This document summarizes the business case for remote patient monitoring. It outlines how remote monitoring has progressed from initial technologies to integrated virtual care solutions. It shows how new care delivery models incentivize providers to adopt remote monitoring to reduce costs and improve outcomes. Studies show remote monitoring can significantly reduce hospitalizations, ER visits, and costs for patients with chronic conditions. The document concludes by describing opportunities for hospitals, physicians, and post-acute providers to leverage remote monitoring.

1. REMOTE PATIENT MONITORING
ROI: The Business Case
Georgia Partnership for Telehealth
6th Annual Spring Conference
March 2015
Joseph Ebberwein
Longitudinal Health

2. REMOTE PATIENT MONITORING
THE PROGRESSION:
• Remote Patient Monitoring
• Telehealth
• Chronic Care Management
• Virtual Care
• Population Health Management

3. VOLUME TO VALUE
HEALTHCARE TRANSFORMATION
NEW CARE DELIVERY MODELS:
• Accountable Care Organizations (ACOs)
• Medical Homes (PCMHs)
• Medicare/Medicaid Dual Eligible State Demonstration Projects
• Bundled Payments:
— Medicare Bundled Payment Care Initiatives (BPIC)
— Insurer (Payer) Initiatives
• Self-Insured Employers
• Other Emerging Models:
— Shared Risk
— Shared Savings
— Capitated/Episodic Payment

4. IN HOME TECHNOLOGIES
• BODY
o Vital Sign Monitors
o Activity Monitors
o Sleep Monitors
o Mobile PERS with GPS
o Medication Adherence
Monitors
o Medication Dispensers
o Urine Analyzer
• HOME
o Fall Detection
o Video Monitoring
o Environment Sensors
o Passive Monitoring Sensors
• COMMUNITY
o Social Network
o Social Communication
o Physical & Cognitive Gaming
o Social Networking
o Gaming Technologies
• CAREGIVING
o Caregiving Portals
o Caregiving Coordination
Platforms
Source: Center for Technology and Aging, The New Era of Connected Aging: A Framework for
Understanding Technologies that Support Older Adults in Aging in Place, 2014.

5. VIRTUAL CARE
VIRTUAL CARE ELEMENTS:
• Remote Biometric Monitoring
• IVR:
— Patient Reporting/Bluetooth
• Telephony:
— Health Coach Prescribed Calls
— SN Intervention Calls
• Bi-directional Video Visits (MD,
RN & Patient)
• ADL Monitoring
• Medication Adherence/Reminders
• 24/7 RN Triage
VIRTUAL CARE TEAM:
• Nurse Care Coordinators
• Triage Nurses
• Specialty Nurses
— Cardiology
— Endocrinology/Nephrology
— Neurology
— Oncology
— Pulmonology
— Geriatric
— Wound/Ostomy
• Pharmacists
• Health Coaches
• Behavioral Specialists
• Dieticians

6. THE RETURN ON INVESTMENT

7. RETURN ON INVESTMENT
REMOTE MONITORING EQUIPMENT ADVANCEMENT IN 10 YEARS
Cabled Equipment costing $7,000 to Wireless Peripherals costing $300
Monitoring Costs from $300/month to Tiered Costs ranging from $40-
$130/month

8. RETURN ON INVESTMENT
TELEHEALTH PRODUCES ROI:
 HOSPITALS:
Current: Reduction in Readmission Penalties
Future: Bundled Reimbursement
 HOME HEALTH AGENCIES:
Current: Increase in Staff Capacity (Caseload)
Reduction in SN Visits/Episode
Future: Bundled Reimbursement
Penalties for Readmissions
 SKILLED NURSING FACILITY:
Current: Reduction in Wound Care Costs
Future: Bundled Reimbursement
Readmission Penalties

9. RETURN ON INVESTMENT
• TELEHEALTH:
– Increases Provider’s Care Team Capacity
– Increases Quality Outcomes
– Reduces Expenses of High Risk/High Cost Patients
– Decreases Days in Skilled Nursing Facilities
– Virtual Wound Care
– Reduction in PMPM Cost (SNF, HHA, Hospice)
– Reduction in Provider Liability for Wound Mgt.
– Higher Reimbursement Rates from Commercial Payers
– Decreases PMPM Spend by Reducing Acute Care Hospital
Admissions & Readmissions Rates
– Increases Commercial Payer Contract Reimbursement

10. RESULTS
NATIONALLY PUBLISHED RESULTS:
• VETERAN’S ADMINISTRATION:
— Remote chronic care management
— 17,000 high risk, high cost complex polychronic veterans
— Results:
 63% reduction in hospital admissions
 88% reduction in nursing home bed days of care
— Current Program includes 65,000 veterans
• CMS:
— Care Management for Beneficiaries Demonstration Project
— Remote chronic care management utilizing Telehealth
— 1,757 high cost, polychronic beneficiaries
— 13.3% reduction in costs per patient per quarter
— $542 reduction per patient per quarter
Source: Center for Technology and Aging, Dual Eligible Brief, 2012

11. RESULTS
Source: Advanced Telehealth Solutions
CHF STUDY:
• 83 heart patients
• 4-5 chronic diseases
• 6 month study

12. RESULTS
Source: Advanced Telehealth Solutions
Reduced Hospitalizations for Multiple Co-morbidities
Telehealth Intervention:
• Post Hospital Discharge Program
• Polychronic Disease Patients
• 30 Day Program
• Telephonic Intervention

13. STATE MEDICAID
TELEHEALTH RESULTS
OVERALL RESULTS *:
• Hospitalization Rate:
— 65% Reduction in Hospitalizations
• ER Visit Rate:
— 68% Reduction in ER Visits
RESULTS BY CHRONIC DISEASE *:
• CHF- 59% Reduction in Hospitalizations
• COPD- 63% Reduction in Hospitalizations
• Diabetes- 63% Reduction in Hospitalizations
• Hypertension- 69% Reduction in Hospitalizations
Source: Advanced Telehealth Solutions* Per 1000 Days

14. OPPORTUNITIES

15. PROVIDER OPPORTUNITIES
• HOSPITALS:
– Reduce Preventable 30 Day Readmissions for CMS Designated
Diagnoses with Associated Penalties (CHF, AMI, Pneumonia,
COPD, Hip & Knee Replacements)
• PHYSICIANS:
– Reimbursement for Medicare Care Management Fees
 Chronic Care Management Fee (2015)
 Medicare Transitional Care Management Fee
 Medicare ESRD Care Management Fee
– Managed Care Contracts (Medicare Advantage, Medicaid,
Commercial Payers)
 Chronic Care Management Fees
 Incentive Based Contracts
• POST ACUTE:
– Increases Staff Capacity, Lowers Cost Of Care
– Increases Quality Outcomes
– Reduces 30 Day Hospital Readmissions & ER Visits
– Care Transitions to Home

16. Joseph F. Ebberwein
Longitudinal Health
Joseph.Ebberwein@LongitudinalHealth.com
(888) 670-6787
www.LongitudinalHealth.com