Transcript Slide 1

Telehealth Medical Home Model:
Strategies and Successes
Eastern Montana Telemedicine Network Retreat
August 31, 2009
Presented by:
Bonnie Britton, MSN, RN
Telehealth Clinical Network Director/Development Dir.
Roanoke Chowan Community Health Center
RCCHC’s Mission:
• Improve health status of underserved and indigent individuals in
northeastern North Carolina by:
• Enhancing access to quality health care
• Implementing coordinated health care delivery best practices
Located in rural North Carolina
• 17 PCP at 3 clinics serving over 14,500 patients
Population:
• 21% uninsured
• 41% high school completion
• 70% African American
Roanoke Chowan Community
Health Center
Health Disparities
• Cardiovascular Disease
• Diabetes Mellitus
• Hypertension
Barriers to care
• Transportation
• Economic Status
• Low literacy
Medical Home Model
•Prevention
•Primary Care
•Chronic Care Management
•Patient Education
•Coordination of Care
•Community Outreach
•Longitudinal Care
Patient Provider Telehealth Network
•Driven by PCP
•Individualized to patient
•Daily remote monitoring
•Daily RN chronic care management
•PCP responds to critical indicators allowing early
detection and intervention
•Follow-up with patient by PCP
Patient Provider Telehealth Network
NC HWTF Health Disparities Phase I Goals
•Reduce health disparities
•Increase access to care
•Overcome barriers to care
•Contain health care expenditures
•Create community based telehealth network
PPTN Phase I Target Populations
CVD, DM, HTN
In-home daily remote monitoring
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Objective monitoring (BP, Pulse, Blood Sugar, O2
saturation, Weight)
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Subjective monitoring (signs/symptoms)
Daily Chronic Care Management
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Medication compliance assessment
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Nursing health assessment
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Education
PCP intervention and patient follow-up as needed
PPTN Phase I
Populations Served
In-home monitoring
• 198 CVD/DM/HTN patients
Kiosks screenings
• 43 population based CVD/DM/HTN screenings
for 2,507 citizens
In-home Patient Outcomes
Enhanced self-management skills
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Increased self care
Empowered patient/caregiver
Improved patient health status
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Decreased HgA1c
Decreased FSBS
Decreased BP
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Decreased weight
In-home Patient Outcomes
Patient Impact
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Increased access to medical care
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Reduced health disparities
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Increased satisfaction
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Increased compliance to medical regimen
Patient Hospitalizations
Number of
Hospitalizatons
70
60
50
40
30
20
10
-
Prior
During
Post
66
40
34
n = 48
n = 17
n = 16
n = 64 In-home patients
Telehealth patient hospitalizations
decreased 39% from 6 months prior to
telehealth to during telehealth. Patient
hospitalizations decreased 48% from
prior to telehealth to post telehealth.
Analyzed charges are related to diseases being monitored.
RCCHC / PPCTN Patient Charge Data Ending March 2008
Total Number of Hospitalizations
Prior Telehealth: $1,693,698 (316 Bed Days)
During Telehealth: $626,387 (154 Bed Days)
Post Telehealth: $503,953 (157 Bed Days)
Patient Emergency Room Charges
30
Number of ER Visits
25
20
15
10
5
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Prior
During
Post
30
17
21
n = 17
n = 10
n = 14
n = 52 In-home patients
Telehealth patient ED visits decreased 43%
from 6 months prior to telehealth to during
telehealth. Patient ED visits decreased 53%
from prior to telehealth to post telehealth.
Analyzed charges are related to diseases being monitored.
RCCHC / PPCTN Patient Charge Data Ending March 2008
Total Number of Emergency Department Visits
Before Telehealth: $83,580
During Telehealth: $58,159
After Telehealth: $35,590
Patient Hospital Charges
1,800,000
1,600,000
Charges
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
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Prior
$1,777,277
During
$684,546
Post
$539,543
n = 64 In-home patients
Telehealth patient charges decreased
61% from 6 months prior to
telehealth to during telehealth.
