Virtual Care
Using
g Health Information Technology
gy ((HIT)) to
Improve the Coordination of Care in the
Community
Hank Fanberg
CHRISTUS Health
PhD Candidate, University of New Orleans
Care Management - Vision
To expand access to care for the
underinsured through the
establishment
t bli h
t off well
ll coordinated,
di t d
sustainable community-based
collaborations in each CHRISTUS
Region; these community
collaborations should provide
accessible primary health care and a
p
array
y of affordable health
complete
and social services.
Care Management - Goals
CHRISTUS Health will pursue its vision
through the
development of a community based delivery
f
framework
k that
th t iincorporates
t the
th following
f ll i
complementary goals:
1. Development of essential health and
social service resources (“building
bl k ”) for
blocks”)
f the
th under-insured
d i
d
2. Proactive management of the underinsured who frequently access
ED/inpatient services for healthcare
CHRISTUS Health
$250 Million charity
Care in 2008
Relationship Between Household
Health
Status
and
Income
Income and Fair or Poor Health Status
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey 1995.
Relationship Between
Health
Status
and
Education
Ed
Education
ti and
d Income
I
SOURCE: U.S. Department of Commerce, Bureau of the Census, Current Population Survey, March 1997
Ranking
% Uninsured
Area
(Commonwealth Fund
2005
N = 51)
% Below Poverty
(US Census 2006
N = 50))
LA
47
49
9
NM
49
48
TX
51
43
Electronic Readmission Prediction Model
Developed at PHHS
Parkland is finding
that readmission rate
is 90% more related
to Social Severity
Index than to Clinical
interventions –
Predicted readm
mission rate
.6
.5
.4
.3
.2
.1
1
0
0
.1
.2
.3
.4
.5
O b s e rv e d re ad m is s ion s ra te
D eriv atio n (n = 11 1 6)
V a lid a tio n (n = 3 76 )
.6
Amarasingham, 2009
Building Blocks for a Healthy
Community
Expanded
Health
Insurance
Coverage
Medical
Home
(Provider)
Behavioral
Health
Services
Uninsured
U
i
d
In the
Community
Specialty
Care &
Diagnostic
Services
Enrollment :
Government
Programs
Transportation
Wellness &
Prevention
Dental
Services
Care
Navigation&
Management
g
Medications
& Home
Medical
Equipment
Synonyms
• Ambulatory Sensitive Conditions
– California; Catholic Health West
• Avoidable Hospitalizations
– Commonwealth Fund
• Preventable
P
t bl Hospitalizations
H
it li ti
– State of Texas DSHS
Chronic Illness
• Chronic illnesses require specialized and complex
t t
treatment
t protocols
t
l that
th t usually
ll involve
i
l a team
t
off health
h lth
care providers from a variety of disciplines.
• By using a variety of advanced telecommunication
t h i
techniques
and
d capabilities,
biliti
care can b
be d
delivered
li
d th
thatt
bridges geographic and synchronization distances.
• It is the nature of the interactions that are important and
not the physical presence of the entire care team at the
same place and time.
• Adopting a patient centric philosophy improves the
collection of monitoring data that supports clinical
decision making, not to mention the improved
communications.
What’ss Changed?
What
• PATIENT centric
• Geographic synchronization v. Time
synchronization
– Right place, wrong time (to quote Dr. John)
– Fact
F t versus perception
ti
• Improved communications
• Improved data collection
• Improved decision making
Disease Management - definition
• A set of coordinated healthcare
interventions and communications for
populations with conditions in which
patient self care efforts are significant.
• Disease Management Association of America
Information and Communication
T h l
Technology
(ICT)
• ICT introduces new ways to enhance and
supplement communication between
patient and provider
• and provider to provider
• ICT enables shift from institution centric to
patient centric systems
Virtual Care
• This approach
pp
is sometimes considered to be
creating “virtual care teams.”
• “Virtual” teams are founded with the purpose of
collectively
ll i l conducting
d i activities
i i i related
l d to care
delivery and education through the use of
telecommunications technology
• The virtual approach allows the patient to stay
home and be involved in the care delivery
process.
Tools for Virtual Care
•
•
•
•
•
•
•
Communications Networks
EMRs
PHRs
Interoperability
H
Home
monitoring
it i d
device
i
Cell Phone
Facebook & Twitter = the EMR of the
future
Tools for the Virtual Clinic
• Smart Grid and Agents
Emergency Department Visits*
C
Care
Managed C
Clients
N = 95
300
250
229
200
150
94
100
50
0
Pre
*Actively managed in second quarter (All Sites Combined)
Source: HPM
Seven sites reporting
•Includes annualized data
Note: Includes ED visits to CHRISTUS Health facility only
Post
Inpatient Admissions*
Care Managed Clients
N = 95
200
150
138
100
51
50
0
Pre
*Actively managed in second quarter (All Sites Combined)
S
Source:
HPM
Seven sites reporting
•Includes annualized data
Note: Includes admissions to CHRISTUS Health facility only
Post
Return on Investment
C
Care
Managed C
Clients
N = 95
$3 00
$3.00
$
$2.76
$2.50
$2.28
$2.01
$2.00
$1.67
$
$1.50
$1.00
$0.50
*Actively managed in second quarter (All Sites Combined)
3/31/2008
Source: HPM
Seven sites reporting
* Includes annualized data
6/30/2008
9/30/2008
12/31/2008
*
Average Cost of Care
C
Care
Managed C
Clients
N = 95
$20 000
$20,000
$18 390 *
$18,390
$17,513
$15,022
$15,000
$10,000
$7,387
$5 209
$5,209
$5,000
$0
Pre
Post
*Actively managed in second quarter (All Sites Combined)
6/30/2008
Source: HPM
Seven sites reporting
* Includes annualized data
9/30/2008
12/31/2008
$4,390*