Continuity Health Solutions
Extending Care Beyond Hospital Walls

The healthcare arena is fast adopting value-based care delivery through Bundled Payments for Care Improvement (BPCI) payment models that facilitate quality post acute care to patients even beyond the walls of the hospital, while opening up new opportunities for monetization for payers and providers. These capabilities require providers to implement agile software solutions for automating care plan delivery, aggregating the results, and identifying relevant, actionable alerts to the virtual, episodic care team. However, healthcare CIOs are experiencing difficulties in determining the infrastructure they need to understand the patients with complicated medical history who are associated with the highest medical cost.

Being at the intersection of healthcare and technology, Continuity Health Solutions (CHS) is committed to simplify the integration of standards-based technology into care delivery for greater patient health outcomes. “Our ally Connected Care solutions are uniquely positioned in today’s healthcare environment to meet the demanding needs in post acute care delivery,” says Bryan Poteet, CEO of CHS. A healthcare industry veteran, Poteet, is passionate about bringing technologies to the healthcare marketplace in order to extend care delivery for post acute patients in an optimized manner. Poteet strives to glean health data, while connecting the care teams so that they can ensure the best health outcome.

CHS’ ally^® Connected Care offers providers a modular, robust feature set to supplement their IT infrastructure in order to monitor the health status of discharged patients while still remaining financially viable. ally^® Connected Care takes the providers’ knowledge or care plans, injects automation, and escalates the exceptions in case of drastic variance in patient health. “We are geared towards empowering provider-patient relationship in order to improve care, and we do that by utilizing the latest technologies and the dynamic business cases existing in the marketplace,” highlights Poteet.

ally^® operates within the defined standards frameworks for connected health devices, creating advanced algorithms for relevant actions and providing results to the existing infrastructure. By leveraging emerging and legacy messaging standards such as HL7 V2.x and FHIR formats, CHS allows care teams to streamline interfaces, training, workflows, and data analytics using ally^® Connected Care. Regardless of whether the patient is in Chronic Care Management, Population Health, or a Wellness program, ally^® Connect Care modules—supported by aggregated data and advanced algorithms— help care teams in monitoring the deviation from baseline, thus complementing care delivery.

Continuity's success is directly associated with our ability to supplement value-based care models with modular technology and services to drive access to their patients in the home and its ecosystem. We have a responsibility to translate the data we gather into an actionable event for the care team

CHS collaborates with organizations in healthcare, payers, and technology arenas to support its core philosophy: Providers should be empowered to choose the best technology to achieve patient compliance for self-reporting data. It works with its partners, providers, and payers to apply technology, care management, and professional services to better improve favorable outcomes. “Our objective is to add automation of care plan delivery, to aggregate the results of the delivery, identify the relevant actionable alerts, and provide that to the virtual care teams,” says Poteet.

While CHS’ A3™ module (Automation, Aggregation and Algorithms) drives the care plan, its CS™ module (Connected Services) offers multiple modes of participation for patients to provide data from various other sources. These services also allow providers to assign the best participation mode to achieve maximum patient participation compliance since they are closer to their patient. The source could be a phone call, a tablet, a voice guided web portal, or face-to-face video participation for gathering health data and allowing customers to leverage the modularity of the technology stack to achieve their business objectives.

“We make smart devices smarter by delivering scientific and custom care plans across large populations, while allowing patients to participate in the method they choose, to achieve the highest level of compliance,” says Poteet. CHS’ technology allows patient data to be integrated into the EHR of the patient’s healthcare provider. “A single vital value pushed into the cloud has limited value on its own. You must combine it with multiple data points and identify an intersection of variance along a relevant time period.

Now, the result is an actionable event that can be delivered to the care team. Otherwise, you just added more work to an overburdened care delivery system.”

Care Delivery with Confidence

CHS has partnered with the American Heart Association (AHA) to incorporate their Connected Heart Health Care Plans for Post Acute Care within its ally^® Connected Care platform. Healthcare provider organizations that already support AHA existing programs, Get with the Guidelines^® and Guideline Advantage^®, can continue the AHA scientific approach to care delivery when ally^® connected care is deployed in conjunction with their existing EHR/EMR systems.

CHS has expanded its portfolio by partnering with Lumedx, a provider of cloud-based cardiovascular information systems, to offer healthcare providers an integrated record for heart failure populations across the in-patient and post-acute care environments. The partnership focuses on reducing heart failure readmissions through a seamless, integrated inpatient and outpatient cardiology record. The results are disease specific care plans incorporating 84 logic driven events consisting of education, challenges, quizzes, exercise plans, nutrition, and medication compliance over a 90-day period. “Through our partnership, organizations can continue their evidence-based treatment approach using FDA approved connected devices,” says Poteet. The results of the care plans are seamlessly exported to the organizations’ EHR using the HL7 FHIR format. “We empower organizations with the best technology for achieving the highest levels of patient compliance and self reporting data.”

Having witnessed his own mother battle Chronic Obstructive Pulmonary Disease (COPD), Poteet resented the long journey his mother had to make for treatments. This motivated him to establish Continuity Health Solutions. Through CHS, Poteet is focused on developing technology that empowers patients to participate in their own care in the post acute care environments. CHS implements FDA approved medical devices of all types, while simplifying the logistical requirements associated with incorporating them into mainstream care delivery.

For Poteet, value-based care delivery models are requiring various organizational types to come together under financial alignments. Regardless of the business arrangement, the patient’s home will become an integral component of their success and they need a modular technology stack to incorporate with their existing infrastructure to achieve the desired clinical and financial results. The next chapter in his journey is to leverage Artificial Intelligence (AI) to help providers in their quest for efficient, proactive care interventions. “It is our goal to continue building partnerships with diverse organizations to accelerate the ease of adoption of our technology stack and improve the care delivery for a better tomorrow,” concludes Poteet.