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

1. ACOs Meet the Triple Aim
with Telehealth Support
Deborah Dahl
VP, Patient Care Innovation

2. 98,000

3. 1,683,290

4. 1

5. Telemedicine:
More than Technology

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. Longitudinal ICU LOS & Hospital Mortality
* APACHE IV predictions begin

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. 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. 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. 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. 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. 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. 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. Health Coach Role
15

16. Philips Telehealth Solutions

20. 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

21. 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

22. If we are to achieve results
never before accomplished,
we must employ methods
never before attempted.
Francis Bacon