AI/AN Long Term Care Conference Chronic Disease Management Through Home Telehealth Monitoring May 2, 2010 Briefers: David T. Peters ANMC ANTHC IHS USCG VA US Air Force US Army US Navy
Legal Authority -- AFHCP Umbrella Agreement USCG Economy Act DoD Activities VA Indian Self-Determination Act ANTHC and Tribal Corporations Indian Health Service Alaska Native Medical Center Beneficiary Population: 276,189 (2008) - 40% of Alaska s 686,293 State Population DoD/DHS Other VA IHS/Tribal Note: Total Federal/Tribal Population includes both dual and triple beneficiaries
What are the Benefits? Regular monitoring helps avoid acute episodes Allows the patient to remain in the home longer Reduces outpatient visits, hospital admissions, readmissions and patient/family travel Increased patient compliance w/health advice Improved patient health and wellness Increases disease knowledge (cause and effect) Reduces costly Medevacs with early intervention Demonstrated real and substantial Cost Savings
Levels of Care - Alaska Tribal Health System Village-based services: Community Health Aide/Practitioners working in village clinics (180 sites in rural Alaska, majority without road access) Sub-regional services: Mid-level providers serving several villages (some regions) Regional services: Regional inpatient hospitals with physician, dental & behavioral health services (6 facilities) Statewide tertiary & specialty services: Alaska Native Medical Center (located in Anchorage) Contract Health Services: Coverage for private sector referrals beyond direct care system
Estimated Medevac Fixed-wing Travel Costs Medevac - Examples Costs from Rural Alaska to Anchorage $29,900 $37,600 $30,100 $24,400 $32,200 St George to Anchorage $32,700 $16,500
Robust and Operational Lifetime Care Chronic Disease Mgmt. Monitors placed in the home permanently Not an Episodic Care Model Partners with existing tribal systemsof-care 24/7 365 Care Center Notifications per Patient s Protocols Vital Sign Monitoring BP Pulse Glucose Weight SpO2 HTM Patients Statewide - 43 Communities
15 - Agreements In Place, 2 - Pending HTM Host Org Length HTM Host Org Length Bassett Army Community Hospital (US Army) 09/12 Eastern Aleutian Tribes 10/12 Aleutian Pribilof Islands Assoc 09/12 Maniilaq Health Association 10/12 ANMC Cardiology Dept 09/12 Copper River Native Assoc 10/12 Kenai - Dena'ina Health Clinic 09/12 Seldovia Village Tribal Clinic 4/13 SEARHC 09/12 3 rd Medical Group (USAF) 4/13 Metlakatla 09/12 Norton Sound Health Corp. 4/13 South Central Foundation 10/12 Bristol Bay Area Health Corp Pending Ninilchik 10/12 Tanana Tribal Council Pending Mt Sanford Tribal Consortium 10/12 What is Provided by AFHCP Equipment; ViTelCare Turtle 400 s with Peripherals 1 (800) Telephone Service for Sending Data 24/7 Call Center Services Data Analyses and Reporting Program Management Funding Advocacy Self-Sustainment Planning
Big Difference 24/7 Care Center (CST-LTL) Extremely valuable That which gets monitored, gets managed Health Organizations Benefit 24/7 Care Center pushes data to providers on per patient basis 24/7 Care Center -- 1st level of Triage for out-of parameter readings Less time spent on tracking Patient data and more time in managing patient performance actual and predictive analysis Filtered escalation -- Hierarchal notification trees work best The Patients benefit Regular feedback and interaction with education Cause and effect reinforcement Confidence knowing that vitals are monitored 100% of the time Huge Advantage - 24/7-365 Monitoring Monitors data/ health assessments 100% of time Checks on patients / encourages sending of data Tracks patient trends / sends reports to providers Culturally sensitive and appropriate contacts Empowers patient self-management Immediate Feedback Provides patient education - Cause and Effect Enhances program satisfaction and simplifies relationships Troubleshoots equipment / Creates Service Tickets
Communications Flow Diagram VitelCare Turtle 400
ViTelCare Turtle 400: Home Messaging Unit 8 Color touch screen with ICONS Voice and visual prompts Supports 4 medical devices simultaneously Optional manual entry screen Weighs 2.3 lbs Health assessment questions Integrated educational prompts Operates on Wired Phone & Broadbandand Documented Actual Return on Investment Category ANMC Patient A (CHF) ANMC Patient B (CHF) ANMC Patient C (Diabetic-CHF+) Pre-HTM Post-HTM Pre-HTM Post-HTM Pre-HTM Post-HTM # Medevacs 3 1 0 0 5 0 Hospitalization 6 1 3 0 5 (53days) 0 Emergency Room 5 1 3 0 5 0 Clinic Visits 5 2 7 7 4 1 Appointment No-Shows 0 0 4 0 UKN 0 ANMC Costs $249,420 $15,826 $119,804 $7,258 $307,558 $433 HTM (1x) + 24/7/yr $0 $2,380 $0 $2,380 $0 $2,380 Total Costs $249,420 $18,206 $119,804 $9,638 $307,558 $2,813 Cost before HTM Cost after HTM Costs Avoided ROI $676,782 $30,657 $646,125 2,107%
