Josh Hofmeyer

Based on preliminary findings, our company’s telemedicine services are reducing transfers and emergency department visits, thereby successfully reducing cost of care for long-term care residents.

Here’s how we did it: In September 2014, Avera eCARE, based in Sioux Falls, SD, was awarded $8.8 million over three years through the Center for Medicare and Medicaid Innovation (CMMI) to improve healthcare and lower costs for residents at long-term care facilities. 

The project’s goals were significant: to reduce hospitalizations by 16% and emergency department visits by 28%, resulting in an 8.25% reduction in total cost of care. Official results on these specific goals will be available at a later date.

Through the award, Avera eCARE Senior Care expanded its program to 45 rural and urban long-term care facilities. The sites represent multiple organizations and partners. Avera Health, The Evangelical Lutheran Good Samaritan Society, and Golden Living facilities (now owned by Skyline Healthcare) were initial partners, and Welcov Healthcare, Trinity Health, and Continuum Healthcare were added mid-way through the award.  The sites for the award period were throughout South Dakota, Minnesota, Iowa and Nebraska.  

At the completion of the award, eCARE Senior Care services had impacted over 11,000 residents – allowing 90% of them, on average, to receive the care they needed in their long-term care facility rather than being transferred immediately after an urgent care encounter.

By eliminating potentially avoidable transfers, reducing emergency department visits and providing timely access to expert care, the cost of care per beneficiary was reduced. Preliminary internal costs savings analysis showed a savings of $342 per beneficiary per month, equating to an estimated savings to Medicare of millions of dollars over the three-year award.

24/7 access to geriatric care

The award connected participating long-term care facilities with 24/7 access to eCARE Senior Care’s geriatric-trained team and urgent care professionals. This innovative technology – including high-definition, interactive video and sophisticated computer monitoring equipment – didn’t replace, but instead augmented the care provided by local healthcare teams.  

Prior to receiving the award, we had a desire to offer long-term care facilities with more than just urgent care. We wanted to support them with a geriatrician and multidisciplinary team 24/7. The award fueled our ability to create and offer that team and services beyond urgent care.

Through the award, eCARE Senior Care built a team with specialized training in how to meet the unique needs of long-term care residents. We now have a full-time geriatrician and two physicians who are currently undergoing their geriatric fellowship to be geriatricians. We’re also staffed 24/7 by certified nurse practitioners who work closely with physicians, pharmacists, registered nurses, a licensed social worker and nurse practitioner of psychiatry.

“With eCARE Senior Care, we can access a professional provider anytime, 24/7, and we need not worry about taking a resident outside of the facility,” said Sue Beyer, Director of Nursing at the Michael J. Fitzmaurice State Veterans Home in Hot Springs, S.D. “That’s a great advantage, and there’s no hesitation – our nurses and caregiving teams don’t have to consider whether a problem is worthy of calling a physician in the middle of the night. We can just use the (Avera eCARE) system.”

Beyer added that the eCARE Senior Care team helps them confirm their approaches, answer questions and raise their quality of care to another level.

To achieve the aims of the award, the eCARE Senior Care team knew it was about more than introducing technology; providing the long-term care facilities with education and empowering their staff were equally important. With that in mind, we focused on the following primary drivers:

  1. Improve management of care transitions by ensuring that resident admissions and discharges go as smoothly as possible
  2. Provide routine, simple and around-the-clock access to urgent care
  3. Staff empowerment and building the assessment capabilities of long-term care staff through monthly educational sessions, ad hoc requests, and advance care planning support among other educational opportunities

“We are fortunate to have the CMMI award funding and to have these additional capabilities for our veterans,” said Brad Richardson, Superintendent of the Michael J. Fitzmaurice State Veterans Home. “In addition to that evident benefit, we also have the enrichment opportunities for our staff, since they are working with specialists and providers they would not work with on the floor at our facility or in this part of South Dakota.”

Engaging staff

Connecting long-term care facilities with advanced technology, experienced geriatric providers and a multidisciplinary team 24/7 were important to the overall success of the program. However, the main key to success is engagement of the local care team, as well as the family members of residents.

By supporting local medical staff, the eCARE team seeks to foster a relationship based on trust and collegiality. This collaboration benefits everyone because the earlier that eCARE teams take part in discussions and assessments surrounding the care of each resident, the better impact we’ll be able to have on overall outcomes.

We found that long-term care facilities benefited when they accepted and engaged with eCARE Senior Care services. Highly engaged sites – those that access our services more often – have a 62 percent lower unplanned transfer rate compared to the sites that have lower engagement scores.

A recent survey of the participating sites also showed overwhelmingly positive response rates from nurses and residents who interacted with the eCARE Senior Care team:

  • 98% of the time nurses rate eCARE Senior Care services as excellent or good

  • 99% of the time residents say they would recommend eCARE Senior Care services to others

The role of telemedicine in the delivery of care is expanding. By building collaborative relationships with clinicians working in long-term care facilities, Avera eCARE supports an overall network of clinicians that reduces the isolation of nurses working in skilled nursing facilities.

Now that the award has ended, Avera eCARE Senior Care will continue its efforts to make these impacts throughout the nation. We have developed a sustainable business-to-business model and also are working in conjunction with the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to bring forward a potential alternative payment model for the Department of Health and Human Services to consider.


Josh Hofmeyer, LNHA, is a senior care officer at Avera eCARE.