cathie markow, bsn, mba, senior director, clinical … 2014/anc/presentations/anc master... ·...
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Cathie Markow, BSN, MBA, Senior Director, Clinical Quality – Castlight Health Ms. Markow leads Castlight’s quality strategy including efforts to find the best possible clinical quality information and to incorporate it into Castlight Health solutions, making it meaningful and actionable to consumers. While at Pacific Business Group on Health (PBGH), she managed the California regional collaborative, a multi-stakeholder organization focused on provider performance measurement and reporting, and was involved in a variety of health care quality reporting and improvement activities within the state and nationally. She holds a BS in nursing and BA in sociology from Hartwick College, and an MBA from Northeastern University.
Sophie Pinkard, Director of Strategic Analytics – Castlight Health Sophie Pinkard is Director of Strategic Analytics at Castlight Health. The Strategic Analytics team focuses on evaluating the impact of Castlight's platform on employers and users and providing meaningful, data-driven insights within the company and externally. Sophie previously worked at the Advisory Board partnering with hospitals on business intelligence tools to improve revenue cycle performance. She received both a BS in management science and engineering and an MBA from Stanford University.
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Avoiding serious medical errors that compromise health and inflate costs
April 22, 2014
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Today’s Speakers
Cathie Markow, BSN, MBASenior Director of Clinical QualityCastlight Health
Sophie Pinkard, MBADirector of Strategic AnalyticsCastlight Health
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Health Care Transparency
Transparency enables benefits success
Engaged Employees
Right Providers
RightCare
Transparency ties the employer’s benefits strategy together
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Castlight supports an employer’s health goals
Quality
Engagement Innovation
Education
Integration Benefit Design
Price Personalization
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Serving benefits leaders across 26 industries
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Meet Bob
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An example: Poor quality, one employer
14members with
serious pressure sores
12members with
catheter-associated blood
infections
13members with
catheter-associated
urinary tract infections
5members with foreign
object left in place after procedure
Data on never events as defined by CMS over a 2 year period.
1member who died or
was left with a serious disability from an
embolism
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Sources: Institute of Medicine (1999), “The Factors Fueling Rising Healthcare Costs 2006”, PricewaterhouseCoopers (2006), Medpec (2007), American Association of Endocrinologists (2006), Center for Disease Control and Prevention (2005), Solucient (2007), U.S. Outcomes Research Group of Pfizer Inc (2005), National Committee for Quality Assurance (2005), Analysis by PricewaterhouseCoopers’ Health
Defensive medicine
Preventable hospital
readmissions Poorly managed diabetes
Medical errors
Unnecessary ER visits
Hospital acquired infections
Treatment variations
Over prescribing antibiotics
$210 billion
$25 billion
$22 billion
$17 billion
$14 billion
$10 billion
$3 billion $1
billion
1/3 of health costs are the result of poor quality care
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Avoidable cost of poor quality care in the U.S.
$25billion
$17billion
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What’s the true cost?
Longer hospital visits
Missed work
Complications
Re-admissions
Personal Financial
Pain
Emotional Toll
Loss of life
Caregiving
Loss of vitalityIncreased care
More provider visits
Productivity loss
Reduced ProfitabilityTime
Stress
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Grave impact of preventable events
Up to 440,000 deaths
attributed to some type of preventable harm or never event suffered in hospitals
3rd leading cause of death
behind heart disease(#1) and cancer (#2)
Source: Journal of Patient Safety (Vol. 9, Issue 3), September 2013 | 10
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Defining never events
28“Never Events”
identified by National Quality Forum
We analyzed 5:
Pressure ulcer
Vascular catheter-associated infection
Catheter-associated UTI
Foreign object retained after surgery
Air embolism
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300 million claims from 2011-2013
87 employers selected for analysis
275 U.S. metropolitan areas covered
Castlight’s data set
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We analyzed the following never events
Pressure ulcers
Catheter-associated UTI
Vascular catheter infection
Retained foreign objects
Air embolism
1
2
3
4
5
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These events are common, but not inevitable
Out of the 87 employers selected for analysis:
77had at least one
event occur
10had no events in
three years
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All events by metropolitan area
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
Dots represent average annual number of never events per 1000 Castlight eligible members, from 2011 - 2013. | 16
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Top 15 metro areas with the most never events
2.28
2.30
2.31
2.59
2.59
2.60
2.69
3.12
3.16
3.17
3.19
3.35
4.42
5.45
5.67
Gainesville, FL
Gadsden, AL
State College, PA
Anniston, AL
Roanoke, VA
Athens, GA
Philadelphia, PA
Richmond, VA
Utica, NY
Jackson, TN
Charleston, WV
Flagstaff, AZ
Augusta, GA
Greenville, NC
Rochester, MN
Annual never events per 1K Castlight-eligible members
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Pressure ulcers by metro area
Dots represent average annual number of pressure ulcers per 1000 Castlight eligible members, from 2011 - 2013.
