examining the “boomerang effect” discussing financial implications for telehealth discussing...

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MATRC 2 nd Annual Summit March18, 2013 Improving The Quality of Care: Reducing Readmissions Bonnie Britton, MSN, ATAF Vidant Health Telehealth Administrator Seth Van Essendelft, MBA Vice President, Financial Services Vidant Medical Center

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MATRC 2nd Annual SummitMarch18, 2013

Improving The Quality of Care:

Reducing Readmissions

Bonnie Britton, MSN, ATAF Vidant Health Telehealth Administrator

Seth Van Essendelft, MBAVice President, Financial Services Vidant Medical Center

Today’s talk involves…… Examining the “Boomerang Effect”

Discussing financial implications for Telehealth

Discussing Vidant Health’s Telehealth Program and outcomes

Questions and Answers

2

Who is in the audience?

3

Chronic Illness & the “Boomerang Effect”

4

Mr. Doe’s Hospital Admission 81 y.o: CVD, HF, DM, Arthritis Exacerbation of Heart Failure

◦ Not following his diet

◦ Not taking all of his medications (8 meds)

◦ Not keeping PCP visits

◦ Low engagement level

8 HF ER visits and 6 hospitalizations < 12 mos.

5

Mr. Doe prepares for Discharge Told he will be d/c home tomorrow

PCP not alerted that Mr. Doe was hospitalized

Given new prescriptions

Told to schedule a PCP appt. in the next month

6

Educating Mr. Doe at Discharge

Patient education:

◦ Smoking cessation

◦ Diabetes care

◦ Nutrition and cooking advice to him and his wife

◦ Must take BP meds even if he feels fine

◦ How to take his diuretics

7

Mr. Doe’s First Day Home Forgets most of what was told to him @ D/C

Can’t remember much/feeling OK-

Not consistently compliant with diet, medication

Doesn’t make PCP appointment

8

The Boomerang Effect Patient issues

◦ Don’t understand their medications

◦ Don’t understand how to follow prescribed diet

◦ Can’t afford their medications

◦ Can’t afford foods to follow their diet

◦ Low engagement level

9

The Boomerang Effect Hospital issues:

◦ Focus: inside walls of the hospital◦ Post d/c service focus: HH & LTC ◦ Incorrect or absent medication reconciliation◦ Extremely limited system of care transitions◦ Brief & fragmented patient education◦ PCP not contacted during hospitalization◦ Fragmented communication between

clinics/specialists/hospital◦ Dictate to patients vs. engage them in their care

10

Vidant Health

12

Vidant Health’s Mission:

To enhance the quality of life for the people and communities we serve, touch and support.

Discharge Options

Portfolio of Tools

Patient Hospital

Physician/Home

SNF

Home Health

Hospice

Palliative Care

Remote Monitoring

LTAC

Rehab

13

What if . . .

Remote Monitoring

DoctorPatient

14

Telehealth Can Alter the Path

Telehealth Intervention

15

16

Health System Strategies Expand access to care Improve healthcare value Continuum of care Best utilize capacity Connect with local employers Improve physician network Improve employer health plan cost position Develop care models of the future

Reimbursement

Reform penalties

Capacity utilization

It is all relative

Challenges

17

Overview and process

Expectations

Lessons learned◦ Adaptation varied◦ Operational details ◦ Length of monitoring assumptions◦ Data requirements◦ Keep the big picture in focus

Business Case

18

Stop Bonnie from beating on my door!

Pilot enhanced continuity of care model

Capture & quantify financial levers

Financial Goals and Objectives

19

Telehealth

Back tothe Future

20

Driving the Telehealth Bus!

Hey Norton - you will get out of your telehealth program exactly what you

put into it!

21

Diagnostic

Transitions

In Care

Friends & Family

September 2012

Chronic Disease Mgt.

VH Telehealth Conceptual Model

22

Transitions in Care Goals Access to Telehealth and care management

for hi-risk hi-cost patients

Reduce 30-day readmissions, hospital bed days and ER visits

Improve clinical outcomes

Improve the patient’s perception of care

Improve quality of health information

23

24

Transitions in Care Services Population: In-patient CVD and Pulmonary

patients PAM Level I & II Frequent ER

visits/hospitalizations Medicare/self pay/un/underinsured

Services: In-home medication reconciliationHome Safety AssessmentDaily Biometric data monitoringWeekly telephonic assessment,

education, coaching

LOS: 3 months

25

Chronic Disease Management Goals

Access to Telehealth and care coordination for hi & medium-risk VMG patients

Increase patient access to care Improve quality of health information and

communication between hospital- home – PCP Improve clinical outcomes Improve the patient’s perception of care Reduce health care costs

