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
2%
4%

2%

1%

1%

4%
9%

55%
22%

Category
Hospital Care (incl ED...
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 ...
iCare Emergency Medicine
Stroke
Neurologist

Correctional
Facility

Nephrologist

Psychiatrist

Trauma
Surgeon

Initiate T...
Home Care
Independent,
Healthy Living

Quality of Life

Chronic Disease
Management

Comfortable
setting
Cost
Effective

Re...
h@h
4.6% Readmission Rate
4 of 86 enrolled Patients
Day 30: CHF- Bradycardia/hypotension
Day 30: CAP- Recurrent pneumonia ...
Patient Segmentation – One Size Doesn’t Fit All
Segmentation based on
healthcare spending

Percentage of
total expenditure...
Principles
• Incorporate well-defined, reliable, systems-based workflows into
routine care provision to ensure consistent ...
Banner iCare Primary Care
IAC Center

Telehealth Team
iPhysician

Primary Care
Intensivist

iMSW

Medical
Assistant

Home
...
Health Coach Role

15
Philips Telehealth Solutions
IAC Program Features
• Unique patient – provider structure
• Dedicated IAC providers ensure availability, expertise and co...
Benefits
Benefit Areas

Reduce Costs of
Providing Care

Improve Quality of
Patient Care

Improve Provider
Efficiency /
Sat...
If we are to achieve results
never before accomplished,
we must employ methods
never before attempted.
Francis Bacon
iHT² Health IT Summit Beverly Hills – Deborah Dahl, Vice President of Patient Care Innovation, Banner Health
iHT² Health IT Summit Beverly Hills – Deborah Dahl, Vice President of Patient Care Innovation, Banner Health
iHT² Health IT Summit Beverly Hills – Deborah Dahl, Vice President of Patient Care Innovation, Banner Health
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iHT² Health IT Summit Beverly Hills – Deborah Dahl, Vice President of Patient Care Innovation, Banner Health

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iHT² Health IT Summit Beverly Hills – Deborah Dahl, Vice President of Patient Care Innovation, Banner Health

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iHT² Health IT Summit Beverly Hills – Deborah Dahl, Vice President of Patient Care Innovation, Banner Health

  1. 1. ACOs Meet the Triple Aim with Telehealth Support Deborah Dahl VP, Patient Care Innovation
  2. 2. 98,000
  3. 3. 1,683,290
  4. 4. 1
  5. 5. Telemedicine: More than Technology
  6. 6. Breakdown Of Cost Base By Category, Industry Benchmarks 2% 4% 2% 1% 1% 4% 9% 55% 22% Category Hospital Care (incl ED visits) Physician and Clinical Services (e.g., dialysis, labs, x-rays, doc visits) Prescription Drugs Nursing Care Facilities Durable Medical Equipment Dental Services Home Healthcare Other Professional Services (PT/OT, other) Other Personalized Care (e.g., ambulance, residential) Total Est Base Cost for Pilot Population ($M) $14.7 $5.9 $2.4 $1.2 $1.1 $0.5 $0.5 $0.3 $0.1 $26.7
  7. 7. Longitudinal ICU LOS & Hospital Mortality * APACHE IV predictions begin
  8. 8. 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
  9. 9. iCare Emergency Medicine Stroke Neurologist Correctional Facility Nephrologist Psychiatrist Trauma Surgeon Initiate TX asap Referring sites eED eCareMobile Clinics  Tele-stroke  Trauma triage  Tele-psychiatry  Specialty call coverage  Intensivist & Hospitalist ED
  10. 10. Home Care Independent, Healthy Living Quality of Life Chronic Disease Management Comfortable setting Cost Effective Residential Care Assisted Living Skilled Nursing Facility Acute Care Specialty Clinic Community Hospital ICU $1 $10 $100 $1000 Cost of Care / Day Source: IBM ‘Connected Health’ Solution, 2011 $10,000
  11. 11. 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
  12. 12. Patient Segmentation – One Size Doesn’t Fit All Segmentation based on healthcare spending Percentage of total expenditure Average expenditure per patient per year 50,6% $40,480 23,7% $ 9,480 22,6% $ 2,583 3,1% $ 248 5% 5-15% 15-50% 50-100% Groups Top % 5 5-15 15-50 50-100 Number of patients (millions) 15 30 105 150 Group Expenditure (billions) 607,2 284 271 37 % of total expenditure Average expenditure 50,6 23,7 22,6 3,1 40480 9480 2583 248 Source: IMS Institute report and AHRQ analysis of spending data using Medical Expenditure Panel Survey
  13. 13. 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
  14. 14. Banner iCare Primary Care IAC Center Telehealth Team iPhysician Primary Care Intensivist iMSW Medical Assistant Home Patient & Caregiver Mobile Team Home Health Nurse iRN iPharmacist Care Quarterback Health Coach Health Unit Secretary 14
  15. 15. Health Coach Role 15
  16. 16. Philips Telehealth Solutions
  17. 17. 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
  18. 18. Benefits Benefit Areas Reduce Costs of Providing Care Improve Quality of Patient Care Improve Provider Efficiency / Satisfaction Improve Patient Satisfaction Expected Benefits • 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
  19. 19. If we are to achieve results never before accomplished, we must employ methods never before attempted. Francis Bacon

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