Integrating Technology into Care: Telehealth and Beyond Cindy Campbell RN, BSN, MHA (c) Director Operational Consulting Fazzi Associates, Inc. Play the 2018 Conference Post to Win Game for a chance to win different prizes each day! 1
Objectives Describe value based outcomes associated with the use of well-integrated healthtechnology. Plan for optimal integration of mobile health technology into clinical modeling; specifically focused on management of high risk, chronic disease populations of people. Discuss the value proposition of integrated remote monitoring and support into alternative models of person-centered care. May 10-12, 2016 CAHSAH 50th Anniversary Annual Conference 3 Telemedicine Defined Telemedicine" and "telehealth" are synonyms and often used interchangeably. Both cases refer to the use of remote health care technology to deliver clinical services using internet, wireless, satellite and telephone. (American Telemedicine Association, 2018) May 22-24, 2018 CAHSAH CHAPCA Annual Conference 4 2
California State Law Definition Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and selfmanagement of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. (http://www.cchpca.org/ca-state-law-telemedicinetelehealth-definition) May 22-24, 2018 CAHSAH CHAPCA Annual Conference 5 Telemedicine Applications Acute Care Post Acute Care Schools - https://leginfo.legislature.ca.gov/faces/billanal ysisclient.xhtml?bill_id=201720180ab2315 MD offices Clinics Home Health Care Direct to consumer May 22-24, 2018 CAHSAH CHAPCA Annual Conference 6 3
California Telehealth Resource California Telehealth Resource Center https://www.caltelehealth.org Originally funded FCC Rural Health Care Pilot Program $22.1 million Currently funding California Emerging Technology Fund California HealthCare Foundation California Teleconnect Fund National Coalition for Health Integration United HealthCare University of California National Telehealth Resource Centers: https://www.telehealthresourcecenter.org/ May 22-24, 2018 CAHSAH CHAPCA Annual Conference 7 Home Health Quality Improvement (HHQI) National Campaign Best Practice Intervention Package (BPIP): Established from evidence-based research a best practice for home care agencies. Disease management, patient selfmanagement, and telehealth are essential interventions to reduce readmissions and improve quality of life for chronic care patients..effective quality improvement programs will merge facets from all three interventions. (HHQI, 2011) May 22-24, 2018 CAHSAH CHAPCA Annual Conference 8 4
Telemedicine in the Home Health Arena Improves Care coordination Timeliness of intervention Continuity of care Self-management Medication Adherence Decreases Hospitalization ED visits Hospital LOS HH nursing visits May 22-24, 2018 CAHSAH CHAPCA Annual Conference 9 What Is Your Agency Goal? Quadruple Aim Triple Aim plus a focus on staff engagement 5
Strategic Management Model What do we know? What should we do about it? What does it mean? Fazzi Industry Report 2017 Original goal of the State of the Industry Study To provide the industry with knowledge on present and future status of all key components of home care and hospice New goal of the State of the Industry Study To provide the industry with insights on what technology, practices, and processes are related to better financial, quality, and VBP outcomes 6
The Must Haves Backroom technology Point of care EHR Telehealth Telehealth need CA stats here, but can t find them in Fazzi report 28.5% 22.9% 23.0% 17.1% Oklahoma 0.0% 2007 2009 2013 2016 7
Currently have a telehealth system by Medicare revenue 90.9% 68.2% 75.0% 33.1% 15.7% $500K - $2M $2M - $5M $5M - $10M $10M-$20M $20M+ Impact From Telehealth Program Decrease No Change Increase Not Sure Overall quality 0.7% 13.8% 74.9% 10.6% Referrals 0.0% 51.5% 38.9% 9.6% Visits per episode 36.4% 46.8% 7.7% 9.1% Unplanned hospitalizations 62.6% 17.9% 8.0% 11.5% Emergent care 50.9% 29.5% 7.3% 12.3% Patient self care 2.4% 28.4% 59.5% 9.6% Patient satisfaction 3.5% 22.4% 63.4% 10.8% Agency costs 18.0% 35.9% 30.1% 16.0% 8
Use Of Telehealth And Quality 41.4% 27.8% 21.3% 9.5% Highest Quality Mid-Highest Quality Mid Lowest Quality Lowest Quality Percent Of Telehealth Units In Use On An Average Day Less 25%-50% 50%-75% 75%-100% Than 25% Hospital-based 30.0% 10.0% 25.0% 30.0% Hospital Affiliated 31.8% 9.1% 13.6% 40.9% Freestanding 25.2% 11.4% 14.6% 43.9% Government 0.0% 0.0% 66.7% 0.0% Total 26.2% 10.7% 16.7% 41.1% Total 2013-14 Study 25.1% 14.1% 19.6% 36.0% 9
