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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

Physician/Home

SNF

LTAC

Rehab

Home Health

Hospice

Palliative Care

Patient

Hospital

Remote Monitoring

what if
What if . . .

Remote Monitoring

Patient

Doctor

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
challenges
Challenges
  • 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
telehealth
Telehealth

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!

slide22

VH Telehealth Conceptual Model

Diagnostic

Transitions

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
metrics
Metrics
  • 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
hospitalalizations
Hospitalalizations
  • 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

38

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
slide46

Bonnie Britton, RN, MSN, ATAFTelehealth AdministratorVidant Healthbonnie.britton@vidanthealth.com Seth Van EssendelftVice President Financial Services Vidant Medical Centerseth.vanessendelft@vidanthealth.com