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Conclusions

This trial demonstrated the ability to significantly reduce costs for high risk patients through use of the CYTTA Connect Ecosystem. The trial demonstrated the ability to quickly achieve cost savings, decrease resource utilization, improve care coordination, and increase adherence to evidence based guidelines. Adherence to evidence based guidelines is increasingly important as CMS 5 STAR ratings garner importance.

Care costs were reduced on average by $11,078 for each trial participant. This trial did not specifically address long term cost of care. However, these patients were selected for the inabilities of the existing healthcare system and care coordination programs to cost effectively address their short or long term healthcare needs. One trial participant noted he realized more value and benefit in 2 months of trial participation compared to his previous 17 months of participation in the best available care coordination services. A quite handsome return on investment is present if the care coordination system is priced at less than $2,000 per year.

This trial also demonstrated that home biometric monitoring using the CYTTA Connect Ecosystem can be easily introduced, dispensed and utilized in the home setting. Care team training was easily completed. CYTTA Connect was easy for patients and care coordinators to learn and effectively use. Technical troubleshooting was prompt and effective.

Improved patient engagement and ability to self-manage care will become increasingly important and require new resource allocation because CMS will soon require Stage II Readiness participation. Through repeated collection and review of biometric data patients learn how to titrate medications and adjust behaviors to achieve target goals which is a cornerstone of CMS 5 STAR performance and CMS Stage II Readiness. Patients and the care coordination team are prompted by alerts to evaluate and to intervene in real time. This produces a patient who is more engaged and prospectively aware of how they must modify behaviors and medications to meet target metrics through self-management. Additionally, improved achievement of target metrics produces significant provider and care team satisfaction. Efforts of both become both more effective and more efficient.

Effective use of the CYTTA Connect Ecosystem requires the managing physicians to develop and communicate care plans and standing orders to adjust medications to achieve target goal. Too often the goals of care and associated care plans including medication administration are poorly communicated or not present. Patients travel through various sites of service and levels of care without a clear understanding of the expected behaviors and medication usage to be executed in the home setting. CYTTA Connect in conjunction with care coordination resolves this deficit and allows for care plan and medication revision as the patient disease processes change in the home environment. Through repeated measurement and with focused care coordination the patient learns how to better manage their health care needs. This produces a patient who is more engaged and prospectively aware of how they must modify behaviors and medications to meet target metrics. This also produces a more satisfied patient, physician, and care coordination team.

This trial discovered patients view CYTTA Connect and remote telemonitoring as a special benefit to patients who are encouraged to retain their relationship with Heritage to continue to access and build their personal health database. Patients develop a special relationship with their care coordination team. The patients viewed CYTTA Connect and care coordination activities as a value rather than an intrusion because information and advice generated by the trial were specific to the patient and time sensitive.

This trial enabled physicians and care coordinators to more effectively manage a larger number of patients. Current care coordination ratios can be expanded by 20% using biometric remote telemonitoring through reduced telephone tag and elimination of unfocused, subjective, generic discussions with patients. Instead specific biometric data, medication usage, review of the active care plan, and comparison to target metrics produces a focused discussion. Patients and care coordinators are taught through rapid cycle improvement to Plan, Do, Study, and ACT. Barriers to successful self-management are identified and addressed. Patients now learn how to revise and update their care management in the home setting rather than a physician office, emergency or hospital room followed by an attempt to translate and implement the care plan in their home setting upon discharge. Patient contacts have become value oriented with immediate return on investment to the care coordinators and patient.

Next Steps

We believe the success of this remote telemonitoring program on managing high risk patients can be replicated and offered to forward thinking, at risk healthcare organizations. The telemonitoring success requires careful patient selection, structured patient enrollment and focused care coordination which have been developed and tested. Ongoing success requires structured patient assessment, patient and provider engagement, alert parameter selection with provider input with standing orders in response to alerts. CYTTA and MHIMS provides coordination between the providers and systems to introduce and educate on the use of the telemonitoring program to reduce ER and hospitalizations usage with increased patient involvement and increased positive outcomes in health self-management for high need members. We can identify high cost members and offer this program to non-high cost patients who are discharging from the hospital but at high risk for readmission due to their inability to effectively self-manage their care in the home setting.

When compared to other remote telemonitoring services available, the CYTTA Connect Ecosystem is clearly the most cost effective, patient friendly system available.

Although the pilot study was completed, CYTTA continued to provide their products which demonstrated additional cost savings and dramatically reduced utilization past the initial 180 day pilot.



Contact:
Mr. Gary Campbell
President
Direct 702 900 7022
Office 702 253 7499
Website: Cytta.com
info@cytta.com