Mercy Health System TeleMedicine 2012 HOSPITALS 25 acute care hospitals 6 managed hospitals 3 heart hospitals 2 children's hospitals 1 rehab hospital MISSOURI STATS: >1.5 million people served 1,071 integrated physicians 413 primary care physicians 9 acute care hospitals 134 clinic locations LEGEND Hospital Managed Hospital Ambulatory Facility Urgent Care AMBULATORY SERVICES 233 clinic locations 27 urgent care centers 7 outpatient surgery centers 4 retail clinics MEDICAL STAFF & CO-WORKERS 37,000 co-workers 1,580 integrated physicians 5,369 active medical staff (includes integrated and non-integrated physicians: OHH) 619 advanced practitioners UTILIZATION 3,937 staffed beds 574,666 ED visits (FY11) 6,566,057 outpatient visits (FY11) 160,382 inpatient discharges (FY11) 2 What are we solving for a new model of care • Access to Care – Primary Care – Specialty Care • Provider Shortages – PCP and Specialty • Cost pressures – Hospital will be a cost center and not a revenue center • Patient Centeredness – High service model Mercy’s Center for Tele Health and Innovation Virtual Care Center Chief Innovation Officer Medical Director Operations Director Clinical Ops VP Operations Director Tele – Medicine Care Model Delivery Virtual Care Population Management Centralized HUB Model Resources have a central feel and central supervision Decentralized Consult Resources are distributed although Scheduling and supervision are central Store and Forward Resources may be either central or distributed encounter is asynchronous and my involve images and or consultation Collaboration Resources are distributed and are outside of Mercy encounter is asynchronous and my involve images and or consultation Chronic Care Management Scheduling Call Center Scheduling & referral management Care Coordination Nurse on Call Center Post Acute Care E-Visits 24/7 Asynchronous Home Health Support Care EHR support Medical Director Operations Director Center for Innovation Epic Informaticist Research Care Delivery Innovation Grants Analytics Tele-Medicine Division Connector Tele – Medicine Virtual Care Asynchronous 24-7 e-visit support Store + Forward patient visits Medical Director Of Critical Care Services & special projects Store and Forward Decentralized Consult Radiology Pathology Dermatology Specialist/patient Specialist/physician Imaging from Critical Access Facilities Pediatric Cardiac Echo’s and EEG’s 15 Specialties Video Remote Interpretation Selected as spine destination Tele-Stroke network Telemedicine core infrastructure Distributed Scheduling Credentialing/Licensing HR Finance Reimbursement management Analytics (CIC?) Epic expertise Account Management Customer relations/Call center Centralized HUB Model e-ICU e-LTAC Tele-Sepsis e-Hospital e-after care home monitoring Mercy’s ACO Readiness: Inpatient hospital utilization management – Avoiding medically unnecessary admissions – Avoiding medically unnecessary discharge delays – Aligned hospitalist programs Outpatient utilization management Case and chronic condition (disease) management Primary care population management – Primary care e-visits – Specialist e-consults – Urgent care centers – Aligned provider incentive programs Mature PCP-driven group practice – Extended office hours – Incorporation of advanced practice RNs and/or PAs Components of Milliman’s study on accountable care organization (ACO) models Impact on Medicare – 8.25% Commercial – 9.61% into primary care “teams” – 24 hour on-call access for patients 6 Virtual Care Services ACO contracts Medicare Advantage – 30,000 lives CMS – ACO – 250,000 lives Traditional FFS contracts < 10% Analytics Medical Home e-ICU >50% Shared Savings/Risk Contracts School Clinics Work site clinics After Care Models e-Hospitals Telespecialty e-Hospitals Community clinics e-SNF VRI e-LTACH EHR Optimization Tele-med Primary Care Video Remote Care Coordination Interpretation Tele - Sepsis Access Family Support Remote Rounding Community Kiosks Navigator Services Tele Surgical f/u E-ICU & TeleVolume stroke Market share PHR EHR support e-NICU Convenient care Predictive Modeling E-visit 24/7 Store & Forward Concierge’s Service Nurse on Call Tele-Home Health Home Monitoring Palliative Care E-ICU + tele-stroke • ICU mortality rates 20% below predicted • 30% reduction in ICU length of stay • 50% decrease in Central Line Blood Stream Infections • >95% compliance with VAP bundle protocols and corresponding significant decline in VAP cases • Tele-stroke – trebled the appropriate use of tPa in Arkansas ER setting Sepsis • Mortality decrease with people in severe sepsis and septic shock of 50% and 60% respectively • Compliance with sepsis bundles increased by 30-40% • ICU LOS – decreased from 8.16 days to 3.43 days • Over 9 months of the program – 100 lives were saved. Video Remote Interpretation VRI • In 2007, over 55 million Americans spoke a language other than English at home • Represents nearly 20% of the population • Increased from 14% of the US population in 1990 and 11% in 1980 •Less likely to have a “usual” source of medical care •They receive preventive services at reduced rates •They have an increased risk of non adherence to medication •Children with asthma have an increased of intubation •Higher rates of hospitalizations and medication complications •Greater resources are used in their care and they have lower levels of patient satisfaction Mercy Health System TeleMedicine 2012