CHRONIC DISEASE
Digitally orchestrate your chronic disease programs
Chronic medical conditions account for more than 75% of US healthcare spending. Not only are traditional chronic condition management programs expensive to run, their effectiveness is diminished because providers lack good tools to make them coordinated, consistent or scalable.
Lumeon enables providers to create lower-cost, automated care journeys for chronic disease that optimally manage the flow of patients across specialists, PCPs, community care professionals and hospital teams.
Our award-winning platform actions your workflow, presenting a shared view of patient progress, with tasking, decision support, risk-based resource allocation and automated patient monitoring.
Key benefits:
- Joined up, lower cost care
- Reduced readmissions
- Easier patient monitoring
Chronic condition care plan coordination
Ensure reviews happen in a timely, consistent manner by creating your own protocol-driven care journey with pre-determined check-up schedules and activities for every care specialty.
Lumeon’s platform automatically tasks care teams to inform them exactly what to do and when, and presents a real-time view of patient progress and key data, shared across an interdisciplinary chronic condition management team.
Pathway content can be varied by risk, to ensure the best operational plan for each individual is delivered, and the platform can also suggest and communicate alternative courses of action, should patient data reflect that this is required.
A few features:
- Risk-based pathways with pre-determined review schedules
- Shared access to multidisciplinary care plan
- Real-time view of key milestone progress
- Bi-directional EHR integrations
- Automated patient appointment reminders and chasing
- Triggers, checklists, timers and decision support for plan updates
Self-care
Improve patients’ ability to self manage their chronic condition, while enabling patient educators and care teams to deliver more targeted assistance, using automated self-care programs.
Lumeon enables providers to automatically distribute up-to-date, easy to absorb patient communications, via the patient’s preferred channel of communication.
Automated eQuestionnaires can be used to assess knowledge and identify gaps. Depending upon the patient’s behavior and responses, follow-up content can be automatically sent to support the patient, or they can be referred to patient educators.
A few features:
- Personalized, automated educational materials
- Periodically assess knowledge using eQuestionnaires
- Targeted follow-up information to address knowledge gaps
- Ability to collaboratively create and monitor personal goals
- Choose from content library of industry-leading publishers, or create your own
Remote monitoring and device integration
Lumeon makes patient monitoring more effective and less resource intensive, by using risk-stratified pathways, virtual care and automation.
A typical pathway for low risk individuals might reduce the number of in-person appointments or phone calls, instead using automated e-questionnaires or SMS to capture key data. For example, diabetic patients could be automatically prompted to send blood glucose levels over SMS, and should data go beyond tolerance, it can trigger coordinated intervention from care teams.
Make the experience even more convenient for patients with the option to integrate data directly into the platform from devices such as continuous glucose monitors and Bluetooth-enabled scales.
A few features:
- Risk-stratified pathways that dictate frequency and channel of remote monitoring
- Ability to use data to trigger actions within the pathway
- Continuous monitoring via e-questionnaires/SMS/email
- No need to download an app
Diabetes use case
A large health system has been using Lumeon’s automated SMS reminders to monitor diabetes patients with poor glycemic control who are at risk of readmission.
The program was devised so that diabetes nurses could keep a regular track of daily blood glucose levels, without having to take readings face-to-face or over the phone. Lumeon’s platform allows patients to receive automated SMS messages each day and text back their self-recorded glucose levels. This means patients on the program, often from low socio-economic backgrounds, don’t have to pay for travel into the hospital or take unpaid time off work.
Nurses have more accurate visibility of patient status and are supported by automated detection of potential hypo/hyperglycemic episodes. The hospital can now successfully stabilize more patients on the program and safely transfer them to PCPs.
Results
- Early intervention for potential hypo/hyperglycemic episodes
- Reduced work for diabetes nurses (fewer calls and no transcribing/result chasing)
- Telephone reviews can be spent exploring action plans rather than collating data
- Consolidated view of data, with bi-directional Epic integration
- Patients much more likely to give accurate results
