A Chronic Care Success Story: Remote Patient Monitoring in Rural Mississippi February 19, 2017
UMMC Telehealth by the numbers 500,000+ patients helped since 2003 200+ UMMC available specialists 35+ specialty services and growing 200+ Locations, with new locations weekly 3
What is Telehealth? Telehealth lets doctors examine and treat patients remotely, in real time, using online streaming video technology and interactive tools. PA TIENT & LOCA L CLINICIA N USING UM M C S ONLINE TELEHEA LTH TOOLS UM M C SPECIA LISTS 4
Why is Telehealth Important? Currently, 53 of Mississippi s 82 counties are more than a 40- minute drive from specialty care. UMMC CENTER FOR TELEHEALTH Provides specialty care that is convenient for patients Offers vital support for primary care physicians Helps decrease the cost of care and improve patient outcomes Supports population health in underserved areas Provides interactive distance education for providers to improve quality of care
Healthcare Disparities & Access 60% of Mississippians live in Rural Areas 37% live in Medically Underserved Areas Mississippi s ED visits per capita are among the highest in the U.S. 68% of Mississippi s physicians are located in urban/metro areas 64% of Mississippians drive at least 40 minutes for specialty care
Sustainable Change via RPM: Engaging the PCP s & Patients Knowledge + Engagement + Support Knowledge Phase 1 Engagement Phase 2 Behavior Change Phase 3 Personal Empowerment Phase 4 7
Remote Patient Monitoring (RPM) Chronic disease management in the patient s home including: Daily Health Sessions Personalized Interventions Targeted Education Health Coach Behavior Modification Patient Empowerment
Empowering Patient with Technology Education is not a building it is learning and I ve learned so much! This program works. I have learned more in this program than I did when I was in a hospital. I never thought to look into my shoes I have learned more in the few months of being in this program than I have in 17 years of having diabetes
MS Diabetes Telehealth Network HbA1c 1.7% Medication Compliance 96% Health Session Compliance 83% Retinopathy Found 9 cases Weight Loss 71 pounds Miles Saved 9,454.11 No Hospitalizations or ER visits for DM Preliminary results on first 100 patients
MS Diabetes Telehealth Network Update Study completed September 2016 Data Analysis and publication coming early 2017
How does RPM work? Below, is our link to a video from how RPM works: https://vimeo.com/171851210/94002717bf The video shows the interactionof the variousstakeholders,which are involvedwith the care of a patient, trying to manageseveralchronic conditions.
Expanding UMMC Borders UMMC s RemotePatient Monitoring A national strategy to address community healthcare needs Better health one person at a time 2017
Better health; one person at a time UMMC s depth and reach to address Telehealth's challenges locally, regionally and nationally Strategy Smart Spending Smart Savings Method Progress Invest and innovate in way breaking through cost, quality and access challenges Effective technology Cost- effective delivery Investment and Partnerships Research and Development in technological innovations Lower cost, expand capacity and improve performance Enable care for more patients within existing facilities Extend access to wider populations Discipline, accountability and transparency Apply methodologies: identify health needs, technology and strategic partnerships Validate disciplines: decreased cost, improved quality and increased access Use state and national resources to address healthcare needs, trends and behaviors Use integration of telehealth and RPM services to transform patient and family centered care models in order to accelerate value creation in a fiscally sustainable way
Collaborations with Organizations, Payers & Providers: Tackling Chronic Care Leader in Telehealth Services AMA United Health Cigna HealthSprings Magnolia Molina HIMSS ACASE The Universityof Mississippi MedicalCenterhas three missions: education,researchand patient care.
