Embracing Telehealth: People, Process & Technology

Embracing Telehealth: People, Process & Technology

Embracing Telehealth: Technology Perspectives from a Clinical Lens Deborah Dahl, BS MBA FACHE VP, Patient Care Innovation Banner Health HIMSS February 20, 2015

Title Embracing Telehealth: Technology Perspectives from a Clinical Lens

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Telemedicine: More than Technology

Breakdown Of Cost Base By Category, Industry Benchmarks 2% 4% 4% 9% 22% 2% 1% 1% 55% Est Base Cost for Pilot Population Category ($M) Hospital Care (incl ED visits) $14.7 Physician and Clinical Services (e.g., dialysis, labs, x-rays, doc visits) $5.9 Prescription Drugs $2.4 Nursing Care Facilities $1.2 Durable Medical Equipment $1.1 Dental Services $0.5 Home Healthcare $0.5 Other Professional Services (PT/OT, other) $0.3 Other Personalized Care (e.g., ambulance, residential) $0.1 Total $26.7

icare Emergency Medicine Stroke Neurologist Nephrologist Correctional Facility Psychiatrist Trauma Surgeon Initiate TX asap Referring sites eed Tele-neuro Trauma triage Tele-psychiatry Specialty call coverage Intensivist & Hospitalist ecaremobile ED Clinics

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Home Care Independent, Healthy Living Comfortable setting Quality of Life Chronic Disease Management Cost Effective Residential Care Assisted Living Skilled Nursing Facility Acute Care Specialty Clinic Community Hospital ICU $1 $10 $100 $1000 Cost of Care / Day $10,000 Source: IBM Connected Health Solution, 2011

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There is time enough to iron your cape......and back into the skies for you Jason Harlem. DARPA.

Patient Segmentation One Size Doesn t Fit All Segmentation based on healthcare spending 5% 5-15% Percentage of total expenditure 50,6% Average expenditure per patient per year $40,480 15-50% 23,7% $ 9,480 50-100% 22,6% $ 2,583 3,1% $ 248 Groups Number of patients Group Expenditure % of total expenditure Average expenditure Top % (millions) (billions) 5 15 607,2 50,6 40480 5-15 30 284 23,7 9480 15-50 105 271 22,6 2583 50-100 150 37 3,1 248 Source: IMS Institute report and AHRQ analysis of spending data using Medical Expenditure Panel Survey

Principles Incorporate well-defined, reliable, systems-based workflows into routine care provision to ensure consistent delivery; Define clear, accountable responsibilities for each team member; Implement foundational digital health tools to facilitate decision support, tracking of adherence to the system of care, and real-time updates to patient records; and Align team incentives so that each member is vested in improving the quality of care and health of patients, thereby controlling the total cost of care. Institute of Medicine, Improved Patient Outcomes in 3 Years with a System of Care for Diabetes, Frederick J. Bloom, Jr., MD, Thomas R. Graf, MD, and Glenn D. Steele, Jr., MD, Geisinger Health System*, October 2012

Banner icare Primary Care IAC Center Primary Care Intensivist Telehealth Team iphysician imsw Medical Assistant Home Patient & Caregiver irn Mobile Team ipharmacist Home Health Nurse Care Quarterback Health Coach 18 Health Unit Secretary

Role of the Telehealth Team Respond to requests for assistance from the member Look for adverse trends and intervene before those adverse trends become adverse events Implement best practices Continuous learning and improvement

Health Coach Role

Banner icare member Banner icare Member interview

Benefits Benefit Areas Reduce Costs of Providing Care Improve Quality of Patient Care Expected Benefits Reduce avoidable Emergency Department visits Avoid costs of readmission within 30 days Reduce inpatient hospital admissions Reduce admissions to Skilled Nursing Facilities Reduce length of stay for patients admitted to SNFs Reduce duplicate and avoidable radiology and lab tests Reduce sub-specialty consultations Improve productivity of Primary Care Physicians and nursing staff Increase generic utilization for certain drugs Improve prescription fill rates Improve compliance with prescribed medication usage Reduce impacts of adverse drug events Reduce length of stay for patients admitted to acute care Improve Provider Efficiency / Satisfaction Improve satisfaction by removing complex patients from majority of PCP's patient panels Improve Home Health nurse retention rates Provide care team with challenging opportunities Improve Patient Satisfaction Improve patient quality of life by delivering more care at home Improve patient quality of life by avoiding hospital or institutional facility admissions Improve patient satisfaction by making healthcare resources easy to access and understand Improve patient satisfaction by automating home health devices

If we are to achieve results never before accomplished, we must employ methods never before attempted. Francis Bacon