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
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Vascular catheter infections by metro area
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
Dots represent average annual number of vascular catheter-associated infections per 1000 Castlight eligible members, from 2011 - 2013.
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
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Catheter-associated UTIs by metro area
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
Dots represent average annual number of catheter-associated UTIs per 1000 Castlight eligible members, from 2011 - 2013.
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
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Retained foreign objects by metro area
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
Dots represent average annual number of retained foreign objects per 1000 Castlight eligible members, from 2011 - 2013.
<1 event per 1000
1-2 events per 1000
2-3 events per 1000
>3 events per 1000
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Top 15 metro areas with the fewest never events
These 15 metro areas have the highest number of of eligible members over the past three years with zero never events.
Within every metro area with never events, there were a number of hospitals with no events.| 22
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Accountability for never events
Hospital? Surgeon?
Both – it’s a team effort.
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1) Know your population
2) Support efforts to measure and report performance
3) Programs and Incentives
What can employers do?
You can’t manage what you can’t measure.
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Use publicly reported metrics
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Benefits to Employers Rich information needed for developing value-based networks of
high-quality providers Better surgical outcomes and decreased absenteeism for
employees
How can employers get involved? Encourage health plans or Third Party Administrators (TPA) to
require registry data from hospitals Ask health plans or TPA to encourage hospital outcomes
transparency Advocate that health plans reward registry-participating
hospitals and surgeons Recognize registry-participating hospitals and surgeons
Support and use registries
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Identify variation, direct-to-high quality facilities
St. Patrick’s Hospital• Surgical Score: Below Average
Memorial Hospital• Surgical Score: Average
Pacific Medical Center• Surgical Score: Above Average
Regional Medical Center• Surgical Score: Average
Surgical score = Hospital’s composite average of CMS surgical safety measuresSelected surgeries include: Hip replacement, knee replacement, hysterectomy, C-section, low back surgery, CABG, radical prostatectomy
Key1-2 selected surgeries for Acme Corp members
3-10 selected surgeries for Acme Corp members
10+ selected surgeries for Acme Corp members
Atlantic Hospital• Surgical Score: Average
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Avoid unnecessary surgery with second opinions
Up to 30%of second opinions reveal that the
original diagnosis was wrong or need to be revised
Up to 90%of second opinions recommend changes to
original treatment plan
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A medical facility that is recognized as a leader in providing high quality, evidenced-based medicine Surgical procedure or medical condition Costs often considered Credentialing program available for some services
Incent use of Centers of Excellence (COE)
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Common COE procedures: Coronary Artery Bypass Graft
(CABG) Heart valve replacement Knee / hip replacement Spinal fusion / disc surgery Bariatric surgery Transplant surgery
1 National Business Group on Health, Large Employer’s 2014 Health Plan Design Survey, August 2013
of large employers offer a COE program for organ transplants1
72%
59%offer a COE program for conditions other than transplants1
Innovative employers see value in COEs
“This national program is about providing our associates with exceptional care and reducing their medical costs…”-SVP of Global Benefits, Castlight Customer
COE value proposition
Hospitals vary in quality
COEs optimize quality vs. cost
Higher quality leads to better outcomes
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Educate employees
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Select a high quality hospital and surgeon
Find provider(s) experienced in performing procedure
Review clinical outcomes data - Complication rates- Readmissions- Mortality
Review process metrics in the absence of outcomes data- Antibiotic management- Blood clot prevention- Timely urinary catheter removal
Employees can minimize risk of surgical events
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Be prepared Start healthy Schedule early in week Have a family member present
Avoid infections Ask about antibiotics Avoid razors Insist on hand washing Have tubes/catheters removed as soon as possible Good skin care
Prevent blood clots Prevention Get moving as soon as you can
Get the right drugs
Employees can minimize risk of surgical events
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Wrong site surgery Preoperative verification Marking the operative site “Time out” immediately before starting
the procedures Safe surgery checklist
Infection prevention Hand washing - can reduce the
nosocomial infection rate by as much as 40%*
Appropriate use of antibiotics Catheter care
What can hospitals do?
