Transcript Slide 1
The Role of Telehealth in Accountable Care HealthLINC Conference Bloomington, IN February 17, 2011 Alan Snell, MD,MMM Chief Medical Informatics Officer St. Vincent Health, Indianapolis Email: [email protected] 317-583-3248 St. Vincent Health An Ascension Health Ministry 1 St. Vincent New Hope 2 Saint John’s Health System 3 St. Joseph - Kokomo St. Joseph FY 2011 Stats Total Admissions: 64,828 Total ER Visits: 240,572 Total Ambulatory Visits: 2,776,895 Total Births: 6,629 Total Beds: 1,751 Gross Revenue: $5,171,730,145 Elkhart Lagrange Steuben 4 St. Vincent Indianapolis Noble De Kalb 5 St. Vincent Stress Center La Porte Porter Lake Marshall Starke Whitley Fulton Jasper 6 Seton Specialty Hospital- LTAC Kosciusko Allen Pulaski Wabash Newton Cass Huntington Adams Wells Miami White Benton Carroll Howard Grant Warren 3 Clinton Tippecanoe 1 1 2Fountain Montgomery Boone 3 1 5 Tipton 2 Jay 10 St. Vincent Heart Center Delaware 1 7 Wayne Madison Randolph Hamilton Henry 1,4,5,6, Hancock 7,8,9,10 Marion Putnam Parke Union Rush 11 Vigo Morgan Franklin Decatur 18 Monroe Sullivan Bartholomew Dearborn Brown Greene Jackson Lawrence Daviess Knox Fayette 1 Jennings 6 Ripley Jefferson 14 Martin 11 St. Vincent Clay CAH 12 St. Vincent Williamsport CAH Johnson Shelby Clay Owen 8 St. Vincent Women’s 9 St. Vincent Carmel Blackford Hendricks Vermillion 7 Peyton Manning Children’s Hosp. Scott Ohio Switzerland 13 St. Vincent Frankfort CAH 14 St. Vincent Salem CAH 15 St. Vincent Mercy, Elwood CAH 16 St. Vincent Jennings CAH Orange Washington Clark Pike Dubois Gibson 1 WarrickSpencer Vanderburgh 9 Posey Crawford Perry 17 St. Vincent Randolph CAH Floyd Harrison 18 St. Vincent Dunn CAH 19 St. Mary’s, Evansville- 2 hospitals (Ascension Health) Ascension Health is the largest Catholic and non-profit health system in the United States, with more than 500 locations in 20 states and the District of Columbia. 3 Telehealth Includes: Patient-Caregiver Virtual Visits 4 www.ihie.org Telehealth Includes: Monitoring in the Home 5 www.ihie.org Telehealth Includes: Store-and-Forward 6 www.ihie.org Telehealth Includes: Education 7 www.ihie.org Ascension Health Telehealth Inventory: 36 Programs Across 21 Health Ministries 20 5 14 21 12 11 10 15 3 9 7 8 16 6 13 17 1 2 19 Breakdown Video Consultation: n = 17 (47%) Teletranslation: n = 8 (23%) Home Teleheatlh: n = 6 (17%) Call Center: n = 3 (9%) Education: n = 2 (6%) 4 18 8 *Numbered in alphabetical order by State and City www.ihie.org Veterans Affairs (VA) Telehealth: Critical Mass Driving Significant Value Video Consults 1 Year 7 Years Research & Refinement Dissemination & Implementation 4,700 Patients 3 Years Store & Forward 75,000 Patients 7 Years Research & Refinement Dissemination & Implementation 3,000 Patients Home Telehealth 3 Years 160,000 Patients 8 Years Research & Refinement 3,000 Patients Dissemination & Implementation 55,000 Patients 9 The average annual cost for a VA home telehealth patient is $1,600 compared to $27,000 for a comparable level of institutionalized care www.ihie.org Telehealth Value in Different Business/Reimbursement Models Business Model Current Environment: Primarily Fee-ForService (FFS) Clinical Use Case Applications of Telehealth FFS with ValueBased Purchasing Use cases listed above plus: Population Health Management Use cases listed in each category above plus: Specialist consultations for patients in rural areas Provider-to-provider consultations Teleradiology consultations Access to primary care/urgent care Teletranslation services Provider education Transitional care for patients with chronic disease Long term care triage Chronic disease management not connected to a hospitalization Screening and prevention Health risk assessments 10 Consumer education/engagement/ health www.ihie.org maintenance Beacon Communities Program Overview • Central Indiana was one of 17 communities selected • The Beacon Program will support these communities to build and strengthen their health IT infrastructure and exchange capabilities. • The