ACOs Meet the Triple Aim

with Telehealth Support

Deborah Dahl VP, Patient Care Innovation

98,000

1,683,290

1

Telemedicine:

More than Technology

Breakdown Of Cost Base By Category, Industry Benchmarks

55%

22%

9%

4%

4%

2%2%

1%1%

Category

Est Base Cost for

Pilot Population

($M)

Hospital Care (incl ED visits) $14.7

Physician and Clinical Services

(e.g., dialysis, labs, x-rays, doc

visits) $5.9

Prescription Drugs $2.4

Nursing Care Facilities $1.2

Durable Medical Equipment $1.1

Dental Services $0.5

Home Healthcare $0.5

Other Professional Services

(PT/OT, other) $0.3

Other Personalized Care (e.g.,

ambulance, residential) $0.1

Total $26.7

Longitudinal ICU LOS & Hospital Mortality

* APACHE IV predictions begin

Acute Care Results

ICU 2012

• >20,000 fewer ICU days than predicted

• >50,000 fewer Hospital days

• >$65,000,000

• >2,000 lives saved (APACHE 0.42)

eHx

• ICU Transfers dropped from 1.1% to 0.6%

• $4.5 M saved

iCare Emergency Medicine

eCareMobile

Correctional

Facility

Clinics eED

Tele-stroke

Trauma triage

Tele-psychiatry

Specialty call coverage

Intensivist & Hospitalist

Stroke

Neurologist

Trauma

Surgeon

Nephrologist

Psychiatrist

Initiate TX asap

ED

Referring sites

Qualit

y o

f Life

Comfortable

setting

Chronic Disease

Management

Cost

Effective

Independent,

Healthy Living

$1 $10 $100

Home Care

Assisted Living

Skilled Nursing

Facility

Residential

Care

ICU

Community

Hospital

Specialty

Clinic

Acute Care

Cost of Care / Day

Source: IBM ‘Connected Health’ Solution, 2011

$10,000 $1000

h@h

4.6% Readmission Rate 4 of 86 enrolled Patients

Day 30: CHF- Bradycardia/hypotension

Day 30: CAP- Recurrent pneumonia (3 admits since then)

Day 1: CHF- A-fib required cardioversion

Day 6: COPD/CHF- Syncope

2 ED visits

National Average (2010) CHF- 24.8%

Pneumonia- 18.4%

Cellulitis/COPD- No data

Patient Segmentation – One Size Doesn’t Fit All

Groups

Top %

Number of patients

(millions)

Group Expenditure

(billions)

% of total expenditure Average expenditure

5 15 607,2 50,6 40480

5-15 30 284 23,7 9480

15-50 105 271 22,6 2583

50-100 150 37 3,1 248

5%

5-15%

15-50%

50-100%

50,6%

23,7%

22,6%

3,1%

$40,480

$ 9,480

$ 2,583

$ 248

Average expenditure per patient per year

Percentage of total expenditure

Segmentation based on healthcare spending

Source: IMS Institute report and AHRQ analysis of spending data using Medical Expenditure Panel Survey

Principles

• Incorporate well-defined, reliable, systems-based workflows into

routine care provision to ensure consistent delivery;

• Define clear, accountable responsibilities for each team member;

• Implement foundational digital health tools to facilitate decision

support, tracking of adherence to the system of care, and real-time

updates to patient records; and

• Align team incentives so that each member is vested in improving

the quality of care and health of patients, thereby controlling the

total cost of care.

Institute of Medicine, “Improved Patient Outcomes in 3 Years with a System of Care for Diabetes”, Frederick

J. Bloom, Jr., MD, Thomas R. Graf, MD, and Glenn D. Steele, Jr., MD, Geisinger Health System*, October 2012

Mobile Team

Home Health

Nurse

Health Coach

IAC Center

Primary Care

Intensivist

Medical

Assistant

Banner iCare Primary Care

14

Telehealth Team

iPhysician

iMSW

iRN

iPharmacist

Care

Quarterback

Health Unit

Secretary

Home

Patient &

Caregiver

Health Coach Role

15

Philips Telehealth Solutions

IAC Program Features

• Unique patient – provider structure

• Dedicated IAC providers ensure availability, expertise and consistency

• Small provider group simplifies change initiative - workflows, technology

tools, quality management, incentive alignment

• Major focus on patient success

• Health coaches provide regular education / support

• Financial incentives to drive desired behaviors

• Operational design elements

• Tele-health model / tools provides highly efficient daily management

• Care Quarterbacks / electronic task tracking ensure follow through

• IAC Center – allows escalation within IAC program

Benefits

Improve Patient

Satisfaction

Improve Quality of

Patient Care

Improve Provider

Efficiency /

Satisfaction

Reduce Costs of

Providing Care

• Reduce avoidable Emergency Department visits • Avoid costs of readmission within 30 days • Reduce inpatient hospital admissions • Reduce admissions to Skilled Nursing Facilities • Reduce length of stay for patients admitted to SNFs • Reduce duplicate and avoidable radiology and lab tests • Reduce sub-specialty consultations • Improve productivity of Primary Care Physicians and nursing staff • Increase generic utilization for certain drugs

• Improve prescription fill rates • Improve compliance with prescribed medication usage • Reduce impacts of adverse drug events • Reduce length of stay for patients admitted to acute care

• Improve satisfaction by removing complex patients from majority of PCP's patient panels • Improve Home Health nurse retention rates • Provide care team with challenging opportunities

• Improve patient quality of life by delivering more care at home • Improve patient quality of life by avoiding hospital or institutional facility admissions • Improve patient satisfaction by making healthcare resources easy to access and understand • Improve patient satisfaction by automating home health devices

Expected Benefits Benefit Areas

If we are to achieve results

never before accomplished,

we must employ methods

never before attempted.

Francis Bacon