Patient charges decreased 70% from
prior to telehealth to post telehealth.
Analyzed charges are related to diseases being monitored.
RCCHC / PPCTN Patient Charge Data Ending March 2008
Total Number of Hospitalizations
Prior to Telehealth: 66 (316 days total) and 30 ED visits
During Telehealth: 41 (154 days total) and 17 ED visits
Post Telehealth: 33 (157 days total) and 21 ED visits
Strategies for Expansion
Vertical Networks
•Centers of Aging: kiosk monitoring
•Senior Centers: kiosk monitoring
•PACE Programs: in-home monitoring
•Hospital discharge monitoring: in-home monitoring
•Diagnosis based: in-home monitoring
• CHF
• DM
Strategies for Expansion
Horizontal Networks
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Expansion to CHCs
•CHC funded
•Grant funded
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Replication to 6 additional CHCs
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Expansion to other PCP practices
Senior
Centers DM &
CVD Pts
RCCHC
CVD Pts
RCCHC
HTN Pts
RCCHC
DM Pts
Piedmont
Senior Care
CVD Pts
ECU CardiologyRCCHC In Home
Monitoring
HF Pts
Piedmont Health
Systems CVD Pts
Roanoke Chowan Community
Health Center
Existing
Patient Provider Telehealth Network
June 30, 2009
Roanoke Chowan
Hospital
Patient Provider
Telehealth Network
Rural Health Group
DM Pts
Gates Co. Medical
Center DM & CVD Pts
RCH
Hospitalized
DM Pts
Post
Discharge
NC HWTF Phase II PPTN
Goals and Objectives
Goal 1: Reduce rate of CVD and it’s complications
Objectives:
Replicate current PPTN
Provide daily in-home monitoring for 6 months
50% compliance to remote monitoring
10% reduction in LDL and BP
Goal 2: Obtain NC Medicaid Reimbursement
Objectives:
Decrease ER visits and hospitalizations 30%
Reduce NC Medicaid expenditures
Horizontal CHC Telehealth Network
July 1 2009 – June 30 2012
RCCHC
PCPs/CVD patients
Cabarrus CHC
Greene County CHC
PCPs/CVD patients
PCPs/CVD patients
RCCHC Telehealth RN
and Team
Kinston CHC
Tri-County CHC
PCPs/CVD patients
PCPs/CVD patients
Rural Health Group
PCPs/CVD patients
Phase II PPTN
Target Patient Population
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NC Medicaid CVD and/or Heart Failure NYSC III/IV and
require frequent monitoring, health assessment and
education.
Frequent exacerbations
Frequent use of health care system
Willing to carry out mutually agreed responsibilities
Desire to participate in the program
Have basic cognitive skills
Able to learn to use monitors
PPTN Phase II
RCCHC Staff Deliverables
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In-home remote monitoring equipment
1.0 FTE RN to provide daily monitoring and chronic
care management
0.03 FTE Data Analyst for data collection and
evaluation
Customized policies and procedures and
implementation documents
Webinar and on-site implementation and planning
meetings
Equipment training
On-site initial equipment deployment
On-site quarterly meeting
PPTN Phase II
CHC Staff Deliverables
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One designated nurse champion
Identifies CVD/HF patients
Completes Plans of Care
Completes patient consent forms
Installs and de-installs telehealth equipment
Troubleshoots and maintains equipment
List of appointed program staff and contact
information
EMR access for RCCHC RN
Quarterly data reports (height, LDL)
Provides oversight care of CVD/HF patients
Evaluation
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IRB approved
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Contract with PhD Wake Forest University
Clinical data
Financial data
Demographics
Hospitalizations/costs
Weight
ER visits/costs
Blood Pressure
PCP visits/costs
Pulse
LDL
Medication Classifications
Contact Information
Bonnie Britton
252-209-0237
[email protected]
www.rcchc.org