medical Care When Needed - ER Diversion - Improving Patient & Member Satisfaction with Better Outcomes
Why Serinus Health?
We all desire to minimize the time spent in traditional health care settings due to the associated high costs, strange and uncomfortable surroundings, and the likelihood of acquired complications. Fortunately, most of a person’s life evolves outside of the medical office or hospital, and the need for ER / Acute Care can be minimized or prevented.
However, it’s typically the situations that arise while a person is outside of the clinical setting usually that commonly contribute to the need for expensive visits to the ER, Acute Care or ambulatory services. Abnormal emergent health conditions usually go undetected or ignored until episodic crisis or a life altering event develops.
Serinus Health has been established and is available to help health care professionals, ACOs, MSOs, Health Plans and Chronic Care Management organizations monitor the health status of their patients and members, while they are in their normal life continuum, outside of traditional health care settings.
This active monitoring enables timely detection of emergent or changing health conditions, which can then be remotely, and promptly reviewed and interpreted by professional clinicians to provide actionable information reducing the frequency and severity of episodic crisis and/or to bring to bear timely care interventions (at the person’s home or ambulatory) lowering acute care requirements.
Scope of Services
A personal ongoing health status, and respective risk profile, is clearly dependent on each person owns physiological life evolution; however, there are also environmental factors that can significantly alter each person resulting health conditions.
Serinus Health’s scope of services also include the assessment of key environmental factors present in the patients / members habitat, that are known to affect a person’s health care cost risk profile; in addition to monitoring the physiological vital signs that are known to be relevant indicators of health emergent conditions.
Assessment and Monitoring is certainly important, however once an abnormal condition is detected, effective and timely access to care is essential to prevent the onset of a crisis which might result on an ER visit and/or acute admission. Likewise, risky environmental conditions in the patients home should be remediated or managed.
Therefore, Serinus Health services scope has three main synergistic components that work in unison to achieve the desirable Goals and Objectives. The client can select which components are applicable to specific patient groups or diagnoses.
1. IN-HOME MONITORING AND COMPLIANCE
Serinus Health integral assessment of the patients in their homes provides risk management clinicians with effective and actionable information for the overall reduction of costs, better patient satisfaction and outcome improvement.
In-Home
Serinus patients’ In-Home monitoring might include two important dimensions to assess the health status of a patient. One is the monitoring of patient’s selected vitals, depending on the condition(s). The following table summarizes the most common conditions and associated indicator vitals which are usually monitored in an ongoing basis.
CONDITION |
VITAL MONITORING |
|
Hypertension |
Blood Pressure and Pulse |
|
CHF |
Blood Pressure and Weight Scale |
|
COPD |
Oximeter and Blood Pressure |
|
Diabetes |
Glucose |
|
Diabetes and Hypertension |
Glucose and Blood Pressure |
There are other selected vitals which are intended to be monitored for shorter periods of time, as an example continuous EKG.
Second, there is another category of In-Home monitoring that targets the assessment of the patient’s conditions other than physiological performance. These conditions have to do with the general wellbeing, “How do you feel?” and mood of the patient. Serinus uses expert developed assessment questions or “surveys”, depending on patients’ specific comorbidities and status (like transition from acute discharges, rehab period). These surveys complete an integral assessment of the patient’s condition.
2. ER DIVERSION - ACCESS TO CARE
Serinus effective Access-to-Care at home, based on clinical evidence, reduces crisis, ER and acute episode costs.
Tele-Consult
The aforementioned It-Home monitoring will alert to emergent conditions, some that might indicate a physician visit in few days time, other conditions might require access to physician care in a more immediate basis to prevent a worsening situation that would likely ends up in an ER visit, and thereafter acute admission, with the much higher elevated cost and associated complications to the patient.
Serinus Health can offer a Tele-Consult to the patient, according to the guidelines of the client. This Tele-Consult will typically occur within a short period of time in the comfort of the patient’s home and avoiding all the expenses and inconvenience of a trip to the doctor. Furthermore, a Serinus Health Tele-Consult is much more effective than other telemedicine alternatives, because the Serinus tele-Consult clinician has access to the actual patient’s condition evidence as indicated by the vitals received remotely from the patient; and possibly, the results of the assessment surveys filled by the patient over days prior to the Tele-Consult.
This valuable clinical evidence in addition to the symptoms as described by the patient during the Tele-Consult. Furthermore, the Serinus Tele-Consult can empower and make more effective the interventions of nurse home health programs.
3. ENVIRONMENTAL ASSESSMENT AND PREVENTION
Serinus Health prevention services can significantly reduce the risk of falls and accidents at home by increasing patient awareness of these risks and promoting mitigation practices.
Home Assessment
The number one cause of ER visits, and acute admissions in adults (50 years and older) is falls and accidents at home. Likewise, the number one cause of respiratory crisis, for persons with COPD, asthma or similar comorbidities, is pollutants like mold, mildew or dust in the patient’s home.
Serinus Health Environmental Assessment and Prevention service options are:
- A personal visit to patient’s home to assess likely causes of falls or accidents and/or respiratory stresses.
- Remediation recommendations to the patient to minimize these potential causes, within the guidelines previously approved by the client.
- Implementation of selected remediation measures as per client guidelines.
- Periodic confirmation of the continuing use of the remediation measures.
Serinus Health environmental services can significantly reduce the risk of falls and accidents in the home by increasing patient awareness to these risks and promoting mitigation practices.