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Examining the “Boomerang Effect”
Discussing financial implications for
Telehealth
Discussing Vidant Health’s Telehealth
Program and outcomes
Questions and Answers
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81 y.o: CVD, HF, DM, Arthritis
Exacerbation of Heart Failure
◦ Not following his diet
◦ Not taking all of his medications (8 meds)
◦ Not keeping PCP visits
◦ Low engagement level
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8 HF ER visits and 6 hospitalizations < 12 mos.
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Told he will be d/c home tomorrow
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PCP not alerted that Mr. Doe was hospitalized
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Given new prescriptions
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Told to schedule a PCP appt. in the next month
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Patient education:
◦ Smoking cessation
◦ Diabetes care
◦ Nutrition and cooking advice to him and his wife
◦ Must take BP meds even if he feels fine
◦ How to take his diuretics
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Forgets most of what was told to him @ D/C
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Can’t remember much/feeling OK-
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Not consistently compliant with diet, medication
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Doesn’t make PCP appointment
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Patient issues
◦ Don’t understand their medications
◦ Don’t understand how to follow prescribed diet
◦ Can’t afford their medications
◦ Can’t afford foods to follow their diet
◦ Low engagement level
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Hospital issues:
Focus: inside walls of the hospital
Post d/c service focus: HH & LTC
Incorrect or absent medication reconciliation
Extremely limited system of care transitions
Brief & fragmented patient education
PCP not contacted during hospitalization
Fragmented communication between
clinics/specialists/hospital
◦ Dictate to patients vs. engage them in their care
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To enhance the quality of life for
the people and communities we
serve, touch and support.
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Discharge
Options
Physician/Home
SNF
LTAC
Rehab
Home Health
Hospice
Patient
Hospital
Palliative Care
Remote Monitoring
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Remote Monitoring
Patient
Doctor
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Telehealth
Intervention
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Expand access to care
Improve healthcare value
Continuum of care
Best utilize capacity
Connect with local employers
Improve physician network
Improve employer health plan cost position
Develop care models of the future
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Reimbursement
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Reform penalties
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Capacity utilization
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It is all relative
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Overview and process
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Expectations
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Lessons learned
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Adaptation varied
Operational details
Length of monitoring assumptions
Data requirements
Keep the big picture in focus
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Stop Bonnie from beating on my door!
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Pilot enhanced continuity of care model
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Capture & quantify financial levers
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Back to
the Future
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Hey Norton - you
will get out of your
telehealth program
exactly what you
put into it!
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VH Telehealth Conceptual Model
Diagnostic
Transitions
In Care
Chronic Disease Mgt.
Friends & Family
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September 2012
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Access to Telehealth and care management for
hi-risk hi-cost patients
Reduce 30-day readmissions, hospital bed
days and ER visits
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Improve clinical outcomes
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Improve the patient’s perception of care
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Improve quality of health information
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Population:
In-patient CVD and Pulmonary patients
PAM Level I & II
Frequent ER visits/hospitalizations
Medicare/self pay/un/underinsured
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Services:
In-home medication reconciliation
Home Safety Assessment
Daily Biometric data monitoring
Weekly telephonic assessment, education,
coaching
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LOS:
3 months
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Access to Telehealth and care coordination for hi
& medium-risk VMG patients
Increase patient access to care
Improve quality of health information and
communication between hospital- home – PCP
Improve clinical outcomes
Improve the patient’s perception of care
Reduce health care costs
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Population:
Clinic based patients
PAM Level I & II – VMG Patients
PAM Level III with frequent ED/hospitalizations
Transfer from Transition in Care Program
monitoring
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Services:
In-home medication reconciliation
Home Safety Assessment
Daily Biometric data monitoring
Daily telephonic assessment, education,
coaching as needed
Bi-weekly assessment, education, coaching
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LOS:
6 months
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Population:
Graduates of TH TIC, TH CDM
VH Employees
Contracted Services (Nash, BasisHealth)
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Services:
Self management monitoring
Biometric data monitoring
Fee for service
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LOS:
TBD
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Clinical Data
◦ LDL, BP, Pulse, Height, Weight, HgA1c, oxygen
saturation
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Patient Satisfaction
Financial Outcomes- 90 days pre TH, during
TH, 30 days post TH
◦ Hospitalizations
◦ Bed Days
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(N=926)
22%
Medicare
10%
56%
Medicaid
12%
No Insurance/Self
Commerical
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(N=926)
44%
Male
56%
Female
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(N= 926)
3%
4%
2% 1%
3%
HTN
HF
33%
54%
COPD
CHF/HTN
Asthma
Asthma/ HTN
HF/HTN
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(N=926)
3%
13%
18%
19%
23%
24%
18-49
50-59
60-69
70-79
80-89
90-99
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(N =926)
2%
9%
9%
18%
34%
28%
< 30 days
30 days
60 days
90 days
current
> 90 days
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(N=325)
1%
43%
56%
STRONGLY AGREE
AGREE
DISAGREE
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Total Patients
(N=695)
Discharge Patients
(N=544)
900
800
772
700
600
500
90 Days Prior
400
During
300
200
30 Days Post
257
143
100
0
Reductions Of Hospitalizations
• Decreased by 69% Prior to During
• Decreased by 76% Prior to Post
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Total Patients
(N=695)
Discharged Patients
(N=544)
4,000
3,500
3,458
3,000
2,500
90 Days Prior
2,000
1,500
During
30 Days Post
1,124
1,000
753
500
0
Hospital Bed Days
Decreased by 67% Prior to During
Decreased by 81% Prior to Post
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8.0
7.0
7.0
6.0
6.0
5.0
5.0
Millions
Millions
8.0
4.0
3.0
4.0
3.0
2.0
2.0
1.0
1.0
-
-
Reimbursement
Hospitalization Costs
90 Days Prior
During
30 Days Post
90 Days Prior
During
30 Days Post
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Lower hospitalization cost
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Readmission aversion
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More effective and efficient care
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Improved access to care at the appropriate levels
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Greater patient satisfaction
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Reduces readmissions penalties exposure
Capacity – increasing CMI & fewer lost admissions
Expands margins
Reduces bad debt losses
Improved discharge planning process
Reduces employer health plan costs
Creates value proposition
Created retail opportunities
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At Hospital Discharge:
◦ D/C with the same medications & education
◦ Cardiologist & hospitalist make referral to TH
◦ TH referral received by Telehealth Team
◦ In-hospital enrollment
◦ PCP visit appt. made
◦ Home visit appt. made
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Patient conducts reading. Wt. increased by 2
lbs.
TH RN calls patient to review medication and
diet compliance
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See - Feel Change
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TH RN provides nutrition counseling
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Objective data:
◦ Wt. increased by 4 pounds
◦ O2 sat. decreased to 92%
◦ BP slightly elevated @ 145/90
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Subjective data:
◦ Reporting SOB and ankle edema
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Actions
◦ TH RN calls patient, conducts health assessment and
provides education
◦ Discovers patient ate Country Ham last night
◦ Didn’t take his Lasix because he had no money
◦ See - Feel Change
◦ TH RN contacts PCP
◦ PCP instructs pt. to come to clinic today
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Conducting in-home med. rec. & providing RPM
services result in:
◦ Early identification and tx of disease exacerbation
◦ Reduced hospitalizations
◦ Reduced bed days
◦ Reduced ER visits
◦ Reduced health care costs
◦ Ending the Boomerang Effect
◦ Active engaged patients
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