Data-backed perioperative screening, a CPAP adherence program, and rapid home sleep testing are among innovations adopted by the WellSpan sleep team to improve patient ease of use
In our May story, we’re excited to feature a sleep organization that has embraced the patient ease of use dilemma. While talking with their team, we admired their focus on adapting cutting edge sleep solutions. From their explosive home sleep testing (HSAT) program growth, to an advanced surgical perioperative screening process, to their data driven CPAP Initiation and Management (CIM) program efforts, WellSpan is innovating at every level of the organization.
Who’s leading sleep innovation at WellSpan?
We interviewed two members of WellSpan’s team, which is headquartered in York, Pennsylvania. A long-standing health leader in the Pennsylvania community, WellSpan Health’s Tammy Sterner is the Senior Director of Sleep Services. Five years ago, WellSpan’s mission was to look at everything in terms of how easy it was for patients. This mission drove Sterner to make drastic changes to the way WellSpan tests sleep patients.
We also spoke with the CIM program creator and pioneer, Luke Yankowy. He is a Regional Manager of Sleep Services and a data guru. Yankowy’s CPAP adherence program is showing extremely impressive results through initial pilot phases, and WellSpan is ready to roll it out throughout the network.
Growing HSAT Volumes
When Sterner shifted from the Heart and Vascular division into Sleep a little over five years ago, WellSpan’s sleep organization was primarily a PSG shop. To make her mark on the sleep department, Sterner set her sights on implementing, growing, and maximizing the home sleep testing (HSAT) program. HSATs were introduced at WellSpan in May of 2016. If WellSpan could simply provide patients with an alternative to in-lab testing, Sterner believed more patients would agree to be tested and more sleep disorders would be diagnosed.
Investing heavily in HSATs
Sterner invested time and resources into expanding the HSAT operation, which represented only 5% of WellSpan’s overall testing volume in May 2016. The plan had three goals: one, improve the patient ease of use for sleep tests, two, maintain current in-lab volume, and three, grow HSAT volume to match current in-lab testing.
WellSpan’s team reached their 50 percent goal in July of 2018, and they currently sit at around a 2:1 HSAT to PSG ratio, all while maintaining their PSG levels. However this growth led to another challenge for WellSpan: standardizing HSATs across their many locations.
HSATs within Multi-Location Health Systems
Multiple locations within the WellSpan health system using different devices and processes caused a lot of headaches during the rollout. Sterner remembered walking into one of the sleep centers that had a mannequin on display in the waiting area to showcase their home sleep test device. It was a different device than the sleep center she’d visited earlier that week. She realized WellSpan’s locations within the system were using different devices, and to her, some were harder to use than others. This led to increased frustration levels for both patients and techs in 2016 and 2017.
“Patients were struggling to use some devices. Studies were incomplete, and for certain devices, education was both time and labor intensive for techs,” Sterner said.
Sterner emphasized the patient challenges, specifically logistical labors. Patients were frustrated that they had to drive to and from the sleep center to pick up and return their devices. Techs often had to wait multiple extra days for returns. Consumables were (and still are) an expensive aspect of HSATs. She also remembers 40+ devices on the market at the time, all vying for market share and each with its own challenges. Ultimately, WellSpan shifted primarily to a single HSAT device in July 2017, and by that same time the next year, they’d reached a 50:50 split in testing.
In recent years, disposable HSAT devices joined the party, and Sterner has given them a lot of consideration. The mix of patient sentiment, payor reimbursement, and pandemic precautions have also expedited changes. With all the advances in home sleep testing, it is no wonder that Sterner’s latest goal is a 75:25 HSAT:PSG split. However, with rising HSAT and PSG testing volumes comes the challenge of treating and monitoring OSA patients for CPAP adherence.
WellSpan’s CPAP Initiation and Management Program
Another innovation in the WellSpan sleep network is their commitment to the full spectrum of the patient care journey and how they manage CPAP usage among patients. In July 2020, Luke Yankowy created what he calls a CIM program, short for CPAP Initiation and Management. In short, the program allows WellSpan’s team to proactively look at patient compliance records in real time. To date, CIM has supported over 200 patients in the first 10 months of the pilot period at select WellSpan locations, with strong initial results.