Chronic Disease Management Services

Population: Clinic based patients

PAM Level I & II – VMG PatientsPAM Level III with frequent

ED/hospitalizationsTransfer from Transition in Care Program monitoring

Services: In-home medication reconciliationHome Safety AssessmentDaily Biometric data monitoringDaily telephonic assessment, education, coaching as neededBi-weekly assessment, education, coaching

LOS: 6 months

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27

VH Telehealth Family & Friends

Population: Graduates of TH TIC, TH CDM

VH EmployeesContracted Services (Nash,

BasisHealth)

Services: Self management monitoringBiometric data monitoringFee for service

LOS: TBD

Clinical Data◦LDL, BP, Pulse, Height, Weight, HgA1c,

oxygen saturation

Patient Satisfaction

Financial Outcomes- 90 days pre TH, during TH, 30 days post TH◦Hospitalizations◦Bed Days

Metrics

28

Demographics – Primary Insurance

56%

12%

10%

22%

(N=926)

Medicare

Medicaid

No Insurance/Self

Commerical

29

Demographics – Patient Gender

44%

56%

(N=926)

Male

Female

30

Demographics – Patient Diagnosis

54%

33%

4%

3%2% 1% 3%

(N= 926)

HTN HF

COPD CHF/HTN

Asthma Asthma/ HTN

HF/HTN

31

13%

19%

24%23%

18%

3%

(N=926)

18-49 50-59 60-69 70-79 80-89 90-99

Demographics – Patient Age

32

Average Time Utilizing Remote Monitoring Services

2%9%

18%

28%

34%

10%

< 30 days 30 days 60 days 90 days current > 90 days

(N =926)

33

Patient Satisfaction Surveys

56%

43%1%

STRONGLY AGREE AGREE DISAGREE

(N=325)

34

Hospitalalizations

Reductions Of Hospitalizations0

100

200

300

400

500

600

700

800

900

772

257

143

Total Patients (N=695)Discharge Patients (N=544)

90 Days PriorDuring30 Days Post

• Decreased by 69% Prior to During

• Decreased by 76% Prior to Post

35

36

Hospital Bed Days

Hospital Bed Days0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

3,458

1,124

753

Total Patients (N=695)Discharged Patients (N=544)

90 Days PriorDuring30 Days Post

Decreased by 67% Prior to During

Decreased by 81% Prior to Post

Hospital Cost and ReimbursementTotal Patients approximately 700

Hospitalization Costs -

1,000,000.0

2,000,000.0

3,000,000.0

4,000,000.0

5,000,000.0

6,000,000.0

7,000,000.0

8,000,000.0

90 Days Prior During 30 Days Post

Reimbursement -

1,000,000.0

2,000,000.0

3,000,000.0

4,000,000.0

5,000,000.0

6,000,000.0

7,000,000.0

8,000,000.0

90 Days Prior During 30 Days Post

37

Financial Benefits – Total Healthcare

Lower hospitalization cost Readmission aversion

More effective and efficient care

Improved access to care at the appropriate levels

Greater patient satisfaction

38

39

Financial Benefits – Hospital System

Reduces readmissions penalties exposure Capacity – increasing CMI & fewer lost

admissions Expands margins Reduces bad debt losses Improved discharge planning process Reduces employer health plan costs Creates value proposition Created retail opportunities

Mr. Doe readmitted to Hospital with HF

At Hospital Discharge:

◦ D/C with the same medications & education

◦ Cardiologist & hospitalist make referral to TH

◦ TH referral received by Telehealth Team

◦ In-hospital enrollment

◦ PCP visit appt. made

◦ Home visit appt. made

40

Mr. Doe’s First Day with RPM Patient conducts reading. Wt. increased by 2

lbs.

TH RN calls patient to review medication and diet compliance

See - Feel Change

TH RN provides nutrition counseling

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Mr. Doe’s Fourth Day with RPM

Objective data:

◦ Wt. increased by 4 pounds

◦ O2 sat. decreased to 92%

◦ BP slightly elevated @ 145/90

Subjective data:

◦ Reporting SOB and ankle edema

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Mr. Doe’s Fourth Day with RPM Actions

◦ TH RN calls patient, conducts health assessment and provides education

◦ Discovers patient ate Country Ham last night

◦ Didn’t take his Lasix because he had no money

◦ See - Feel Change

◦ TH RN contacts PCP

◦ PCP instructs pt. to come to clinic today

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Take Home Points Conducting in-home med. rec. & providing

RPM services result in:

◦ Early identification and tx of disease exacerbation

◦ Reduced hospitalizations

◦ Reduced bed days

◦ Reduced ER visits

◦ Reduced health care costs

◦ Ending the Boomerang Effect

◦ Active engaged patients

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Questions and Answers

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Bonnie Britton, RN, MSN, ATAFTelehealth AdministratorVidant [email protected]

Seth Van EssendelftVice President Financial Services Vidant Medical [email protected]

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