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MATRC 2 nd Annual Summit March18, 2013 Improving The Quality of Care: Reducing Readmissions Bonnie Britton, MSN, ATAF Vidant Health Telehealth Administrator Seth Van Essendelft , MBA Vice President, Financial Services Vidant Medical Center. Today’s talk involves …….

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MATRC 2nd Annual SummitMarch18, 2013Improving The Quality of Care: Reducing ReadmissionsBonnie Britton, MSN, ATAF Vidant Health Telehealth AdministratorSeth Van Essendelft, MBAVice President, Financial Services Vidant Medical Center

today s talk involves
Today’s talk involves……
  • Examining the “Boomerang Effect”
  • Discussing financial implications for Telehealth
  • Discussing Vidant Health’s Telehealth Program and outcomes
  • Questions and Answers
mr doe s hospital admission
Mr. Doe’s Hospital Admission
  • 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.
mr doe prepares for discharge
Mr. Doe prepares for Discharge
  • Told he will be d/c home tomorrow
  • PCP not alerted that Mr. Doe was hospitalized
  • Given new prescriptions
  • Toldto schedule a PCP appt. in the next month
educating mr doe at discharge
Educating Mr. Doe at Discharge
  • 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
mr doe s first day home
Mr. Doe’s First Day Home
  • 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
the boomerang effect
The Boomerang Effect
  • 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
the boomerang effect1
The Boomerang Effect
  • 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
vidant health s mission
Vidant Health’s Mission:

To enhance the quality of life for the people and communities we serve, touch and support.

portfolio of tools
Portfolio of Tools

Discharge Options





Home Health


Palliative Care



Remote Monitoring

what if
What if . . .

Remote Monitoring



telehealth can alter the path
Telehealth Can Alter the Path

Telehealth Intervention

health system strategies
Health System Strategies
  • 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
  • Reimbursement
  • Reform penalties
  • Capacity utilization
  • It is all relative
business case
Business Case
  • Overview and process
  • Expectations
  • Lessons learned
    • Adaptation varied
    • Operational details
    • Length of monitoring assumptions
    • Data requirements
    • Keep the big picture in focus
financial goals and objectives
Financial Goals and Objectives
  • Stop Bonnie from beating on my door!
  • Pilot enhanced continuity of care model
  • Capture & quantify financial levers

Back to

the Future

driving the telehealth bus
Driving the Telehealth Bus!

Hey Norton - you will get out of your telehealth program exactly what you put into it!


VH Telehealth Conceptual Model



In Care

Chronic Disease Mgt.

Friends & Family

September 2012

transitions in care goals
Transitions in Care Goals
  • 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
transitions in care services
Transitions in Care Services
  • 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
chronic disease management goals
Chronic Disease Management Goals
  • 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
chronic disease management services
Chronic Disease Management Services
  • 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
vh telehealth family friends
VH Telehealth Family & Friends
  • 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
  • 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
  • Decreased by 69% Prior to During
  • Decreased by 76% Prior to Post
hospital bed days
Hospital Bed Days

Decreased by 67% Prior to During

Decreased by 81% Prior to Post

financial benefits total healthcare
Financial Benefits – Total Healthcare
  • Lower hospitalization cost
  • Readmission aversion
  • More effective and efficient care
  • Improved access to care at the appropriate levels
  • Greater patient satisfaction


financial benefits hospital system
Financial Benefits – Hospital System
  • 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
mr doe readmitted to hospital with hf
Mr. Doe readmitted to Hospital with HF
  • 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
mr doe s first day with rpm
Mr. Doe’s First Day with RPM
  • 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
mr doe s fourth day with rpm
Mr. Doe’s Fourth Day with RPM
  • Objective data:
    • Wt. increased by 4 pounds
    • O2 sat. decreased to 92%
    • BP slightly elevated @ 145/90
  • Subjective data:
    • Reporting SOB and ankle edema
mr doe s fourth day with rpm1
Mr. Doe’s Fourth Day with RPM
  • 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
take home points
Take Home Points
  • 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

Bonnie Britton, RN, MSN, ATAFTelehealth AdministratorVidant Seth Van EssendelftVice President Financial Services Vidant Medical