Guiding principles. The spectrum of home based hospital care 4/26/2018. Consistent with Triple Aim. Safe. Patient Centered

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1 Lake Superior QIN: 2018 Readmissions Action Learning Day April 30, 2018 Guiding principles Consistent with Triple Aim Safe Patient Centered Create new business opportunities and benefits for HealthPartners 2 The spectrum of home based hospital care 1

2 Hospital care and more in the patient s home Innovative care model Early discharge of patients, to provide remaining hospital-level care in patients home Cost effective alternative Improves inpatient acute care access and flow Supported by technology Safe and high quality Follow and monitor patient for up to 90 days post-acute 4 Why Congestive Heart Failure Increasing number of patients with congestive heart failure Patients with the condition typically have longer hospital stays Sometime the last two days of hospitalization focus only on monitoring vitals Hospital + Home Feasibility Pilot Hospital at Home Education Wellness From Day 0 to Days 4-7 From Days 4-7 to Days Through 90 days 2

3 Detailed selection criteria Conditional Exclusions (subject to daily review) Worsening respiratory status Unstable arrhythmias and vitals New EKG findings not yet resolved Needing vasopressor support to stabilize blood pressure Cognitive delay without adequate in-home support Myocardial Infarct within last three months (need cardiologist input) Homebound preferred but not required At the discretion of the care team Permanent Exclusions Anyone not responding to CHF treatment Needing dialysis (does not include patients in Renal Failure, only patients with current dialysis needs excluded) History of IV drug use in last 10 years Living greater than 25 miles away from hospital (we can be flexible here to some extent and should be evaluated on a case by case basis depending on our in-home staffing) Severe Aortic Stenosis Pilot summary In the first few days, patient received physician and community paramedic visits in the home Pharmacy completed an in-home medication assessment (MTM) Five days worth of heart healthy meals provided Dietary/Nutrition consulted with the patient on proper eating inhome For 90 days, the patient had technology monitoring their vitals and received in-home visits Frequency of visits were determined by the level of care needed for the patient Triple aim results Experience 83% Top Box (rating scale of 1 to 10 with 10 the best) 100% surveyed said they would recommend program to others Individual patient stories about the program and it s benefit to them Health 90% compliance with daily health checks On average 16 interventions/interactions per patient due to our monitoring Zero patient falls or incidents of delirium 3

4 Patient Volume Qualified Patients Regions - 23 Methodist 24 Total Program 47 Patients Enrolled Regions - 10 Methodist 4 Total Program 14 Enrollment Pause- December 18, 2018 Still screening qualified patients and putting into Community Paramedic program at Regions Enrollment Percentage Regions 43% Methodist 17% Total Program 30% Quality and LOS Data Patients Readmitted Regions 1 patient (10% overall rate) Methodist 1 patient (25% overall rate) Total Program 2 patients (14%) Inpatient Hospital Length of Stay (average) Regions 3.9 days Methodist 2.5 days Total Program 3.4 days Inpatient Hospital Expected Length of Stay (average) Regions 6.9 days Methodist 3.75 days Total Program 6.0 days Quality and LOS Data Saved Bed Days Regions 31days (3.1 days per patient) Methodist 5 Days (1.25 days per patient) Total Program 36 days (2.6 days per patient) In-home Home Length of Stay (average) Regions 7.3 days Methodist 10 days Total Program 8.1 days 4

5 Visit Data Regions Home 13 visits per patient Methodist Home 27.2 visits per patient Regions Video 0 visits per patient Methodist Video 0.5 visits per patient Regions Phone 7.5 visits per patient Methodist Phone 16.8 visits per patient Regions Total Patient Touches 205 visits (20.5 per patient) Methodist Total Patient Touches 178 visits (44.5 per patient) Patient feedback and stories *not an actual patient pictured 5

6 Lessons learned Clinician Variation Enrollment and Screening Medications Documentation, finances, and data tracking Medtronic Technology Ancillary and Support Services Food/ Nutrition Lab Processing Thank you For more information, please contact: Rory Malloy or Tia Radant - Community Paramedicine Chrisanne Timpe, MD Medical Director Homebased Medicine 6