Business Models and Economic Issues of

telehealth: Experiences of Yorkshire

Rebecca Malin

Head of Business Development and Investment

Airedale NHS Foundation Trust

The Local Context Airedale’s catchment area:

2012-13 = 3 Commissioners

2013-14 = 7 Commissioners

The bigger picture …

scale of financial

challenge

growing demand

unmet need

inappropriate

utilisation

stretched capacity

+ traditional

hospital dominated

medical model

designed

by default

=

… a system

designed by default

and more

out there…

so less in here

Our focus,

the patient experience

But how to change?

Introducing telehealth

• tele care

• tele coaching

• tele monitoring

teleconsultation

Airedale Teleconsultation • Prison health care

7 year programme

Live in 20 prisons

Up to 50% change in patient flow

>2200 consultations past 2 yrs

• Care in the community

• Care at home

• Stroke patients

• Occupational health

• Supporting end of life patients

• Nursing and Residential care homes

care in the community

nursing and residential care homes

Emerging evidence

)

Results:24 hr tele consults

to 25 COPD patients at home

Bed Days used

0

50

100

150

200

250

300

Year pre post Year pre post

-29.5%

-36.5%

Nursing and Residential

Care Home Results

(Hull University) 47% reduction in ED attendances for homes with Teleconsultation vs. 27%

45% reduction in hospital admissions for homes with Teleconsultation vs. 33%

Based on 13 Nursing and Residential

Care Homes

April –

September

2011*

April –

September

2012*

Difference

ED attendances (mean per home, per month) – care homes with

telemedicine in 2012 (n=13) 2.56 1.37 -47%

ED attendances (mean per home, per month) – care homes without

telemedicine in 2012 (n=67) 1.31 0.95 -27%

Hospital admissions via ED (mean per home, per month) – care

homes with telemedicine in 2012 (n=13) 1.44 0.79 -45%

Hospital admissions via ED (mean per home, per month) – care

homes without telemedicine in 2012 (n=67) 0.71 0.47 -33%

*Figures are rounded to two decimal points; percentage difference is calculated using unrounded figures.

Business Models

)

Which business

model?

To consider…

•Who is commissioning?

•Where is the pressure coming

from?

•Provide own clinical service

(how)?

•Own hub (how)?

•Technical infrastructure?

•Experience?

•Commissioners on board?

Models available

1. Full Telehealth Hub service?

2. Call triage only?

3. Use of technical infrastructure

only?

4. Training and consultancy

only?

5. Hub of Hubs?

Each model has different benefits

and cost savings

Region A

Nursing Homes 53

Patients Involved 1,105

Associated Admissions 2,928

Associated Bed days 29,199

> 25 Admissions per year

Data modelling

overview

Region B

Nursing Homes 116

Patients Involved 1,750

Associated Admissions 2,505

Associated Bed days 27,901

> 9 Admissions per year

Data modelling Region A

Total impact on costs (292,400) 995,348 702,948

Net impact associated with 53 Nursing Homes 1,050,571 565,177 1,615,748

PCT

Service

Provider

Net Impact to

health

Economy

Income Emergency Admissions 30% rate 156,480 (156,480) 0

Changes 70% left 365,120 365,120

Other Income saved ( OPD & A&E ) 15,458 (15,458) 0

Income impact 537,058 (171,938) 365,120

Costs Investment in telemedicine (225,080) (225,080)

Trust Cost savings 922,162 922,162

Total impact on costs (225,080) 922,162 697,082

Net impact associated with 53 Nursing Homes 311,978 750,224 1,062,202

20% reduction in short stay admissions (0-5 days) from nursing homes

50% reduction in short stay admissions (0-5 days) from nursing homes

Data modelling Region B

20% reduction in short stay admissions (0-5 days) from nursing homes PCT Service

Provider

Net Impact to

Health

Economy

Income Emergency admissions (above threshold) 30% rate 133,382 (133,382) 0

Changes Emergency admissions (below threshold) 70% left 311,224 0 311,224

Other income saved (Outpatients and A&E) 10,986 (10,986) 0

Impact on Income 455,592 (144,368) 311,224

Costs PCT investment in telemedicine (425,360) (425,360)

Service providers cost savings 421,704 421,704

Impact on Costs (425,360) 421,704 (3,656)

Net impact associated with 116 Nursing Homes 30,232 277,336 307,568

50% reduction in short stay admissions (0-5 days) from nursing homes

Total Impact on Costs (472,640) 462,647 (9,993)

Net impact associated with 116 Nursing Homes 666,050 102,019 768,069

What are the

challenges?

tariff

the importance of scale

evidence base

culture change

scheduling

collaborative working

(community teams, GPs)

technical

call to action

“…we need to have the courage to make changes and be less risk averse,

we need to take a longer term view on investments, and we need to ensure staff are

supported to introduce new ideas and technologies…”

Business Models and Economic Issues of

telehealth: Experiences of Yorkshire

Thank you