Cost Effective Care for 130M Chronically ill 5% 15MPatients Limited Scope: high-cost, high acuity, and high- touch High Risk 10% At- Risk 35% Healthy 50% 130M Patients Opportunity: Patient-focused, mobile technology yields scalable, low-cost care for entire chronic population Source: IMS Institute report and AHRQ analysis of spending data using Medical Expenditure Panel Survey
Medicare DPP Market Opportunity DPP CMS Expansionof Medicare Diabetes Prevention Program Model. 30M >250M 1.8M USA MS SE Region LA, AR, TN, AL
Business Strategy: Addressing healthcare needs through RPM, telehealth and collaborations 1. Evidence Development: Interest is in gathering evidence around reducing cost and/or increasing quality or access Cigna HealthSprings United HIMSS Connected Health Initiative 2. Development/Innovation: COE or Pilot sites for new solutions targeting reducing cost and/or increasing quality or access AMA CMS On3Health 3. Community Programs: Interest is in programs addressing Population Health Revitalizations AMA CDC Virtual DPP 4. Leadership Commitment: Collaborate with UMMC-TH Locally, Regionally, and Nationally AMA HIMSS UNITED Cigna Healthsprings On3Health CHI
Preventative We can start to impact modifiable risk factors which contribute to chronic disease Tobacco use Alcohol consumption Physical activity Diet High blood pressure High cholesterol weight It has estimate that if the major risk factors for chronic diseases were eliminated, at least 80% of all heart disease, stroke, type 2 diabetes, and 40% of all cancer cases would be prevented. 1 How much could this save you? 1 Report on the Burden of Chronic Diseases in MS, 2014 (2014). MSDH. Retrieved from http://msdh.ms.gov/msdhsite/_static/resources/4775.pdf
UMMC Virtual Care Platform The easiest way to manage and prevent lifestyle diseases, anywhere. VIRTUAL HUB TARGETED PROGRAMS INTEGRATED BIOMETRICS SECURE COMMUNICATIONS SOCIAL GROUPS
Virtual Approach to expand the benefits of traditional DPP Traditional DPP Limitations Requires physical meeting location Fixed weekly meeting schedule Cohort-based queuing UMMC Virtual DPP Accessible anywhere (web + mobile) Self-directed pace Flexible start date Convenience Value Broader participant pool Continuous engagement Extended opportunity to complete program sessions Operational efficiency Optimize health coach case load Paper-based curriculum/logging Multimedia learning + Automated tracking Cater to diverse learning styles Accurate / transmittable data
Plan to Play: Clinical Alignment and Resource Effectiveness 5 Demonstrate the ability to transform Telehealth Own Solutions 1 4 Become THE preferred TH partner Solve important care continuum issues from within Telehealth networks Make UMMC easy to do business with Mobilize BD/Clinical/IT teams to make a difference 2 3
Resources Link to the PDF physician survey: https://www.ama-assn.org/sites/default/files/mediabrowser/specialty%20group/washington/ama-digital-health-report923.pdf Michael L Hodgkins, MD, MPH Chief Medical Information Officer American Medical Association Michael.hodgkins@ama-assn.org
AMA Digital Health Study Physicians motivations and requirements for adopting digital clinical tools Heavier users tend to be PCPs and physicians in large and complex practices Physicians want digital healthcare tools to do what they do better Physicians require digital tools to fit within their existing systems and practices Physicians want to be part of the decision making but they look to others as well
Remote Monitoring for Efficiency Smart versions of common clinical devices such as thermometers, blood pressure cuffs, and scales that automatically record readings in the patient record so you do not have to type it This tool has not yet cross the chasm of adoption but there is some enthusiasm, driven by PCPs. It would need to be proven to improve efficiency and diagnostic ability while being well integrated into current data systems
RPM Drivers among Physicians where Tool is Relevant, but Not Yet Used Most Attractive Elements Above average importance & ranking Improves work efficiency, Improves diagnostic ability, Increases patient safety, Increases patient convenience, Increases patient adherence & Improves patient-doc relationship Key Functional Requirements Above average importance & ranking 1. Well integrated with EHR 2. Data security assured by EHR vendor 3. As good as traditional care 4. Requires no special training
Remote Monitoring & Management for Improved Care Apps and devices for use by chronic disease patients for daily measurement of vital signs such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician's office. Alerts are generated as appropriate for missing or out of range readings. This tool has not yet cross the chasm of adoption but there is some enthusiasm, driven by PCPs. Improved safety and adherence would motivate use, as long as it was easy to adopt and well integrated with current systems base
Remote Monitoring & Management for Improved Care Point of Entry Actively target services to chronic patients. Facilitate communicationbetween sites of care with shared care pathways and protocols. Leverage PCP and specialist relationships to improve transitions and crossdisciplinary RPM care. Measure of Success Reduce potentially avoidable admissions by 35% or more. Cut cost per by 10% or more over the next year. Decrease the 30-Day Readmission Index, targeting 0.85 or a reduction of >50%.
