FCC Healthcare Connect Fund Network Plan

FCC Healthcare Connect Fund Network Plan GEISINGER HEALTH SYSTEM Devised December 26, 2013 Revised September 29, 2016 1

Revised December 13, 2016 Revised April 27, 2017 Network Plan Narrative Geisinger Health System (Geisinger) is an integrated health services organization widely recognized for its innovative use of the electronic health record, development and implementation of innovative care models, including ProvenHealth Navigator, advanced medical home model, and ProvenCare programs. The system serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania. 78% percent of the population in the Geisinger service area resides in rural-designated counties, and greater than 60% of the population has one or more chronic health conditions. In addition, 18% of Geisinger s service area population is aged 65 years or older and represents a growing age cohort in every county. These geographic, condition and age factors create barriers to care, inhibiting early intervention and negatively impacting longitudinal disease management. In addition, the population of those aged 65 and older will more than double from 50 million to 89 million by 2050. Keeping care local represents a core Geisinger mission. Many rural community hospitals transfer patients to Geisinger (and other regional referral centers) who, if effective care teams and evidence-based care processes were in place, could remain at their own local facilities. While this low-acuity transfer volume is detrimental to the financial stability of rural hospitals, it also strains capacity at referral facilities by denying beds and specialist care to patients who truly require tertiary care. To help address these barriers and challenges, Geisinger is expanding our telemedicine program to improve access, reduce patient travel, and create efficiencies for optimal deployment of Geisinger specialists. Unlike urban centers, many community hospitals, especially those in rural areas which serve many un-insured and under-insured patients, have operating margins that are small with little capital to grow or implement new technology solutions. Without funding, facilities would not be able to afford telecommunication line costs as well as telemedicine equipment, and they would be forced to either seek interest-bearing loans or not implement a telemedicine solution at all. Because 65% of the telecommunication line is funded by the FCC and the remaining 35% is funded by Geisinger, it allows the outlying hospital to be able to purchase the much-needed telemedicine equipment without jeopardizing their already-lean budget. Experience shows that if assistance is available to get a telemedicine program off the ground, we typically see that sustainability follows. Geisinger s proven experience in coordinating multiple stakeholders and managing technology-enhanced patient care will provide this project with the infrastructure and staff necessary to accomplish the goals of this program effectively and efficiently. Our demonstrated leadership in leading large collaborations helps ensure the successful implementation of this program. 2

(1) Goals and Objectives of the Network Geisinger is committed to extending the telemedicine services throughout northeastern and central Pennsylvania to benefit patients and providers in rural and medically under-served areas. When Geisinger originally applied for FCC Rural Healthcare Pilot funds, our immediate focus was on trauma image transfer, tele-echo, and improving bandwidth of poor-performing or non-existent digital connections. As Geisinger s telemedicine program broadened, the project direction changed to focusing on fitting the specific needs of the outlying hospitals in our region. Our telemedicine program is not one-size-fits-all, but more of an a la carte model. One of our first lessons learned was that that not all facilities have the same healthcare gaps, and we have the ability to offer telemedicine services as they are needed instead of a bundled approach. Geisinger will continue to focus on offering telemedicine services based on the needs of the outlying community hospitals and their patients while keeping them in a close-to-home setting. We have worked with another Pennsylvania FCC Pilot Consortium and will continue to work with them in the Healthcare Connect Fund (HCF) project to determine the best option for primary and back-up telecommunication lines. This collaboration offers the best solution to deliver telemedicine to patients in our service area while keeping costs low. In addition to evaluating outlying community hospital needs, Geisinger-owned community practice clinic sites also have gaps. Our program will expand clinic site connectivity by ramping up telemedicine services in these Geisinger-owned facilities. The Geisinger Health System Consortium s goals and objectives will be to expand our proven telemedicine model by: Increasing connectivity to additional non-geisinger and Geisinger facilities Providing specialty resources to community hospitals which enables patients to receive the same level of care regardless of location Working closely with other HCF Consortia projects Preserving local employment and the ability to care for patients closer to home Improving overall rural healthcare across our service area Decreasing healthcare costs by decreasing transfers to tertiary care centers Applying for funding related to research and education-based endeavors (2) Strategy for aggregating the specific needs of health care providers (including providers that serve rural areas) within a state or region We continue to work with outlying community hospitals to install the appropriate size bandwidth at the most cost-effective price to offer the telemedicine services that are needed for their particular situation. The primary trends that will drive telemedicine growth include a growing shortage of specialty services at rural hospitals, the need for hospitals to reduce readmissions, the need for skilled nursing facilities (SNFs) and home care providers to treat in-place and growing consumer demand. Geisinger s intent is simply to aggregate the increasing broadband connectivity needs of Geisinger s telemedicine mission to obtain better pricing. 3