Keys to Successful TM Programs NEVER AN ADD-ON PROGRAM Top-down and bottom-up buy-in Opt-out rather than Opt-in Integral part of care delivery for patient populations unless contraindicated Patient education for self-management Symptom management TM has specific goals and interventions Care Plan includes TM May 22-24, 2018 CAHSAH CHAPCA Annual Conference 19 Keys to Successful TM Programs Equipment installation at SOC TM team is part of Interdisciplinary Care Team Integration into EMR Care management still rests with the field staff Timely field staff intervention when needed May 22-24, 2018 CAHSAH CHAPCA Annual Conference 20 10
Outcomes Athena Home Health (2010) Heart Failure patients 30-day rehospitalization - 7.8% Sharp Health Care (2015) COPD and Heart Failure patients 50% 30-day rehospitalization 13-19% 180-day readmission + Patient Satisfaction with program May 22-24, 2018 CAHSAH CHAPCA Annual Conference 21 Telemedicine Outcomes VA home TM program focus chronic conditions 156,000 pts in 2015 Results decrease in hospital admissions and hospital bed days (MedPAC, 2016, p. 249) Low cost alternative to home-based primary care (case management and in-home nursing) (VA Health Administration, 2015) MedPAC 2018 report to congress (MedPAC, 2018, p. 499-501) RPM has mixed results Improves access to Medical Care Improves quality of care Potential significant increase in costs d/t large potential pool of users Recommendation Expand use for ACOs, risk-bearing entities, CMMI projects Continue research on telehealth to control cost, access and quality May 22-24, 2018 CAHSAH CHAPCA Annual Conference 22 11
Financial ROI Medi-Cal does not reimburse for remote telemonitoring Private Insurance reimbursement varies by provider Medicare Rural care Home Telemonitoring covered for Next Generation ACO patient s home as site of care approved (MedPAC, Report to Congress, 2018, pg. 472) May 22-24, 2018 CAHSAH CHAPCA Annual Conference 23 Value Proposition Financial 30/60 day rehospitalization Hospitals ACOs MD Practices Home Health Readmission penalties Cost savings MIPS score Potential financial reward Provider of choice d/t low hospitalization rate STAR rating Quality outcomes hospitalization Quality scores Quality scores Quality scores MIPS score STAR rating Access PAC options for at risk who may not qualify for traditional programs options without limited ACO resources options without limited MD office resources Care provided with staff resources of traditional F2F visits Efficiency Ease of referral for chronic disease at risk patients Care provision without limited ACO resources Care provision without limited ACO resources Improved resource allocation Patient Satisfaction HCAHPs for appropriate discharge CAHP score CAHP score HHCAHP scores May 22-24, 2018 CAHSAH CHAPCA Annual Conference 24 12
Value Proposition - Hospitals May 22-24, 2018 CAHSAH CHAPCA Annual Conference 25 Value Proposition -ACO May 22-24, 2018 CAHSAH CHAPCA Annual Conference 26 13
Value Proposition MD Offices/Clinics May 22-24, 2018 CAHSAH CHAPCA Annual Conference 27 From Traditional Telemonitoring Traditional Programs Asychronous Heart Failure b/p cuff, pulse ox, weight scale, monitor for questions Diabetes b/p cuff, glucometer, weight scale, monitor for questions COPD b/p cuff, pulse ox, weight scale, monitor for questions Synchronous Use of 2-way video for F2F interventions May 22-24, 2018 CAHSAH CHAPCA Annual Conference 28 14
To Next Gen Telemonitoring Hospital at Home (HaH) Johns Hopkins - https://www.johnshopkinssolutions.com/solution/hospital-at-home/ Partners Healthcare https://www.bostonglobe.com/metro/2016/11/10/hospitalshome-launch-boston/zz4abeeqxukvsmmpkkzo4j/story.html Atrius ACO https://www.atriushealth.org/about-us/innovation-center Mount Sinai https://www.mountsinai.org/patient-care/service-areas/geriatrics-andaging/mobile-acute-care-team/hospital-at-home-and-observation-unit-at-home Observation-at-home Provider incentives Gain sharing Shared risk Beyond traditional home care Connected Cardiac Care Program Partners Hospice Telemental/Behavorial Health May 22-24, 2018 CAHSAH CHAPCA Annual Conference 29 Equipment Beyond B/P Cuffs Abdominal Sounds Digital Otoscope Interactive Stethoscope Med Dispenser Clinical Avatar Smartphone Apps Thermometer Spirometer Wearable sensors - rings Visual Symptom Tracking May 22-24, 2018 CAHSAH CHAPCA Annual Conference 30 15
THIS SESSION IS SPONSORED BY: May 22-24, 2018 CAHSAH CHAPCA Annual Conference 32 16
Speaker Information Cindy Campbell RN, BSN, MHA (c) Director Operational Consulting Fazzi Associates, Inc. Northampton, MA Del Mar, CA 858.864.8995 (mobile) 413.584.5300 (office) ccampbell@fazzi.com www.fazzi.com May 22-24, 2018 CAHSAH CHAPCA Annual Conference 33 17