Enthusiasm & Critical Drivers D. MELESSA (LESSA) PHILLIPS, M.D., M.P.H. Dr. Phillips is currently Medical Director for the United Healthcare Community Plan of Mississippi, one of the coordinated care organizations contracted to administer the Mississippi Division of Medicaid s MSCAN program. She is also the founder and president of Global Family Medicine, PLLC, an international primary care consulting firm. Dr. Phillips is Professor of Nursing and Professor Emeritus of Family Medicine at the University of Mississippi Medical Center (UMMC) in Jackson, Mississippi, and Adjunct Professor of Social Studies at Tulane University of New Orleans, Louisiana (Ridgeland, Mississippi campus). Dr. Elizabeth Stahl Received her undergraduate degree from Berry College, and her medical degree from the University of Alabama School of Medicine in Birmingham, AL. She completed both Internal Medicine residency training and her Endocrinology fellowship in Birmingham. She was in private practice for 19 years, with a special interest in the treatment of DM 1, polycystic ovary syndrome, and obesity, and transitioned to her current role as a medical director with Cigna-HealthSpring in December of 2013. She is very involved in population health as it relates to the needs of those with diabetes and its comorbid conditions. She believes strongly that most people with complex medical conditions want to take better care of themselves, but at times lack the tools and understanding to do so it is our job, as health care professionals, to empower these individuals through education, engagement and compassion and in doing so, we will hopefully improve outcomes and quality of life.
RPM Performance Solutions Strategy What We Do Lead Telehealth transformation by driving safer and more efficient patient care Shape Reform Solutions Area Capacity Management, Patient Safety, Strategy & Leadership, Care Design, Asset Management, Pursue value and population health driven business model Solutions Value Proposition Combine innovative technology with expertise to help payers & providers achieve health outcomes while sustaining operational and cultural changes Market Message Perform at the next level- Meeting patient needs across the continuum while optimizing Clinical Assets & Resource Effectiveness
UMMC s Clinical Alignment & Resource Optimization Our team is dedicated to helping healthcare organizations deliver better care and access to more patients at a lower cost, while providing resources and clinical expertise. Addressing today s quality, cost and access challenges. Expand Center Of Excellence Ensuring the right technology Marketing & Public Relations Driving cultural change via RPM Big swing strategies 100k+ Telehealth Visits a year Focus on patient experience 218 Sites of Services 35 Specialties DPP V/DPP CDC/AMA/CMS Population Health RPM Collaboration Care-Innovation AT&T GE C-Spire American Well On3Health Apple Health DELL Samsung MS Governor Academic Center UMMC Foundation CEO VC --MDs CHI Legislation SB2209 (2013) Parity SB2646 (2014) -S&F; RPM S&F; RPM S. 2484 CONNECT for Health Act (Schatz, Cochran, Wicker) Create culture of accountability and operational excellence Create a standardization philosophy for services and equipment Collaborations with key partners RPM Nationally CMS Virtual DPP AMA Direct-to-Consumer Rural expansion Belzoni HIMSS Case Study Excreta PA HIMSS/Parity
Michael Adcock & Matthew J. Rumbaugh UMMC Center for Telehealth @ummctelehealth