health it summit in seattle 2014 – “think big, act small” with deborah dahl, vp, patient care...
TRANSCRIPT
![Page 1: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/1.jpg)
Think Big, Act Small
Deborah Dahl VP, Patient Care Innovation
August 2014
![Page 2: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/2.jpg)
1,683,290
![Page 3: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/3.jpg)
1
![Page 4: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/4.jpg)
![Page 5: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/5.jpg)
Telemedicine:
More than Technology
![Page 6: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/6.jpg)
Breakdown Of Cost Base By Category, Industry Benchmarks
55%
22%
9%
4%
4%
2%2%
1%1%
Category
Est Base Cost for
Pilot Population
($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
![Page 7: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/7.jpg)
Longitudinal ICU LOS & Hospital Mortality
* APACHE IV predictions begin
![Page 8: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/8.jpg)
Acute Care Results
ICU 2012
• >20,000 fewer ICU days than predicted
• >50,000 fewer Hospital days
• >$68,000,000
• >2,000 lives saved (APACHE 0.42)
eHx
• ICU Transfers dropped from 1.1% to 0.6%
• $4.5 M saved
![Page 9: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/9.jpg)
iCare Emergency Medicine
eCareMobile
Correctional
Facility
ClinicseED
Tele-stroke
Trauma triage
Tele-psychiatry
Specialty call coverage
Intensivist & Hospitalist
Stroke
Neurologist
Trauma
Surgeon
Nephrologist
Psychiatrist
Initiate TX asap
ED
Referring sites
![Page 10: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/10.jpg)
Qualit
y o
f Life
Comfortable
setting
Chronic Disease
Management
Cost
Effective
Independent,
Healthy Living
$1 $10 $100
Home Care
Assisted Living
Skilled Nursing
Facility
Residential
Care
ICU
Community
Hospital
Specialty
Clinic
Acute Care
Cost of Care / Day
Source: IBM ‘Connected Health’ Solution, 2011
$10,000$1000
![Page 11: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/11.jpg)
h@h
4.6% Readmission Rate 4 of 86 enrolled Patients
Day 30: CHF- Bradycardia/hypotension
Day 30: CAP- Recurrent pneumonia (3 admits since then)
Day 1: CHF- A-fib required cardioversion
Day 6: COPD/CHF- Syncope
2 ED visits
National Average (2010)CHF- 24.8%
Pneumonia- 18.4%
Cellulitis/COPD- No data
![Page 12: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/12.jpg)
Patient Segmentation – One Size Doesn’t Fit All
Groups
Top %
Number of patients
(millions)
Group Expenditure
(billions)
% of total expenditure Average expenditure
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
5%
5-15%
15-50%
50-100%
50,6%
23,7%
22,6%
3,1%
$40,480
$ 9,480
$ 2,583
$ 248
Average expenditureper patient per year
Percentage oftotal expenditure
Segmentation based onhealthcare spending
Source: IMS Institute report and AHRQ analysis of spending data using Medical Expenditure Panel Survey
![Page 13: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/13.jpg)
Mobile Team
Home Health
Nurse
Health Coach
IAC Center
Primary Care
Intensivist
Medical
Assistant
The Hospital of the Future…
Telehealth Team
iPhysician
iMSW
iRN
iPharmacist
Care
Quarterback
Health Unit
Secretary
Home
Patient &
Caregiver
![Page 14: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/14.jpg)
Philips Telehealth Solutions
![Page 15: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/15.jpg)
![Page 16: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/16.jpg)
![Page 17: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/17.jpg)
![Page 18: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/18.jpg)
Let’s Hear From the Patients
http://www.innovationandyou.philips.com/
#!/content/2/21
![Page 19: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/19.jpg)
Benefits
Improve Patient
Satisfaction
Improve Quality of
Patient Care
Improve Provider
Efficiency /
Satisfaction
Reduce Costs of
Providing Care
• 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 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 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
Expected BenefitsBenefit Areas
![Page 20: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/20.jpg)
Data overview• Using data of 62 3-month follow-up patients, enrollment = equipment
installation
Months -12/0 -11/1 -10/2 -9/3 -8/4 -7/5 -6/6 -5/7 -4/8 -3/9 -2/10 -1/11
Pre 2276 2755 4182 2281 1851 2477 2384 2101 2016 2447 2747 1482
Post 2151 747 863 578 450 265 0 0 0 0 0 0
IAC period
![Page 21: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/21.jpg)
Conclusion and Next Steps
• Cost reduction approximately 50%
(uncorrected)
– Estimates range from 40-60% (using
different definitions of enrollment)
• To be investigated further:– Seasonality
– Regression towards the mean
– Cost breakdown in IP, OP, Meds
– Drop-outs (in next iterations with longer follow-up)
– Death bias adjustment
![Page 22: Health IT Summit in Seattle 2014 – “Think Big, Act Small” with Deborah Dahl, VP, Patient Care Innovation, Banner Health](https://reader030.vdocument.in/reader030/viewer/2022032514/55d55c70bb61eb094d8b4757/html5/thumbnails/22.jpg)
Think Big
Act Small
Fail Fast
Scale Quickly