TRU Community Care Leverages Emerging Technologies Amid Pandemic

TRU Community Care is among several hospice providers across the country to employ new machine learning tools to deliver home-based care, overcoming challenges such as cost, implementation and patient reception.

Though integrating additional technologies has become a new priority for hospices during the COVID-19 pandemic, many hospice providers were already leveraging technologies such as data analytics, telehealth and remote patient monitoring in anticipation of forthcoming value-based payment models from the U.S. Centers for Medicare & Medicaid Services (CMS), set to begin in 2021.

TRU Community Care provides elderly, grief, hospice and palliative care services throughout five Colorado counties. Prior to the onset of the pandemic, their leaders were looking ahead to the potential impacts of new payment models, such as the demonstration project that will test hospice coverage through the value-based insurance design model, commonly called the Medicare Advantage hospice carve-in. 

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As President and CEO Michael McHale told Hospice News, TRU Community Care spent roughly two years developing and testing new machine learning technology in collaboration with tech firm Vivify Health as a tool to help identify patient needs, as well as rolling out a new remote patient monitoring system in January of this year. Similar to many hospice providers, the organization has leveraged telehealth during the COVID-19 pandemic to continue serving home-based patients in need.

“We were trying to figure out how we could deliver patient care better,” said McHale. “We were looking at the direction of where Medicare reimbursements were growing with a recognition that the way care is delivered today may not continue to be affordable in the future based on changes to the repayment model. We have had these grand plans, and our board has allowed us to invest in terms of this technology, but because of COVID-19 we’ve had to really ramp it up.”

Remote patient monitoring systems use different technologies to collect medical and health data from patients to securely maintain and share across settings as they progress throughout the continuum of care. These systems can monitor data such as blood pressure, weight, heart rate, blood sugar, oxygen levels and more.

“With remote patient monitoring, we were able to put iPads and Bluetooth-enabled technology into a patient’s home with handheld devices,” said McHale. “We also had things like a blood pressure cuff, a pulse reader. In between visits daily readings automatically come in and get recorded, which would then trigger the nurse practitioner if something was out of acceptable range for that patient. This would signal a call out to the patient and helped us better manage our staffing resources.”

A large concern of implementing remote patient monitoring systems is the often large price tag. As hospices face uncertainty of the pandemic’s financial impact, many have faced several challenges as they work to incorporate technology into the realm of patient care, with affordability among the top concerns. Hospice providers are wrestling with the upfront costs of remote patient monitoring technology such as software set up and maintenance, hardware pieces and devices, along with testing and evaluation.

Uncertainties related to the forthcoming payment models are also complicating hospices’ ability to plan. CMS recently released the payment capitation rates for the 2021 Medicare Advantage carve-in, meaning the maximum amounts that the agency would pay to health plans. Adding an additional financial concern for providers, CMS has yet to indicate what percentages of those funds will go to the hospices. That question may ultimately be settled through individual negotiations between providers and the health plans.

“We thought [this technology] would be in our 2021 spending as part of its rollout, but we had to pull it into this year to help protect this fragile population,” McHale said. “We have been going out to donors and trying to get all kinds of grants and funding to help us ramp up this technology sooner and purchase all the peripheral equipment that goes with it. Each device’s cost can add up, along with having a video connection to the monitoring and analytical software and a call center of nurses, social workers, chaplains and other providers. It does come at a cost, but it’s in hopes that it would be balanced out with potential savings in other areas.”

Reduced costs in staffing mileage for travel between patient homes is one potential area of savings. Another potential return on investment could be a rise in the number of patients hospice providers would be able to serve each day due to increased access via telemedicine.

Part of growing remote patient monitoring systems is ongoing evaluation after the initial rollout phase. In collaboration with mHealth Impact Lab at the University of Colorado’s School of Public Health, TRU Community Care conducted a quality improvement project to test the efficacy of the new technology, including overall reception of telehealth utilization. Acceptance levels tested high among both patients and providers evaluated, providing hopeful data for continued and future use of telehealth in hospice home settings.


“Hospice Telehealth Acceptance”
provided by TRU Community Care and mHealth Impact Lab

“It’s about augmenting high touch with high tech,” McHale told Hospice News. “We don’t want to diminish in-person care, but [instead] complement and add to it through this technology. With this technology, patients and providers can still have meaningful conversations. We can still do updates through remote devices. This allows us to still provide a level of care that is meaningful to their disease progression, regardless of what [Medicare] benefit they’re on before reaching us.”

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