MAHP Annual Conference October 18 th -19th
Learning Objectives Highlight UMMC s National Business strategy Provide MAHP members a UMMC Center for Telehealth update Understand the need for Telehealth services in rural communities and the value of strategic collaboration Provide overview of UMMC s Center for Telehealth and Cigna HealthSpring s clinical offering, collaboration, and RPM Pilot Illustrate the cost-effective benefits of a comprehensive RPM program Discuss how the RPM pilot will reduce cost, improve quality of care and increase access Detail our sustainable RPM model for Telehealth services which will be implemented in Alabama 2
UMMC Center for Telehealth Michael Adcock Administrator, Center for Telehealth 3
UMMC Telehealth Timeline 1990s 2003 2008 Diagnostic test interpretation Adult and Pediatric Cardiology First videoconferencing of telemedicine Emergency Medicine TelePsychiatry underway 2011 2013 Full-time staff assigned to Telehealth Center for Telehealth formed 24/7 Telehealth Call Center 4
UMMC Telehealth by the numbers 500,000+ Telehealth encounters since 2003 200+ UMMC available specialists 30+ specialty services and growing 200+ locations, with new locations weekly 5
UMMC Center for Telehealth in Mississippi Community Hospitals & Clinics Mental Health Clinics FQHC s Schools & Colleges Mobile Health Vans Corporations Prisons Patient s Homes 6
Clinical Quality Maintain same standard as in-person care If the technology can not replicate the exam you would do inperson then the visit is not appropriate for telehealth. Do not cut corners. Study clinical outcomes and compare to in-person outcomes 7
Telehealth Scope of Services Telemedicine: Live (Audio-Video) Interaction Scheduled and unscheduled Specialty consults, Primary Care, Employee & Student Health, Prison Health Ancillary health and wellness services Remote Patient Monitoring Chronic disease management Hospitals- at risk population, cost avoidance/reduction Clinics- ACOs, Private practice, hospital owned Telemetry monitoring Post Acute monitoring Store & Forward & Diagnostic Tests Interpretation Cardiology, Radiology, Neurology, Audiology Dermatology, Pathology, Ophthalmology 8
UMMC Telehealth Update 9
Expanding Telehealth EXPANDING SITES OF SERVICE Sites across Mississippi- 218 Up 49 from July 2015 Counties with UMMC Telehealth- 68 Up 7 from July 2015 PROGRAM EXPANSION New/Expanded Services Allergy Child Safe Program Genetics OB/GYN Services Perinatal High Risk Monitoring Remote Patient Monitoring Store and Forward Dermatology TeleConcussion expansion Video Monitoring for Pediatric EEG 10
MS Diabetes TH Network Update Study will be complete this week Data Analysis and publication 11
Remote Patient Monitoring CURRENT RPM PROGRAMS Employer Based Program Telapex Chronic Disease Bone Marrow Transplant Congenital Heart Congestive Heart Failure Diabetes (Adults and Peds) Hypertension Kidney Transplant FUTURE RPM PROGRAMS Asthma (Adults and Peds) COPD High Risk Pregnancy Medical Weight Loss Neonatal TB- Direct Observed Therapy with MSDH 12
Cost- effective care for 130m chronically ill 5% 15M Patients $40k patient / annual Limited Scope: high-cost, high acuity, and high-touch High risk 10% At-risk 35% 130M Patients $4.5k patient / annual Opportunity: Patient directed tech democratizes care management; yields scalable, low cost care for entire chronic population Healthy 50% Source: IMS Institute report and AHRQ analysis of spending data using Medical Expenditure Panel Survey
Future Focus Population Health Management Patient Engagement Data Sharing/Access Outcomes Analysis Provider Adoption Expanding UMMC s Brand Nationally 14
Expanding UMMC Borders Matthew J. Rumbaugh Director National Network Relations, Center for Telehealth 15
UMMC s depth and reach to address Telehealth's challenges locally, regionally and nationally Addressing cost, quality and access Strategy Smart Spending Invest and innovate in a way to break through cost, quality and access challenges Effective technology Cost- effective delivery Investment and Partnerships Research and Development in technological innovations Smart Savings Method Progress 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 16
National Business Strategy: RPM, Telehealth & Strategic Collaborations 1. Evidence Development: Interest is in gathering evidence around reducing cost, increasing quality/access via RPM/TH CIGNA HIMSS Connected Health Initiative 2. Development/Innovation: Pilot sites for UMMC to showcase solutions and expansion of RPM AMA CMS On3Health 3. National Programs: Interest is in programs addressing Population Health Revitalizations, RPM & Virtual DPP AMA CDC Virtual DPP 4. Leadership Commitment: Collaborate with UMMC-TH Locally, Regionally, and Nationally AMA Mercy Virtual CIGNA On3Health - CHI 17
UMMC s Remote Patient Monitoring National strategy to address community healthcare needs Better health one person at a time 2016/17 18
Stakeholders UMMC Center for Telehealth Cigna Healthspring Michael Adcock, FACHE Administrator Matthew Rumbaugh, Director of National Network Relations Jaime Wheeler, MSN, BSN Clinical Director of Nursing Megan Duet Lead Project Manager Dr. Elizabeth Stahl, Senior Medical Director Cigna-HealthSpring Phil Osczepinski, Institutional Network Administrator Cigna-HealthSpring Jill Bledsoe, Project Manger Cigna-HealthSpring 19
An Industry Leaving Partnership Leader in Telehealth Services Leader in Global Health Services REFORM 3 core values at the center of our mission: education, research and patient care Committed to helping beneficiaries live healthier, more active lives through personalized, affordable and easy-to-use health care solutions
Dr. Elizabeth Stahl, Senior Medical Director 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. 21 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.