program’s intent is to improve health through information technology while supporting job creation. Focusing on specific and measurable improvement goals in three vital areas for health system improvement: Quality Cost Efficiency Population Health • Indiana Health Information Exchange, as the lead organization, received a $16.1 million award to develop the 3 year program. www.ihie.org Indiana Beacon Objectives - Quantified Objective Measure HbA1c levels Increase by 10% the proportion of patients whose A1C levels are <=9% LDL-C levels Increase by 10% the proportion of patients whose LDL-C levels are controlled ACSC Admissions Reduce by 3% ACSC Re-Admissions Reduce by 10% ACSC-related ED visits Reduce by 3% Redundant imaging Reduce by 10% Colorectal Cancer Screening 5% in proportion of patients screened Cervical Cancer Screening 5% in proportion of patients screened Immunization Data Increase by 5% amt. of adult imms data available Meaningful Use Achieved by 60% of Primary Care Physicians 12 Copyright 2011 Indiana Health Information Exchange, Inc. www.ihie.org Facts about Congestive Heart Failure • Congestive heart failure (CHF) is the most common Medicare DRG accounting for more costs than any other condition. • 30 day readmission rate for patients with CHF is 21% nationally • Behavioral factors, such as noncompliance with medications, lack of timely follow up visits and social factors frequently contribute to early readmissions, suggesting that many such readmissions could be prevented • Total annual healthcare expenditure for both direct and indirect healthcare cost of CHF approximates $28 Billion (http://content.onlinejacc.org) Hospital Readmission Reduction Program • Allocated funding or estimated cost: $7.1 billion in estimated federal savings • Effective date: Oct.1, 2012 (data collection started 10/1/11) • Provision authority: Health and Human Services secretary • Scope of jurisdiction: Medicare; nationwide • Requirements: HHS secretary to develop calculations for hospital's readmission payment reduction and publicize hospital readmission rates Effect of Tele-monitoring on Reducing Readmissions A Randomized Study of Short-term Post-Discharge Chronic Disease Management with Tele-monitoring and Nurse Telephone Support •15 Goals & Objectives • Reduce readmissions for patients with Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) • Multidisciplinary treatment approach for early intervention for patients at high risk • Include hospitals representing diversity in size and geographical locations • Enroll patients immediately post-discharge for 30 days ( December 2010 – December 2012 ) Home Monitoring Vendor Selection • Transformation Development Department at Ascension assisted in developing technology selection criteria • Eight vendors were invited to bid, four presented to the selection committee and Care Innovation’s Health Guide was awarded the offer. Care Innovations Health Guide • Allows for video conferencing with the nurse contact center. • Provides health educational learning sessions • Monitors daily bio-metric readings (BP, O2 sat, weight) • Interacts with the patient daily inquiring about health status Participating Hospitals St. Vincent Health sites: • St. Vincent Indianapolis • St. Vincent Heart Center • St. Vincent Carmel • St. Johns Hospital (Anderson) • St. Joseph Hospital (Kokomo) • 3 St. Vincent Critical Access Hospitals Non- St. Vincent Health participating sites: • Columbus Regional Hospital (Columbus) • Hancock Regional (Greenfield) • Henry County Hospital (New Castle) • Witham Hospital (Lebanon) • Wishard Hospital (Indianapolis) Baseline ReadmissionsInitial Participating Hospitals Source: Indiana Hospital Association 2009 reported data Enrollment Process •Hospital Study Coordinator offers and completes study informed consent Consents ? •Y •Randomization into study group (Randomized by Study Site and Prin Dx) • Patient enrollment form completed • Physician notified •SVH Contact Center arranges device deployment •SVH Contact Center completes patient enrollment •50% •R •50% •Complete Study Protocol •N •Not in study Source: Care Innovations 2011 by permission only Source: Care Innovations 2011 by permission only Source: Care Innovations 2011 by permission only Accomplishments • • • • • • • Establish baseline data for participating hospitals Obtain IRB approval (Indiana University and St. Vincent) Integrate with hospital discharge planning Selected device vendor Prepared site hospital teams Selected/trained equipment management company Selected/trained RNs with cardiac care or ICU experience • Clinical protocols developed • Communication materials developed (patient welcome video; physician letter, patient, and nurse resources) First Year Processes • Qualify patients & enroll in study • All patients randomized into either Control Group or Intervention Group • Device deployment & retrieval in the home • Daily interaction and monitoring of patients • Discharge patients from the study after 30 days • Pre and Post survey instrument “Patient Activation Measure” (PAM). Univ. Oregon; Judith Hibbard Preliminary PAM Survey Results Control 1. I am responsible for my health 2. I can reduce my health problems 3. I know what my medications do 4. I know when I need to call a doctor 5. I can follow through on medical treatments 6. I know the treatments available 7. I have kept up with lifestyle changes 8. I can find solutions to new problems 9. I can maintain changes during stressful times Intervention Goals for 2012-13 • Continue enrollment in randomized trial till Dec 2012 • Identify best practices, refine program • Recruit additional patients outside research trial Other chronic diseases Accept referrals from providers, hospitals, home health agencies Longer monitoring periods High Risk patients not currently hospitalized Different care settings- long term care, assisted living • Jan-Mar 2013- Program evaluation and dissemination of results to stakeholders and other Beacon programs Conclusions • Challenges Recruiting patients Research study restrictions Lack of physician involvement • Potential Contributions Cost analysis of early intervention to prevent readmissions and ED visits Examination of mediating variables: patient compliance and behavior Telemonitoring study with additional social support “Whole System Demonstrator Programme” results released Dec.2011 National Health Service in the United Kingdom randomized 6,191 patients from 238 practices to be monitored in their homes. First year preliminary findings show: • 15% reduction in A&E visits (similar to our E&M) • 20% reduction in emergency admissions • 14% reduction in elective admissions • 14% reduction in bed days • 8% reduction in tarriff costs • Most striking was a 45% reduction in mortality rates 30 www.ihie.org CMS Innovation Challenge Grant CMS Center for Innovation was funded with $10 Billion from Patient Protection Act of 2010 • $1 Billion in grant awards announced in Dec. 2011, ranging from $1 million minimum to $30 million max over 3 years • Challenge Grant required: • Innovative model to meet the Triple Aim (Berwick 2009) • Better Health, Better Healthcare, Lower Cost • Alternative Payment Model • Workforce Development Plan • Six month rapid deployment with measureable impact • Financial Plan to demonstrate cost savings over 3 years that exceeds amount of award 31 www.ihie.org Target Populations • High Cost- use data analytic tools to identify based on clinical data and utilization data or claims data • High Risk- use predictive modeling to identify based on current conditions, baseline utilization, history of multiple risk factors • Will Target “Avoidable Events” • Inpatient Admissions for Ambulatory Care Sensitive Conditions (ACSC) • Reduce Readmissions- target CHF, COPD, Acute MI, Pneumonia • Reduce Inappropriate Emergency Dept visits (use Prudent Lay Person criteria) • Reduce Premature Births- target high-risk pregnancies with prior history of premature births and/or multiple gestation 32 www.ihie.org Care Coordination Vision 33 www.ihie.org CAUTION! 34 www.ihie.org Questions?