Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical Center
Improving the Quality of Care: Reducing Readmissions
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Examining the “Boomerang Effect”
Discussing financial implications for
Telehealth
Discussing Vidant Health’s Telehealth
Program and outcomes
Questions and Answers
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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.
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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
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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
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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
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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
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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
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12. To enhance the quality of life for
the people and communities we
serve, touch and support.
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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
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21. Hey Norton - you
will get out of your
telehealth program
exactly what you
put into it!
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22. VH Telehealth Conceptual Model
Diagnostic
Transitions
In Care
Chronic Disease Mgt.
Friends & Family
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September 2012
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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
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Population:
In-patient CVD and Pulmonary patients
PAM Level I & II
Frequent ER visits/hospitalizations
Medicare/self pay/un/underinsured
Services:
In-home medication reconciliation
Home Safety Assessment
Daily Biometric data monitoring
Weekly telephonic assessment, education,
coaching
LOS:
3 months
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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
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Population:
Clinic based patients
PAM Level I & II – VMG Patients
PAM Level III with frequent ED/hospitalizations
Transfer from Transition in Care Program
monitoring
Services:
In-home medication reconciliation
Home Safety Assessment
Daily Biometric data monitoring
Daily telephonic assessment, education,
coaching as needed
Bi-weekly assessment, education, coaching
LOS:
6 months
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Population:
Graduates of TH TIC, TH CDM
VH Employees
Contracted Services (Nash, BasisHealth)
Services:
Self management monitoring
Biometric data monitoring
Fee for service
LOS:
TBD
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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
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Lower hospitalization cost
Readmission aversion
More effective and efficient care
Improved access to care at the appropriate levels
Greater patient satisfaction
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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
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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
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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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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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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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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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Seth, I can do this and you can write down notes.Who is our audience….MDs, RNs, CFO, CEO, What organizations have implemented remote patient monitoring?How many organizations plan to implement remote patient monitoring in the next 6 mos? 12 mos?Rationale for reducing hospital readmissions
Reimbursement does not necessarily align with new care models. Creation of incremental value is not necessarily captured by the creatorReform penalties are retrospective and often based on lagging dataNot all capacity can be reprogramedIt is all relative – we are all getting better!
Reimbursement does not necessarily align with new care models. Creation of incremental value is not necessarily captured by the creatorReform penalties are retrospective and often based on lagging dataNot all capacity can be reprogramedIt is all relative – we are all getting better!
If you start using telehealth at this point in Mr. Doe’s episode of care, you will start with Remote Patient Monitoring from Mr. Doe’s home.