(3) Strategy for leveraging existing technology to adopt the most efficient and cost-effective means of connecting those providers Through bulk buying and challenging vendors to reduce costs through competitive bidding, Geisinger has been able to leverage existing build-outs owned and operated by vendors throughout the state and obtain reasonably priced telecommunication lines to provide the most efficient and cost effective means for laying the foundation for our telemedicine program. Layering specialty services one at a time on the foundation made our program a success. Not every outlying community hospital has the same healthcare needs. By leveraging existing technology and offering the right telemedicine service when it is needed, this has proved to be an efficient and cost-effective approach to our Pilot project. We will continue to use the scalable a la carte approach in the HCF project and have the flexibility to increase individual broadband size as telemedicine services expand. We will continue to collaborate with other Healthcare Connect Fund Consortiums like Pennsylvania Mountains Healthcare Alliance (PMHA) to choose the most cost-effective method of delivering telemedicine services over existing broadband lines. In addition to telemedicine, primary care delivery and ProvenHealth Navigator deployment across Geisinger Community Practice Service Line (CPSL) clinic sites also requires broadband connectivity for electronic health record use. Geisinger s electronic health record (EHR) is fully implemented and integrated across all Geisinger ambulatory and inpatient care sites and is utilized by clinicians for in-patient and outpatient care with integrated electronic scheduling, clinical lab and radiology systems. (4) How the supported network will be used to improve or provide healthcare delivery To ensure a broad-based approach to health management for our managed care population, a mix of Geisinger outpatient clinic sites, outlying community hospitals and possibly SNFs will participate in this project in order to adequately cover all spectrums and enable growth in telemedicine services. Geisinger s telemedicine program enables better-coordinated care for patients with acute and chronic needs, inpatient and ambulatory patients, as well as post-acute populations. Recent research revealed: TelePsychiatry: Patients drove approximately 10,000 fewer miles (FY12) TeleDermatology: Patients are seen within 7-30 days (the average wait time to see a dermatologist nationally is > 90 days) TeleStroke: Rural hospitals kept 48% more stroke patients (FY11-FY12) TeleRheumatology: Telemedicine improved the wait time for new patients by approximately 30 days (FY12). VirtualSleep: Patients are evaluated for over 80 different sleep disorders, and over 90% of appointment slots are filled (FY13) Maternal Fetal Monitoring: Though a new Verizon grant, each year an estimated 450 pregnant women with possible multiple conditions can be effectively managed without having to leave their local area (FY13) Tele-ICU programs at two of our participating community hospitals have decreased length of stay for ICU and hospital patients, improved mortality rates for ICU patients, and reduced hospital transport costs. 4

(5) Any previous experience in developing and managing health information technology (including telemedicine) programs During Geisinger s pilot program participation, telehealth statistics quickly showed a sustainable program. In a timeframe of six months, 25 telestroke consults were performed, along with 189 pediatric echo consults, and 140 trauma CT transfers. This is a win-win situation for all involved since it addresses the nationally- recognized shortage of specialty physicians in rural and medically underserved areas and allowed community hospitals to care for patients and their families close to home through consultative services while retaining the much needed revenue at their facility. By the end of the Pilot program, the total Fiscal Year 2012 telemedicine volume was 44,577 store-andforward (asynchronous) consults, and 5,732 audio-video (synchronous) consults, with each eicu patient counted as one encounter. The RHCPP ended in June 2013, and the FCC has transitioned into a new program, termed the Healthcare Connect Fund (HCF). With the program s goal in mind, Geisinger will focus on improving the quality of health care available to patients in rural communities by implementing broadband for telemedicine services. Through collaborations with multiple community hospitals, Geisinger IT has developed the knowledge and expertise to manage and coordinate high-level telemedicine implementations by identifying barriers to educate and coach IT resources at rural hospitals (and their third-party vendors). This is done in a step-bystep process through workflow designs, implementation guides, fact sheets, and toolkits. Geisinger IT adheres to industry standards, policies and procedures in the development, implementation, testing and deployment of telemedicine services. Over the years, we have shared our lessons learned regarding engaging rural hospitals in telemedicine with regional, state and national organizations. Sharing knowledge supports our long-lived investment in advanced technology and an unwavering commitment to innovation. (6) A project management plan outlining the project s leadership and management structure, and a work plan, schedule and budget This project approach parallels the Project Management Institute (PMI) agile methodology, where Scrum team members from Geisinger s implementation team, vendors, and customer sites check in daily to manage the various development, implementation, and support projects. Project management processes such as initiating, planning, executing, monitoring, and controlling and closing (IPEMCC) are utilized and repeated for each task. The traditional project management processes have been implemented, reviewed, and corrected over time to deliver a successful project. Geisinger uses a phased approach to executing projects, where each phase uses iterative, simultaneous, and phase-to-phase sequential relationships for task execution. Typically, one phase must be completed before the next phase can begin. However, other Geisinger and vendor independent sequences can often occur in parallel. Geisinger manages risks proactively and deploys multiple mitigation strategies for the successful execution of each project. The approach for managing and monitoring risks for this project includes a methodical process by which the project team identifies the risk and reduces the likelihood that the event will occur to 5

