Overview

1. Lee Memorial Health System How Telehealth Can Provide the Bridge betweenPatients and Healthcare Providers

2. Overview • Current environment: the catalyst for Telehealth adoption • Goal: reduce readmissions by 1-2 percent per year • Methodology • Role of Telehealth • Outcomes • Lessons learned: a six sigma approach to constant improvement • The future

3. The catalyst for Telehealth adoption Shift from Fee for Service Model to Fee for Value Value Driven Business Model Volume Driven Business Model • Patients • Episodes • Treatments • Patients • Visits • Ancillaries Fee for Service • Patients Satisfaction • Resource/Case • Case Outcome • Fixed Costs • Variable Costs • Profit/Case • Case Mix Fee for Value • Profits 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 careandoverall population health whilereducing healthcare costs. * Oliver Wyman CHI-HLCO5601-018

4. The catalyst for Telehealth adoption Clinical Transformation: Redefining how patients are viewed and managed. Volume Driven Care Model Value Driven Care Model Radiologist PCPs Cardiologist Pediatrician Episodic Management Models: Condition Management Models: • Orthopedic Surgery “focused factory” • Neurosurgery“focused factory” • General Surgery Factory Model • Integrated Cardiology • Integrated Oncology • Diabetes • ESRD • Depression Population Management Models: • Primary care med home • Complex Med home • Frail/Elder Med Home • Pediatric Med Home OrthopedicSurgeons OB/GYNs Urologist Oncologist Oliver Wyman CHI-HLCO5601-018

5. The catalyst for Telehealth adoption • Approximately19 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 Readmissions cost the U.S. approximately $600 billion – or 30 percent of the $2 trillion spent on health care each year;

6. The catalyst for Telehealth adoption 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. http://newsroom.accenture.com/news/most-patients-want-to-self-manage-healthcare-online-accenture-survey-finds.htm

7. The catalyst for Telehealth adoption • 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.  

8. Lee Memorial Health System 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

9. 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.

10. 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.

11. 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-infor 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.

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

13. 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 owner­ship 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.

14. Outcomes: measure of success 100 Saves in February A new record! Telehealthstaff 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 apositive 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.

15. Outcomes: measure of success An example of Lee Memorial Home Health “save” data:

16. Outcomes: measure of success 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.

17. Outcomes: measure of success Based on the average cost of $5,600* per hospital admission, this data represents a total savings of $7.1 Millionto 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.

18. Outcomes: measure of success Lee Memorial Home Health 30-day readmission statistics:

19. 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.

20. 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.