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770229/
It doesn’t have to cost a lot to save a life!| 34
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Use of information technology Electronic order entry Electronic medical records
Care management Discharge planning/instructions Care coordination
What can hospitals do?
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Back to Bob
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Questions?
Q&A
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Rena Brewer, RN, MA – Southeast Telehealth Resource Center (SETRC) Rena Brewer, RN, MA serves as the Director of the Southeastern TeleHealth Resource Center (SETRC). www.setrc.us which is one of 14 federally funded (HRSA/OAT) regional & national resource centers with the mission of providing support/guidance to those wishing to implement telehealth services. SETRC’s region includes Alabama, Florida, Georgia, and South Carolina. Rena also serves as the Director of the National School of Applied Telehealth (NSAT) which is the online educational arm of SETRC. www.nationalschoolofappliedtelehealth.org. SETRC is a branch of Georgia’s highly successful, not-for-profit, state-wide telehealth network; Georgia Partnership for Telehealth (GPT). Rena, a Registered Nurse with a Masters in Organizational Leadership, has 9 year’s experience in building telehealth networks with GPT and 25+ years of experience in community health education and organization building.
The New Wave of Health Care:
Telehealth
FHCC 2014
Annual National Conference
April 22-23, 2014
The New Wave of Health Care:
Telehealth
Plenary Session III
Moderator: Ken Peach, Executive Director - Health Council of East Central Florida
Panel Members:
Rena Brewer, RN, MA - SE TeleHealth Resource Center
John K. Holland, Senior VP for Research - AMC Health
Anna Baznik, President/CEO – IMPOWER
…...Healthcare was available anytime and anywhere
…..Clinicians / patients could obtain
consultations with medical centers of excellence anytime and anywhere
…..Home bound patients could be
monitored remotely anytime and anywhere
…..Medical education programs were
available anytime and anywhere
This is the potential of telehealth!!!
Can you imagine what health care would be like if….
Healthcare: Any Time….Any Place….
The healthcare system is coming under increasing pressure to:
•improve the quality of care while; •decreasing the cost to provide this improved care.
Telehealth has the potential to address some of the pressing issues
facing today’s stretched and stressed healthcare system.
Telehealth is simply….
The use of telecommunications technology to support and deliver healthcare from a distance.
On Site Telehealth Services
help organizations keep employees
where they are needed the most...
On the job!
Corporate Telehealth Benefits
• Access to on-site healthcare
• Convenience for employees
• Minimizes employee downtime
• Early diagnosis & treatment can minimize spread of disease
• Applicable to many common conditions
• Supplements current on-site health program
• Suitable within the corporate environment and adaptable to company culture
Cost Savings
• Onsite Provider Cost Savings
• Improved Health Outcomes
– Timely Acute Care Treatment for Common Illnesses
– Potential for Improved Disease Management
– Decreased Need for Crisis Care
• Decreased Employee Absenteeism
• Healthier Workforce
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TELEHEALTH APPLICATIONS
Clinical Services – Patient / Provider Consultations; such as Primary Care, Specialty Care, ICU Monitoring, Emergency/ Stroke Services, Chronic Care Monitoring / Home Monitoring, Employee Health Care
• Live / Synchronous–Video, Interactive, Face to Face
Both the patient and the healthcare provider are available in real time and can communicate as though in the same room.
• Store & Forward / Asynchronous
Used when face to face interaction is not required ;
Radiology, Dermatology, Pathology, Home Monitoring, etc.
Educational Services – Patient and Clinical Staff Education.
Administrative Support – Video Conferencing for One-One Meetings or Multi-Point Meetings.
