The potential of digital health, or mHealth, is a popular topic right now. Conversations around how to leverage this technology often focus on the soft benefits rather than the real-dollar impact it can have on improving healthcare efficiency. One of the biggest opportunities lies in modernizing different perioperative phases that exist, from pre-op to post-op. While many first-generation digital healthcare strategies were focused on checking a box, this wave is part of a much larger transformation of healthcare itself.
“The ballooning costs of (health care) act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable.”
— Warren Buffett
Tackling skyrocketing healthcare costs associated with surgery
The growth model of companies like Amazon is to target operational efficiencies and apply them in view of a long-term commitment to customer experience. While this is more challenging in the opaque world of healthcare, an in-depth review of the available literature quickly highlights several areas where an easily implemented digital strategy can effect cost savings by using apps. These savings average $300 per procedure, just by targeting same-day cancellations and preventable readmissions.
When using mobile to address some of these perioperative inefficiencies, consider this:
- Surgeries account for approximately 60 percent of total hospital revenues.
- Hospitals and ambulatory surgical centers incur a cost of $5,264 per cancellation. This includes the 37.3% of cancellations that are never rescheduled.
- With an estimated 60 percent of all same day cancellations deemed preventable, a proactive mobile strategy is critical and can save your facility $199 per procedure.
- Around 25 percent of same-day cancellations are due to inadequate preparation, with 73 percent of cancellations specifically attributed to a lack of patient preparation considered preventable.
In addition to this lost revenue, there are high missed-opportunity costs like unused OR time and resources.
Improving perioperative care in the future
One of the things that makes this category of mobile apps so innovative is its simplicity and connection to human behavior. As digital health evolves and patients leverage connected devices, healthcare will still be fundamentally reliant on education, awareness, and particularly behavioral modification.
Numerous studies have demonstrated that mHealth apps have a positive impact on patient self-management and can aid in behavioral modifications, with users of health apps found to have higher health literacy levels than non-app users.
Mobile apps are also highly flexible and adaptable, able to be customized for numerous workflows within a single health system, and still retain the personalization that makes them valuable to the patient. The video below illustrates how a simple perioperative app works, and can be applied to other service lines as outlined:
By identifying actions and information standard to all major surgeries in a facility, a healthcare system can reduce same-day cancellations and significantly improve the health literacy of surgical patients. This includes surgery-date-specific milestones, reminders and alerts, trackers, wayfinding, and direct and community-based resources.
The timeline for bariatric surgery can be daunting, and coupled with the emotional and physical toll the attrition rate is typically 50% to make it to surgery. Noncompliance is also pervasive following bariatric surgery, with over 50 percent of patients not exercising and not following weight loss instructions, yet when given an app with targeted messaging bariatric patients reported an increase in nutrition knowledge, felt more engaged in a healthy lifestyle and felt more connected to the care team. Timely, progressive guidance and plenty of support with recipes, exercises and motivation can make all the difference in getting patients to and through surgery.
Since arthroplasty patients are often older or more inactive due to injury, it is particularly critical to educate them on the value and proper form of preparatory exercise programs and follow-up care. Implementing a preoperative patient education program in TJA patients, for example, correlated with a decrease in 30-day readmission rates from 5.6% to 3.03% Another 87% of the patients felt that pre- and post-messaging helped them be better prepared for their surgery, with the corresponding increase in patient satisfaction reflecting in HCAHPS scores.
The archetype of the patient education model, a pregnancy app perfectly targets the Millennial parents who want to understand every nuance of the pregnancy and what to expect at delivery. As a result, apps are often the first resources accessed by pregnant Millennial women due to accessibility and availability. Don’t miss the opportunity to start a dialogue with these important decision-makers at the inception of their family’s healthcare journey, building a brand loyalty that will capture new patients and can increase HCAHPS scores as much as 68%.
When parents are the caregivers for their young child, the best thing you can do is over-inform. Frequent reminders for necessary prep avoids last-minute cancellations, and setting accurate expectations for postop care can mitigate unnecessary readmissions—revisits are typically concentrated within first 15 days and highest on day two with 67.7% preventable. The leading readmission causes of pain, nausea/vomiting, and dehydration are all very common and can be proactively addressed with information and alerts.
Behavioral modification is primary for improving population health and stemming the tide of chronic, comorbid conditions straining the healthcare system at its core. Eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions, and the projected total cost of chronic disease from 2016-2030 in America is $42 trillion. Participants in an app-based diabetes maintenance curriculum, however, lost 7.5 percent of their initial weight after 12 months, improved blood sugar levels, and lowered cholesterol.
Heart (CVD, CHF)
Costs associated with heart disease in the U.S. will reach $818.1 billion a year by 2030, yet many patients at-risk for heart disease and related emergencies are unaware of symptoms or pro-active care strategies. Expanding patient literacy, awareness, and access to resources makes a demonstrable difference in outcomes. Individuals who used an app to participate in a mobile cardiac rehabilitation program and track their own medical progress post-stent placement procedure had 67% fewer 90 day readmissions and ER visits that those not using the app.
Responding to evolving consumer expectations in healthcare
With the combination of a consumer-technology mindset and the rising tide of Millennials entering the healthcare system, apps are primed to take on these inefficiencies in the care coordination process just like they have in banking, transit, hospitality and numerous other industries.
Healthcare spending in the U.S. accounts for almost 18 percent of GDP and per-capita spending is double that of comparable OECD countries. The costs from chronic diseases alone are projected at $42 trillion through 2030. Reducing these costs by creating touchpoints throughout each phase of a high-cost procedure like a surgery has tremendous cost-saving potential for providers not yet using them.
These app use cases mentioned are just a few of the areas where your health system can cut costs associated with surgeries and other procedures. For more information on how apps are making an impact, check out our latest case study with South Shore Health System and check out our Perioperative App Calculator.