Real time compliance monitoring provides a few major benefits. From a numbers perspective, compliance rates among the overall WellSpan sleep population hovered around 60% prior to the program. Within the pilot centers using the CIM program, WellSpan’s data shows an 85% compliance rate, a 25% improvement. If expanded throughout the network, this program has the potential to impact tens of thousands of Pennsylvanians struggling with their CPAP devices.
“Patient compliance isn’t a set it and forget it solution. Patients tend to ebb and flow with their CPAP usage. Proactively monitoring allows us to intervene with patients before further complications arise,” said Yankowy.
As part of the program, WellSpan auto-generates tasks at 30-60-90 day increments for staff to follow-up with patients if needed. For techs, this is a major ease of use win. For example, if the program requires a face-to-face visit, staff will be notified via the CIM automations. Techs don’t have to manually parse through all the patient data to see which patients need to be brought in for additional consultations.
Automated events simplify the process from start to finish, and according to Yankowy, the process is becoming more and more seamless as the program matures. The program is now on track to expand to ALL WellSpan locations by the end of 2022. It’s an ambitious rollout goal, but the benefits clearly vouch for expeditious action.
With the CIM program, WellSpan’s team believes wholeheartedly that it can and will make a difference in CPAP usage rates in Pennsylvania. Better usage rates translates directly to better patient results, of course. OSA comorbidities cause a lot of challenges, and while CPAP usage does not immediately fix the issues patients face with their overall health, a good night of sleep is vital to building a healthy body. Yankowy is adamant that better patient outcomes are the very achievable end goal with his program, and so far, the numbers back up that claim.
Ultimately, Yankowy envisions CIM will help staff bring more empathy and compassion to the job. Sterner sees major promise in both the CIM program and the perioperative screening process, another ambitious project in the works within the WellSpan sleep network.
WellSpan’s Perioperative Screening Process
Like any great sleep director, Sterner stays up at night trying to find ways to improve her patient care journey. What’s going to make getting a sleep test easier? That’s a bit of a guiding light for WellSpan’s team. It is that constant, persistent drive to improve patient care that fuels Sterner’s vision for perioperative OSA testing. Perioperative, meaning prior to, during, and after surgery care for obstructive sleep apnea, is about the overall patient care journey.
“Our team really cares about the complete care continuum. The perioperative initiative is based on principles established by the SASM (Society of Anesthesia and Sleep Medicine). We quickly realized we were NOT following their path. Repeat: we were not. We also knew we wanted to not only follow guidelines, but set a new standard of care,” said Sterner.
While assessing their situation, they realized they were not on the same level as SASM principles, and there was a lot of activity within the system to get there. In her mind, the urgency of surgery was always a key barrier. You simply can’t delay surgeries in the majority of scenarios, so the traditional pre-screening process included challenges. However, many surgical patients also suffer from OSA, with a large portion of that group undiagnosed. Fortunately, WellSpan had recently hired a physician champion who also cared passionately about improving OSA diagnosis within this population, Dr. Arnaldo Valadon, MD.
Dr. Valadon oversees the Hanover surgery center, and after moving over from Maryland, he quickly reached out to Sterner to discuss the screening process. Dr. Valadon, Sterner, and others on the WellSpan team developed a new process to implement that will have major impacts on downstream patient costs. It’s an expensive process, with much of the cost up front. That said, the program will pay substantial dividends over time as it saves on additional costs associated with hospital readmissions among patients with OSA and other comorbidities.
“Some research says that 60% of OSA surgery patients are undiagnosed, which likely puts the estimate at 6-7% of all outpatient surgeries. In our new perioperative program, patients would get screened, tested, and treated, all within the same program.” said Sterner.
Talk about a holistic solution for thousands of people suffering from OSA in the Pennsylvania communities.
Keeping the Momentum Going
Between the HSAT, perioperative, and CIM programs, Sterner and the WellSpan sleep team have a lot on their plate. They are determined to build out a sleep continuum in the WellSpan network that will improve patient care and ease of use when it comes to sleep testing and CPAP usage.
“We’ve gotten so far in just 5 years. People would have said we were 20 years behind, but now, we’re moving toward the cutting edge of sleep medicine,” said Sterner. “I have the most amazing team of leaders and staff at WellSpan, and I know we have the right ideas on the horizon to continue this momentum.”
We’re excited to see your continued growth, Luke and Tammy, and the entire WellSpan team. Thank you for taking time to chat with us. For those looking for another story, check out some of our past articles: