Post on 06-Jan-2016
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Mercy Health System
Tele-Medicine
2012
UTILIZATION3,937 staffed beds574,666 ED visits (FY11)
6,566,057 outpatient visits (FY11)
160,382 inpatient discharges (FY11)
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HOSPITALS25 acute care hospitals6 managed hospitals3 heart hospitals2 children's hospitals1 rehab hospital
AMBULATORY SERVICES233 clinic locations27 urgent care centers7 outpatient surgery centers4 retail clinics
MEDICAL STAFF & CO-WORKERS37,000 co-workers1,580 integrated physicians5,369 active medical staff (includes integrated and non-integrated physicians: OHH)
619 advanced practitioners
Hospital
Managed Hospital
Ambulatory Facility
Urgent Care
LEGENDMISSOURI STATS:>1.5 million people served1,071 integrated physicians413 primary care physicians9 acute care hospitals134 clinic locations
MISSOURI STATS:>1.5 million people served1,071 integrated physicians413 primary care physicians9 acute care hospitals134 clinic locations
What are we solving fora new model of care
• Access to Care– Primary Care– Specialty Care
• Provider Shortages– PCP and Specialty
• Cost pressures– Hospital will be a cost center and not a revenue
center• Patient Centeredness
– High service model
Tele – MedicineTele – MedicineVirtual CareVirtual Care
Care Model Care Model DeliveryDelivery
Population ManagementPopulation Management Center for InnovationCenter for Innovation
Medical DirectorOperations Director
Clinical Ops VPOperations Director
Medical DirectorOperations Director
Mercy’s Center for Tele Health and InnovationVirtual Care Center
Chief Innovation Officer
Centralized Centralized HUB ModelHUB Model
Decentralized Decentralized ConsultConsult
Store and Store and ForwardForward
CollaborationCollaboration
Chronic Care Chronic Care ManagementManagement
SchedulingSchedulingCall CenterCall Center
Nurse on Call Nurse on Call CenterCenter
Scheduling & Scheduling & referral referral
managementmanagement
Care Care CoordinationCoordination
Post Acute Post Acute CareCare
Care Care Delivery Delivery
InnovationInnovation
ResearchResearch
GrantsGrants
AnalyticsAnalytics
Epic Epic InformaticistInformaticist
Resources have a central feel andcentral supervision
Resources are distributed althoughScheduling and supervision are central
Resources may be either central or distributed
encounter is asynchronous and my involve images
and or consultation
Resources are distributed and are outside of Mercy
encounter is asynchronous and my
involve imagesand or consultation
E-VisitsE-Visits24/724/7
AsynchronousAsynchronous CareCare
Home HealthHome HealthSupportSupport EHR supportEHR support
Tele-Medicine Division
Tele – MedicineTele – MedicineVirtual CareVirtual Care
Centralized Centralized HUB ModelHUB Model
Decentralized Decentralized ConsultConsult
Store and Store and ForwardForwardAsynchronousAsynchronous
e-ICUe-LTAC
Tele-Sepsis
e-Hospital
Telemedicine core Telemedicine core infrastructureinfrastructure
Distributed SchedulingCredentialing/Licensing
HRFinance
Reimbursement managementAnalytics (CIC?)Epic expertise
Account ManagementCustomer relations/Call center
e-after care
Specialist/patientSpecialist/physician
15 SpecialtiesVideo Remote Interpretation
Selected as spine destinationTele-Stroke network
Imaging from Critical Access FacilitiesPediatric Cardiac Echo’s and EEG’s
RadiologyPathology
Dermatology
24-7e-visit support
Store + Forward patient visits
home monitoring
Medical Director Medical Director OfOf
Critical Care ServicesCritical Care Services& special projects& special projects
Connector
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Inpatient hospital utilization management– Avoiding medically unnecessary admissions– Avoiding medically unnecessary discharge delays– Aligned hospitalist programs Outpatient utilization management Case and chronic condition (disease) management Primary care population management– Primary care e-visits– Specialist e-consults– Urgent care centers– Aligned provider incentive programs Mature PCP-driven group practice– Extended office hours– Incorporation of advanced practice RNs and/or PAs
into primary care “teams”– 24 hour on-call access for patients
Inpatient hospital utilization management– Avoiding medically unnecessary admissions– Avoiding medically unnecessary discharge delays– Aligned hospitalist programs Outpatient utilization management Case and chronic condition (disease) management Primary care population management– Primary care e-visits– Specialist e-consults– Urgent care centers– Aligned provider incentive programs Mature PCP-driven group practice– Extended office hours– Incorporation of advanced practice RNs and/or PAs
into primary care “teams”– 24 hour on-call access for patients
Mercy’s ACO Readiness:Mercy’s ACO Readiness:
Components of Milliman’s study on accountable care organization (ACO) models
Components of Milliman’s study on accountable care organization (ACO) models
Impact onMedicare – 8.25%Commercial – 9.61%
e-ICUe-ICU School School ClinicsClinics
Work site Work site clinicsclinics
After Care After Care ModelsModels e-Hospitalse-Hospitals Tele-Tele-
specialtyspecialtyMedical Medical HomeHome e-Hospitalse-Hospitals CommunityCommunity
clinicsclinicsAnalytics
EHR EHR supportsupport
Convenient Convenient carecare
Predictive Predictive ModelingModeling E-visit 24/7E-visit 24/7 Store & Store &
ForwardForwardConcierge’s Concierge’s
ServiceServiceNurse on Nurse on
CallCallTele-Home Tele-Home
HealthHealthHome Home
MonitoringMonitoringPalliative Palliative
CareCare
Virtual Care Services
AccessAccess
VolumeVolumeMarket shareMarket share
Care Care CoordinationCoordination
< 10%< 10% Shared Savings/Risk ContractsShared Savings/Risk Contracts >50%>50%
e-SNF
e-LTACHe-LTACH
Tele-medPrimary
Care
Community Community KiosksKiosks
Navigator Navigator ServicesServices
PHRPHR
VRIVRI
EHR Optimization
Family Family SupportSupport
Remote Remote RoundingRounding
Tele Tele Surgical f/uSurgical f/u
e-NICUe-NICU
ACO contractsMedicare Advantage – 30,000 lives
CMS – ACO – 250,000 lives
Traditional FFS contracts
Tele - SepsisTele - Sepsis Video Remote Video Remote InterpretationInterpretation
E-ICU & Tele-E-ICU & Tele-strokestroke
E-ICU + tele-stroke
• ICU mortality rates 20% below predicted• 30% reduction in ICU length of stay• 50% decrease in Central Line Blood Stream
Infections• >95% compliance with VAP bundle protocols
and corresponding significant decline in VAP cases
• Tele-stroke – trebled the appropriate use of tPa in Arkansas ER setting
Sepsis
• Mortality decrease with people in severe sepsis and septic shock of 50% and 60% respectively
• Compliance with sepsis bundles increased by 30-40%
• ICU LOS – decreased from 8.16 days to 3.43 days
• Over 9 months of the program – 100 lives were saved.
Video Remote InterpretationVRI
• In 2007, over 55 million Americans spoke a language other than English at home
• Represents nearly 20% of the population
• Increased from 14% of the US population in 1990 and 11% in 1980
•Less likely to have a “usual” source of medical care
•They receive preventive services at reduced rates
•They have an increased risk of non adherence to medication
•Children with asthma have an increased of intubation
•Higher rates of hospitalizations and medication complications
•Greater resources are used in their care and they have lower levels of patient satisfaction
Mercy Health System
Tele-Medicine
2012