Patient Population Outcomes Patient Centered Self-Care : Compliance with Provider Instructions Increased Disease Knowledge and Self-Care Positive Reinforcement Improved Laboratory Results: HgbA1C: Sustain levels within Parameters Improved Vital Signs Obtained Patient Specific Provider Set Parameters 180 160 140 120 100 80 60 40 20 0 Actual Patient Outcomes -- Pulse Down = Good
230 Actual Patient Outcomes -- Weight 220 210 200 Down = Good 190 180 170 Weight Linear (Weight) 300 Actual Patient Outcomes -- Glucose 250 200 Down = Better Axis Title 150 100 Good 50 0 Jul-08 Aug- 08 Sep-08 Oct-08 Nov- 08 Dec-08 Jan-09 Feb-09Mar-09 Apr-09 May- 09 Jun-09 Jul-09 Aug- 09 Sep-09 Oct-09 Nov- 09 Glucose Linear (Glucose)
160 Actual Patient Outcomes - Blood Pressure 140 120 100 80 60 Diastolic Systolic Medication is working 40 20 0 Systolic Diastolic Linear (Systolic ) Linear (Diastolic) 500 450 Kenai Population Daily Glucose Average 400 Average 350 300 250 200 150 100 50 Down = Good Linear (Average) 15 PN Group Ave - 8 pts over last 480 days 0 0 50 100 150 200 250 300 350 400 450 500
200 180 160 140 120 100 80 60 40 20 0 Glucose and HbgA1C Down 0.7pts Down 15 pts Glucose 11/3/2009 11/23/2009 12/13/2009 1/2/2010 1/22/2010 2/11/2010 3/3/2010 3/23/2010 A1C Glucose A1C Linear (Glucose) Linear (A1C) 6.8 6.7 6.6 6.5 6.4 6.3 6.2 6.1 6.0 5.9 5.8 5.7 350 330 310 290 270 250 230 210 190 170 150 130 110 90 70 50 Actual Patient Outcomes -- Glucose 8/1/2009 9/1/2009 10/1/2009 11/1/2009 12/1/2009 1/1/2010 Down = Good -79 Points Glucose Linear
320 315 310 305 300 295 290 285 280 275 270 265 260 255 250 245 240 235 230 225 220 215 210 205 200 Actual Patient Outcomes -- Weight Down = Good Down 18 Lbs over 6 months (3lbs/mo. ave.) 8/1/2009 9/1/2009 10/1/2009 11/1/2009 12/1/2009 1/1/2010 Weight Linear (Weight) Actual Patient Outcomes -- Blood Pressure 190 170-17 150 130 Systolic 110 90 70 50-2 Diastolic 8/1/2009 9/1/2009 10/1/2009 11/1/2009 12/1/2009 1/1/2010 Systolic Diastolic Linear (Systolic) Linear (Diastolic)
300 295 290 285 280 275 270 265 260 255 250 245 240 235 230 225 220 Weight Within 3 months from starting the HTM program patient s weight was within set parameters Weight Linear (Weight) Why Use HTM? Better Patient Data more Often Enables Trend Based Analysis & Preventative Intervention Helps Prevent Chronic Conditions from becoming Acute Avoids Medevac Situations, ER Visits Helps Avoid Hospitalizations and Readmissions Avoids Routine Clinic Visits just to take Vital Signs Improves Patient Outcomes; Improves Self Care Enables Patient Education & Lifestyle Changes Better Patient Compliance with Provider Instructions Reduced Provider Burden; Call Ctr Monitors Patients 24/7 Reduced Patient Burden; Fewer Medical Appointments Better Quality of Life; Feel Better and More in Control
Challenges Keeping up with Service Tickets Commitments to grow to over 280 Turtles by summer 120 units w/15% inop. 18 units (includes 4 new) Ave downtime; 128.3 days, oldest 259 days @ Sand Point Solution is: Near-term: Recall Out of Service Units and Replace with new Long-term: Need man-hours to make connection with clients after hours (6 pm - 9 pm) Challenges Coding and Billing Provider Involvement 24/7 Call Center Program Management Clinical Analyses Equipment Travel Data Hosting
Challenges Data Analyses Baseline Data required to assess HTM benefit Baseline data is being received on all patients Data up-load in progress then we ll analyze it Solution is: Near-term: Recruit temporary help from Partners Long-term: Need man-hours to keep up with the need for data loading, analyses and reporting Conclusions Operational Now Positive Results Massive ROI Improved Outcomes Benefits Providers Patients Questions Dave Peters @ 729-4488 or dtpeters@anthc.org
AFHCP Recognitions National Indian Health Board Award for Regional Impact (2009) Disease Management Association Award for Outstanding Government Program (2008) Published in Journal of Native Aging and Health (2008) Best Practices Awd: National Indian Council on Aging (2007) AstraZenca Partnerships In Government Award (2003) Published in Veterans Health Journal (1999) US Dept of HHS Secretary s Award (1998) Published twice in US Medicine (1997) VP Gore s Hammer Award - Reinventing Government (1997) Dr. Kizer s Strategic Alliance Award (1997) Federal Employee Team of the Year Award (1997) David T. Peters, Senior PM Program (907) 729-4488, dtpeters@anthc.org Alaska Federal Heath Care Partnership 1919 Bragaw St Anchorage AK 99508 (907) 729-4480 fax 907-729-4490