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 22
Who qualifies for RPM? Enrollment criteria to be determined by Cigna HealthSpring Patient s provider recommends disease management via RPM
Virtual CHF Outcome Metrics 30% reduction in admissions National rate of readmissions for CHF is approximately 25% - I think we would want to reduce this (and I will find out what C-HS readmission rate is for CHF) by at least 20% 25% reduction in ER visits related to CHF as we all know, an ER visit typically results in an admission, so if we can address issues before they become emergent/urgent, we should be able to reduce admissions 10% improvement in adherence. 2 categories CHF medications (beta blocker, ACE/ARB use, diuretic use) STAR measures adherence medications (statins, BP meds, oral DM drugs and DM injectable that are NOT insulin) Track adherence to sessions, number of calls made by UMMC staff to customers, and additional tracking metrics that UMMC has used in the past with its DM program 24
Enrolling Patients Cigna HealthSpring will provide list of eligible patients to UMMC UMMC TH will conduct a patient engagement call. UMMC TH will send order to PCP Patient will receive kit and call 800# for set up Patient will collect daily biometrics and complete health sessions and education UMMC RN Care Coordinators to monitor patient for duration of program If patient is interested, consent will be obtained UMMC RN Care Coordinator will educate the patient on the program and equipment use. All data is input into tablet and uploaded to UMMC RN Care Coordinator dashboard Upon completion of the program, patient will return kit to Care Innovation for repurposing
Care Innovations Guide Virtual Care Suite- Population Stratified by Risk
Meet Ruth Ruth 50 years old Heart failure 3 inpatient days 1 ER visit Enrolled in Remote Patient Monitoring due to meeting eligibility criteria 27
Day 1 Ruth is not feeling well. Her biometrics reported today are: BP: 144/88 Weight: Up 6 pounds from yesterday Cindy, RN Care Coordinator, at the Center for Telehealth receives the biometrics from Ruth. She calls Ruth to discuss her responses in her daily health session and her biometrics. Since Ruth gained more than 3 pounds overnight, Cindy uses motivational interviewing to discuss salt and fluid intake, medications, and symptoms and a treatment plan. 28
Day 2 Ruth s biometrics reported today are: BP: 136/86 Weight: No change in weight from yesterday (still up 6 pounds) Cindy, RN Care Coordinator, at the Center for Telehealth receives the biometrics from Ruth. Cindy reviews Ruth s orders and doesn t see a Lasix protocol. She contacts Dr. Davis to notify of Ruth s weight gain. Dr. Davis, Ruth s PCP, sees the biometrics for Ruth and reviews the protocol that Cindy has followed. Dr. Davis orders a Lasix protocol for Ruth. Cindy notifies Ruth, helps get the Lasix, and instructs Ruth what to do. 29
DPP
Medicare DPP Market Opportunity 30M 1.8M >250k USA MS SE Region LA, AR, TN, AL CMS Expansion of Medicare Diabetes Prevention Program Model. 31
CMS Virtual DPP Lifestyle Change Program 2018 Reach UMMC local target population Joint promotion regionally to payors/employers Market nationally direct to patients (CMS) Market Opportunity 30M (USA) 250K (MS) 1.8M (AL,TN,FL,LA) CMS acknowledges, the use of connected health tech products and services will be vital to the success of the MDPP. Further, CMS proposed approach to treat MDPP as separate from current Medicare telehealth benefits and related restrictions will avoid the stifling limitations 46417 32
DPP using Telehealth Platform- Going Beyond Traditional DPP Enable patients who are remote to participate in what would otherwise be an in-person DPP session Enable patients to converse with their coaches using audio and video vs. just email Enable patients to send updated A1c values and changes in BMI to the DPP provider Enable DPPs and referring clinicians to share data on patients. 33
UMMC Virtual Care Platform The easiest way to manage and prevent lifestyle diseases, anywhere. VIRTUAL HUB TARGETED PROGRAMS INTEGRATED BIOMETRICS SECURE COMMUNICATIONS SOCIAL GROUPS
Thank you Michael Adcock Administrator, Center for Telehealth University of Mississippi Medical Center madcock@umc.edu? Matthew Rumbaugh Director National Relations, Center for Telehealth University of Mississippi Medical Center mrumbaugh@umc.edu 412.425.7676 @ummctelehealth Bridging the gaps in quality healthcare 35