Lee Memorial Health System How Telehealth Can Provide the Bridge between

Patients and Healthcare Providers

Overview

1. Current environment: the catalyst for Telehealth adoption

2. Goal: reduce readmissions by 1-2 percent per year

3. Methodology

4. Role of Telehealth

5. Outcomes

6. Lessons learned: a six sigma approach to constant improvement

7. The future

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Shift from Fee for Service Model to Fee for Value

Volume Driven Business Model

• Patients• Visits• Ancillaries

Fee for Service

• Fixed Costs• Variable Costs

• Profits

Value Driven Business Model

• Patients• Episodes• Treatments

• Patients Satisfaction• Resource/Case• Case Outcome

Fee for Value• Profit/Case• Case Mix

Against the changing landscape of health care reform, health care organizations in the United States are focused on achieving the industry’s identified “Triple Aim” goals of improving patient care and overall population health while reducing healthcare costs.

* Oliver Wyman CHI-HLCO5601-018

The catalyst for Telehealth adoption

Condition Management Models:

• Integrated Cardiology

• Integrated Oncology

• Diabetes

• ESRD

• Depression

Episodic Management Models:

Population Management Models:• Primary care med home• Complex Med home• Frail/Elder Med Home• Pediatric Med Home

• Orthopedic Surgery “focused factory”

• Neurosurgery“focused factory”

• General Surgery Factory Model

Clinical Transformation: Redefining how patients are viewed and managed.

Radiologist PCPs Cardiologist Pediatrician

Volume Driven Care Model Value Driven Care Model

OrthopedicSurgeons

OB/GYNs Urologist Oncologist

Oliver Wyman CHI-HLCO5601-018

The catalyst for Telehealth adoption

The catalyst for Telehealth adoption

Readmissions cost the U.S. approximately $600 billion – or 30 percent of the $2 trillion spent on health care each year;

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Approximately 19 percent of Medicare admissions are readmitted to the hospital within 30 days of discharge;

More than 75 percent of 30-day readmissions are due to avoidable circumstances, including:• Poor communication across the patient care continuum;• Poor planning prior to patient discharge from the hospital; and • Lack of understanding on the part of the patient or family members

involved in patient discharge.

• http://www.cms.gov/mmrr/Briefs/B2013/mmrr-2013-003-02-b01.html• Medicare Payment Advisory Commission

In conjunction with increasing health care costs, patients are willing to incorporate technology into their overall care management:

• 90 percent of patients want online access to health information and education to help them manage conditions.

• 83 percent of patients want to access personal medical information online;

• 72 percent of patients want to book, change or cancel appointments online;

• 72 percent of patients want to request prescription refills online; and• 88 percent of patients want to receive email reminders about

preventive or follow-up care.

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The catalyst for Telehealth adoption

http://newsroom.accenture.com/news/most-patients-want-to-self-manage-healthcare-online-accenture-survey-finds.htm

ACO’s are required to define a process to coordinate care, such as with the use of telehealth, remote patient monitoring, and other enabling technologies. Coordination of care includes:• Strategies to promote, improve, and assess integration;• Consistency of care across primary care physicians, specialists, and acute and post-acute

providers and suppliers; and • Methods to manage care as the patient transitions between care environments.  

The catalyst for Telehealth adoption

Lee Memorial Health System is a public health care system and includes:

• Four acute care hospital locations • A children’s hospital • A rehabilitation hospital • Lee Memorial Home Health agency• A nursing home• Out-patient treatment and diagnostic centers• Physician offices• House calls

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Lee Memorial Health System

Reduce readmissions & save money

2010 - In preparation for changes in CMS reimbursement rates for Medicare patients, Lee Memorial Health System committed to a two-pronged goal:

• Reduce readmissions by 1-2 percent per year

• Save money throughout the System by lowering the number of patient visits per disease episode.

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Methodology

The Lee Memorial Home Health team garnered system-wide support to implement a new telehealth program, designed to monitor patients following hospital discharge:

• Launched in late 2010, the telehealth program began with 50 remote patient monitors, and has since grown to more than 250.

• Lee Memorial used Honeywell HomMed’s LifeStream Solutions, a combination of remote patient monitoring devices and back-end support software, which provided analytical tools to help health care staff track patient outcomes and patient case load, as well as standard reports to measure operational and clinical staff efficiency.

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Methodology

• The care model was team-based, involving physicians, nurse practitioners, telehealth nurses, trained technicians, pharmacists and specialists (principally cardiologists).