reduce any adverse impact on the project. The approach includes conducting risk assessments, performance measures, escalations, and rapid decision making to mitigate risks. Risk assessment is completed by a senior project manager upon the kickoff of every project phase. Risks will be re-evaluated at each major milestone to reassess the overall project timeline. Risks arising due to time, scope, and cost will be documented, evaluated, and mitigated through a series of meetings and/or leadership engagement. Some anticipated risks associated with this project are: Vendor alignment, so each vendor that Geisinger currently contracts with for unfunded lines is willing to participate and bid for RFP(s) associated with HCF program inclusion Vendor willingness to alter existing multi-year contracts without charging Geisinger financial penalties, which would delay implementation at related sites No bids are received for functionally-equivalent service, i.e., service that meets the technical requirements of the situation Non-Geisinger hospitals slated to join the Program decline participation In our RFP, we ask vendors to include actual, detailed cost information as well as implementation schedules. The timeline for the RFP16 project is as follows: Posting of RFP16 (28 days) ACSD and Competitive bid evaluation period (7 days after posting ends) Vendor Award Notification and Contract Negotiations (1 day after end of competitive bid evaluation period) Equipment Purchases (to start after Award Notifications) An HCF Management Oversight Committee was formed, with responsibility to: Implement and oversee the HCF specific to site selection and inclusion (including bandwidth determination, and telemedicine need) Optimize HCF funding (by maintaining a 51/49 balance of rural versus non-rural sites) Monitor the HCF for potential inclusion of new site types (e.g., SNFs) The HCF Management Oversight Committee (Exhibit A) will be chaired by Scott Davis and will include Mary Honicker, Bob Murcek, Tim Barrett, Scott Davis, Gary Zack and a CPSL leader (Matt Nussbaum). Day-to-day HCF operational management, reporting updates and FCC and USAC relationship management and connectivity coordination functions will be performed by Mary Honicker and Lori Goss. Connectivity costs and vendor relations will be managed by Tim Barrett. Budget: Unlike urban centers, many community hospitals, especially those in rural areas which serve many uninsured and under-insured patients, have operating margins that are small with little capital to grow or implement new technology solutions. Without funding, facilities would not be able to afford 6

telecommunication line costs as well as telemedicine equipment and would be forced to either seek interest-bearing loans or not implement a telemedicine solution at all. 65% of the telecommunication line is funded by the FCC and the remaining 35% matching contribution will be funded from Geisinger s operating income. This 35% match will include all sites within the Geisinger Consortium. Ineligible sites will also be funded out of Geisinger s operating income. This arrangement allows the non-geisinger community hospitals to be able to purchase the much-needed telemedicine equipment without jeopardizing their already-lean budget. 7

Exhibit A FCC Health Care Connect Fund Geisinger Consortium Management Structure HCF Management Oversight Committee Committee Members: Chair Scott Davis (VP, Achieving Excellence), Bob Murcek (Director, IT Network Infrastructure), Mary Honicker (Program Director), Gary Zack (Director, IT External Customer Relations), Matt Nussbaum (AVP, Regional Operations, CPSL Administration) and Tim Barrett (Data Network Analyst) Scott Davis Geisinger Consortium Leader Mary Honicker Geisinger Consortium Project Coordinator Internet Service Providers Geisinger Telemedicine Analysts Telemedicine Work Group Geisinger Network Analysts Lori Goss Geisinger Consortium Associate Project Coordinator USAC MyPortal Geisinger Accounts Payable Geisinger will transition the existing FCC RHCPP Pilot sites to the new HCF Program and upgrade designated lines where appropriate, as well as request funding for new participating sites. Geisinger s skilled IT professional services team will provide the boots on the ground necessary for the coordination of new broadband terminations and implementation of telemedicine services. These personnel will work on-site and remotely to ensure all deliverables are completed in a timely manner and to the complete satisfaction of the clinical and administrative customers. In summary, Geisinger has demonstrated the ability to work with multiple partners to develop coordinated care processes, to support them with HIT, and to deliver telemedicine services beyond organizational boundaries. We plan to use this funding to improve access, reduce patient travel and create better outcomes for our patients. 8