Barriers and Possible Reasons for the slow adoption of Telehealth:
• Human Factor – Low awareness by providers & receivers of telehealth and its benefits – Reluctance to change or embrace technology
• Lack of Wide-Scale Reimbursement – Reluctance of many insurers to pay for services – Medicare reimbursement restrictions – Medicaid reimbursement varies from state to state
• Regulations – Licensure of physicians / providers in multiple states – Credentialing of providers
• Technology – Hardware/Software Cost* (*Note: The industry is moving to higher
quality / lower cost solutions) – Disconnected Health Information because of the lack of standards & interoperability between systems / networks – Limited broadband access for patients in some regions
Final Thoughts… • Telehealth is one of the most promising evolutions in the
health care landscape.
• Remote healthcare services
and technology are quickly becoming commonplace in
the healthcare setting.
• Now is the right time for
telehealth to gain prominence
in helping the healthcare industry
resolve cost and care quality challenges.
The Florida Telehealth Workgroup
The Florida Telehealth Workgroup is a volunteer group of telehealth stakeholders interested in advancing telehealth services in Florida.
Workgroup Objectives:
• To provide insight and direction regarding the advancement of telehealth in Florida
• To encourage collaboration among existing telehealth networks and programs.
The Florida Telehealth Workgroup is Facilitated by the
Southeastern Telehealth Resource Center
Southeastern Telehealth Resource Center (SETRC). www.setrc.us
SETRC is one of 14 Regional/National Resource Centers funded by the Office for the Advancement of Telehealth through a grant program to provide support and guidance to telehealth programs. (# G22RH20212-04-00)
SETRC serves Alabama, Florida, Georgia, & South Carolina and is operated by the Georgia Partnership for TeleHealth, Inc.,
Georgia’s successful nonprofit statewide telehealth network.
14 TRCs are located across the country…..
John K. Holland, Senior Vice President for Research – AMC Health John K. Holland, Sr. Vice President for Research Prior to joining AMC Health in 2010, Mr. Holland founded LifeLink Monitoring, a leading national telemonitoring company, in 1994. He developed the first home blood pressure telemonitoring service in the U.S., followed by a suite of telemonitoring services for clinical trials, homecare, managed care and disease management. He has spoken on telemonitoring at Partnerships in Clinical Trials, the American Heart Association, the American and International Societies of Hypertension, the Society of Behavioral Medicine, and the American Association of Health Plans, and has written several scientific articles. Mr. Holland was a member of the Working Group on Compliance of the National Heart, Lung and Blood Institute, and co-inventor, with Dr. Thomas Pickering, of a mercury-free hybrid sphygmomanometer.
Telemedicine Goes Mobile
John HollandSr. VP for Research & Business Development
Collect data at home, transmit electronically to clinician who prescribes treatment
Objective data: 101o F
Subjective data: sore throat and cough
Transmitted to clinician electronically
MD prescribes treatment and follow-up
“Take 2 aspirins and call in the morning.”
It’s Nothing New…
4/20/2014Telemedicine Goes Mobile 2
Today, It’s Automated
BP HR BG Weight Temperature ECG FEV1 PEF PT/INR Fluid status Lipids HbA1c Stethoscope
Bluetoothto Mobile
4/20/2014Telemedicine Goes Mobile 3
Video Visits Can replace many office & home visits
Supervise biometric monitoring
Affect, posture, gait, speech quality, etc.