• This helped to accomplish system-wide buy-in for the program’s success from the start, and ensured all care providers in the patient care continuum were aware of how patient oversight following discharge would occur.

• Key metrics around readmission rates were established, which were tracked and communicated to raise system-wide awareness for the program and its ability to impact reduced admission rates.

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The program was launched with a strategic plan and approach for continual improvement:

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Collect data and report metrics within the system;

Analyze data for trends to improve program

methodology;

Calculate readmissions monthly and track against

previous months.

Methodology

Role of Telehealth

• Reducing readmissions centered on improving patient care transitions using telehealth because patient biometrics could be regularly monitored post discharge. Any changes in the patient’s condition could be detected to enable early medical interventions, preventing potential complications and/or a hospital readmission.

• Care providers could use telehealth to provide patients and families with education related to discharge instructions or diagnosis.

• For patients, this experience provided them with increased owner ship in the management of their diagnosis post-discharge. This feeling of empowerment resulted in increased patient compliance and engagement, improved quality of care, and improved clinical outcomes.

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Outcomes: measure of success

• Telehealth staff document interventions that prevented patient readmissions and documented them as a “save” for the system.

• A typical “save” might include notifying a physician that a patient’s vital signs had fallen out of the established parameters, for which the physician might provide additional orders.

• These types of immediate interventions resulted in a positive outcome for the patient who could then remain in their home, avoiding a trip to the emergency room, which may have also been followed by a hospital admission.

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100 Saves in FebruaryA new record!

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MR # Problem Intervention Result Hospital Date

Tachycardia MD Contact Meds Adjusted NO JG 5/1/2013

Hypertension MD Contact Meds Adjusted NO JG 5/1/2013

Hypertension MD Contact Meds Adjusted NO JG 5/3/2013

Hypertension MD Contact Meds Adjusted NO CB 5/1/2013

Tachycardia MD Contact Meds Adjusted NO CB 5/2/2013

Weight Gain MD Contact Tests ordered No Ca B 5/3/2013

Weight Gain MD Contact MD Visit NO JG 5/2/2013

Weight Gain SN Collaboration SN Visit NO JG 5/5/2013

An example of Lee Memorial Home Health “save” data:

Outcomes: measure of success

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Through December 31, 2013, Lee Memorial Home Health has cared for 8,967 unduplicated patients since the telehealth program’s inception (increasing the number of patients by 971.5 percent), with a total of 1282 avoided hospital readmissions.

Outcomes: measure of success

2010 2011 2012 20130

500

1000

1500

2000

2500

3000

3500

4000

4500

Number of Telehealth PatientsNumber of "Saves"

Based on the average cost of

$5,600* per hospital admission,

this data represents a total savings of

$7.1 Million to the Lee Memorial Health System since the program’s inception in 2010.

*Avg. cost for a Congestive Heart Failure Patient per Lee Memorial Health System Decision Support Dept., and much lower than the national average of $9,600/readmission.

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Outcomes: measure of success

Lee Memorial Home Health 30-day readmission statistics:

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FY 2011 2012 2013

All Telehealth patient

readmissions13% 10% 9%

Outcomes: measure of success

Lessons learned: A Six Sigma approach for constant improvement

Lee Memorial Home Health staff members are committed to ongoing program improvement through the collection and analysis of metrics designed to measure results and identify areas for future improvement:

– Readmission rates– Discharges from acute care for resumption of agency care– The total number of patient home visits for per episode– Feedback from the Lee Memorial Health System readmission

group

Clinical outcome data is shared with all applicable practitioners across the full care continuum at readmission team meetings.

The same outcome metrics are also analyzed along with financial data to validate the System cost savings, and reported regularly to the Lee Memorial physician group and senior leadership.

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The future

As health care organizations begin operating as integrated delivery networks and ACO’s to capitalize on a more streamlined health care model, the system-wide embrace of telehealth solutions as a communication bridge for the patient discharge process can be the difference between success and failure.

In looking at the success Lee Memorial Health System has had in reducing readmissions, it is clear that telehealth can significantly impact the efficacy of health care delivery at every point in the care continuum, providing the opportunity to reduce readmissions and improve patient care coordination.

Lee Memorial’s next phase is to provide a more multi-dimensional look at the patient through video visits. A pilot program is in progress to demonstrate the value of face-to-face interactions for improving overall health:

• Video enables clinicians to better assess the patient’s living situation and emotional state, while providing individuals with a greater level of comfort with their care providers.

• Improving the rapport between care providers and patients via video visits can help activate individuals to take a more proactive role in managing their own health.

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