Liberty HomeCare & Hospice Services provides homecare, hospice, and palliative care services to communities across North Carolina, South Carolina, and Virginia. Liberty’s comprehensive services are designed to meet the evolving needs of patients. Since its founding, Liberty HomeCare has focused on reducing hospital readmissions by increasing education and communication with their patients.
“As a result of the additional support telemonitoring provides, we’re seeing more patients be proactive in their care, noticing when their symptoms are acting up, and visiting their primary care physicians before their health reaches a crisis point.”
Donna Turlington VP of Homecare, Hospice & Palliative Care Services
Servicing a large region of the Southeast, Liberty HomeCare was confronting growing challenges in reducing hospital readmissions to surrounding health systems. To deliver care to their highest acuity patients, Liberty HomeCare required a patient centered solution that would enable their clinical team to improve communication and extend disease-specific patient education to their patients.
In 2018, Liberty HomeCare launched their telehealth program with HRS. Visit reduction and decreased re-hospitalization were at the core of the program. Focusing on the most high-risk patients, Liberty enrolled chronic care patients with COPD, CHF, hypertension, or other combinations of co-morbidities. To address visit reduction, Liberty developed care pathways that included best practices for addressing patient exacerbations. Liberty’s team leveraged the communication tools available via the HRS solution, including text messaging, phone calls, and video conferencing. Telehealth clinicians monitored patient vitals, symptoms, and medication adherence 24/7 and promptly responded to patient needs and changes in health status. Communicating with every patient following a high-risk alert, enabled the telehealth team to assess, educate, and prevent not only hospitalizations, but future exacerbations.
Over six months, Liberty HomeCare monitored over 350 patients via telehealth and RPM, achieving an average 30-day hospital readmission rate of 7.1%. Not only did the increased communication and individualized treatment plans reduce hospital readmissions and in-home visits among high-acuity patients, they strengthened care plan coordination between Liberty staff and referring physicians. After six months, Liberty achieved a 98% patient satisfaction rate among telehealth patients.