Fine motor coordination
Psychological assessment
4/20/2014Telemedicine Goes Mobile 4
Monitor Physical Activity and Sleep Quality
GPS and accelerometers in smartphones track activity over time
2-3 days’ total activity may be a better indicator of recovery than an office assessment
Wrist bands monitor sleep quality
Measure the things that matter to patients
4/20/2014Telemedicine Goes Mobile 5
“Drugs Don’t Work in Patients Who Don’t Take Them”
Major cause of treatment failure Monitors remind patients to take medication If patients fail to take Rx on time, clinicians
&/or family are alerted
Oral Rx in single container or multi-compartment tray
Inhaled Rx in MDI or DPI
4/20/2014Telemedicine Goes Mobile 6
Reducing Readmissions
Geisinger patients with high readmission risk
Automated phone calls identify care gaps Unfilled prescriptions and poor adherence No follow-up appointment Symptoms Psychosocial support
Nurse case managers address problems Risk of 30-day readmission reduced 44%
n= 3,195, p= .0004 Medical Care, 2012; 50(1):50-57
4/20/2014Telemedicine Goes Mobile 7
Controlling Diabetes
330 NYC HHC Medicaid patients with high HbA1c
Blood glucose and blood pressure telemonitoring
Nurse case managers coordinated care Primary health care contact for many patients Advocated with clinic staff, counseled patients
Reduced HbA1c by 1.8 points! Lower risk of HF, PVD and microvascular complications Even patients who didn’t complete benefited
Journal of Managed Care Medicine October 2012
4/20/2014Telemedicine Goes Mobile 8
Blood Pressure Health Partners (MN) patients with elevated BP
Home BP telemonitoring managed by PharmDs Adherence counseling MD-approved protocol to escalate Rx as needed
Randomized trial compared telemonitoring and pharmacist care with MD office management
BP reduced 21.6/9.3 mmHg in 6 months
50% more patients achieved goal BP than usual office care by MDsJAMA July 3, 2013
4/20/2014Telemedicine Goes Mobile 9
Back to the Future…
TELEMEDICINE ON YOUR PHONE
DEMONSTRATION
4/20/2014Telemedicine Goes Mobile 10
Anna M. Baznik, President/CEO - IMPOWER Ms. Baznik has over 25 years of experience leading, managing and working within a wide range of social service and behavioral health programs for large, multi-program, non-profit and public sector entities delivering bottom-line results, efficient systems and strong community relations. IMPOWER provides mental health and child well being services in Orange, Osceola, Brevard, Seminole, Volusia and Polk counties. During her time with IMPOWER, she has ensured the financial stability of the agency during tumultuous economic times; enhanced visibility and involvement in the Central Florida community and the state; improved quality assurance programs; and greatly expanded our funding sources and relationships. IMPOWER is leading the way in Florida utilizing telehealth for psychiatric, mental health and child wellbeing/welfare services. Ms. Baznik has her BA in psychology, Sociology and Religious Studies from Eckerd College. She obtained a Masters in Organizational Management from the University of Phoenix.
TELEHEALTH
Anna M. BaznikPresident/CEO
Why Telehealth? Why Now? Behavioral Health Well-Suited Affordable Care Act 4 Million New in Florida to be Insured Shortage of Practitioners Rural / Geographic Challenges Insufficient Transportation
•Brings Care to Patient; Reconceptualization• Increases Access to Care • Reduces Travel Time and Costs • Improves Satisfaction in Health Care • Reduces Delays & No-Shows • Enables Continuity of Care • Reduces Stigma
Telehealth Benefits
Our Pilot
• Partnered with Value Options and American Well
• Designed Virtual Provider Connect (vPC)• Breakthrough• ePsychToday
Our Pilot Developed P&Ps & Best Practices Trained Docs in vPC Brevard Family Partners - Hub The Haven - Hub Went Live in May 2013 Over 100 Individual Sessions – All Children
Legislative Update• House and Senate Bills• Agency for Healthcare Administration
www.impowerfl.org
QUESTIONS ??
Stay Connected
www.impowerfl.org
Ken Peach, FACHE , Executive Director - Health Council of East Central Florida Ken Peach is Executive Director of the Health Council of East Central Florida, the health planning agency for Orlando and the Space Coast. The Health Council provides planning, program development and evaluation support that enables community-based health organizations to enhance population health.
Before joining the Health Council in December, 2010, Ken owned a medical practice business development company and health insurance agency.
From 1985 to 2005, Ken was an administrator in hospitals, health systems, and senior living facilities. Ken began his career in New Jersey and Florida building, managing, and owning AM and FM radio stations.
Ken holds a B.A. in Communications degree from Seton Hall University and an M.B.A. with Health Services Administration degree from Florida Institute of Technology.
BIG PICTURE: HEALTH CARE EXPENSES WILL RISE…
Source: Centers for Medicare & Medicaid Services,“Estimated Financial Effects of the “Patient Protection and Affordable Care Act,”as Amended, April 22, 2010.
REFORM WON’T FIX THAT.
CHANGING WHERE CARE IS OFFERED WILL HELP REDUCE COSTS.
$GOAL
Telehealth Team Care
Self-Care mHealth
CHANGING LOCATION REQUIRES TECHNOLOGY AND NEW TEAM ROLES.