Reducing the Cost of Healthcare Delivery via Virtual Care

Transcription

1 Reducing the Cost of Healthcare Delivery via Virtual Care Tuesday April 14, 2015 Ronald F. Dixon MA, MD Assistant Professor of Medicine, Harvard Medical School Director for the Virtual Practice Project John W. Schmucker MBA Virtual Visits Lead DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Ronald Dixon MA, MD Has no real or apparent conflicts of interest to report. John Schmucker MBA Has no real or apparent conflicts of interest to report. HIMSS 2015

3 Learning Objectives Identify ways to decrease costs through virtual care delivery Diagnose potential barriers to adoption of virtual care in your organization Compare asynchronous and synchronous modes of virtual care delivery

4 Benefits Realized Through Virtual Care Research indicates that clinicians and patients have a high level of satisfaction with virtual care delivery modes Virtual care (asynchronous and synchronous) are being successfully used at MGH to deliver clinical care Asynchronous care delivery modes generate a high volume of valuable patient data Increasing patient involvement in their own care outside the practice setting can prevent advancement to higher disease states Clinician time and efficiency savings using asynchronous care modes results in cost savings

5 What is driving healthcare costs some things we already know Chronic Diseases $1.875 Trillion in annual health costs $3 out of every $4 spent on healthcare in the US Aging Population 1 in 8 Americans are : 65+ comprised 12.9% of the population 2030: 19% of the population is projected to be 65+ Hospital Readmissions In 2011 nearly 1 in 5 patients admitted to the hospital were readmitted within 30 days This represents an estimate preventable cost burden of $25 billion annually Source: Grace Terrell, Pres. and CEO Cornerstone Health Care 5

6 3 out of 5 face-to-face appointments could be VIRTUAL Patients with chronic disease (e.g. diabetes, depression) Patients with transportation/mobility challenges Caregiver and elderly parent Parent with child

7 Our research path to virtual care *Dixon RF, Stahl JE. A randomized trial of virtual visits in a general medicine practice. J Telemed Telecare. 2009; 15(3):115-7.

8 Our research path to virtual care 2009: Web Visits for Acute Conditions Commercial product 147 patients, 7 physicians, 231 web encounters over 5 months Convenience highly rated; user interface important Did not fit physician thought process or chronic care needs Barriers ** Virtual Practice Project research using Relay Health. Whitepaper: The Virtual Practice - Tomorrow s medicine, today.

9 Move patients to most efficient, least expensive, appropriate care mode Virtual Care: Asynchronous Visits % of Patients Move heavy Office Users to Virtual Care o Substitute some office visits with asynchronous evisits o Create capacity for new/more complex patients o Under global payments/capitation evisits would be less costly Engage high ED/hospital utilizers in nonhospital setting For low office users (low-low) encourage appropriate evisits and office visits to improve routine care/prevention High Office Utilization Low Office Users 19% 43% of visit volume! Low Users Low 70% Prolific Users 3% 8% Non-office Users Hospital Utilization (ED/Inpatient) High

10 Asynchronous evisits for Chronic Condition Follow-up A set of condition-specific questions that a patient answers in a secure website Clinician reviews answers and replies to patient with care plan/next steps 2012:eVisit Pilot Study 10 chronic conditions, 175 patients completed visits, 10 clinicians Average patient evisit time = 8.3 minutes Average clinician review time, including note = 3.6 minutes 5x efficiency gain for clinicians Dixon RF, Rao LR. Asynchronous Virtual Visits for the Follow-up of Chronic Conditions: A Telemedicine and e- Health, July, 2014

11 Asynchronous evisits Pilot Results Patient Experience (N=156) Physician Experience N=143 Dixon RF, Rao LR. Asynchronous Virtual Visits for the Follow-up of Chronic Conditions: A Pilot Study. In publication review Telemedicine and e-health

12 Telehealth Definitions: MGH Activity Visits (Provider to Patient) Real Time Synchronous Store and Forward Asynchronous Video Virtual Visit evisit Video visit between MGH MD and patient 1 Online exchange of medical info between MGH MD & patient 1 Consults (Provider to Provider) Virtual Consult econsult Video consult from MGH MD to patient s MD 2 Online consult from MGH MD to patient s local MD 2 1 Exchange where the provider gives the patient medical advice 2 Exchange where the MGH consultant Expert gives MGH provider or external community provider medical advice 12

13 Video Virtual Visits and Consults Volume Cumulative Volume: 2,816 Asynchronous evisits have been adopted more quickly April 2013 July 2013 October 2013 January 2014 April 2014 July 2014 October Asynchronous evisits Volume Cumulative Volume: 4, March 2013 July 2013 November 2013 March 2014 July 2014 November

14 What we know about change Most people initially resist rapid, complex change Complex change is typically accepted if enough time is allowed Rapid change can occur if it s a small adjustment Special challenges innovating inside a large organization Provider Approaches Patient Approaches Compensation is critical Minimal practice disruption mirror workflows Laser focus on efficiency Software targeted to solve a specific problem not overly ambitious or complex See YOUR physician, just in a different mode Access: recognize patient time and mobility constraints and provide a solution Patient participates in their own care outside the office Not a substitute for all visits

15 Group Discussion Brief introductions at your table Discussion questions: In your organization, what types of virtual care are being delivered? o How do you expect to realize cost savings? o Are they leading to measurable cost savings or improved outcomes? Why/Why not? What barriers have you encountered in implementing virtual care? o Have you been able to overcome them? Does the executive responsible for virtual care lead it enthusiastically? Is there a clinical champion? What unanswered issues/dilemmas does your table want to discuss in the larger group. Provide your perspective. Presentation and discussion of group findings

16 Thank You! Ron Dixon John Schmucker