CHANGE MANAGEMENT –ROOM 103“ENHANCING ACCESS TO HIGH QUALITY CARE BEYOND TRADITIONAL BRICKSAND MORTAR.”
Natasa Sokolovich, JD, MSHCPM, Executive Director Telehealth, UPMC
Donald Kosiak, MD, MBA, FACEP, CPE, Chief Medical Officer, Leidos
Moderator: Jonas Ekstrom, MD, Specialist in Internal Medicine, Sweden
Twitter: TelehealthNow@Sokolovichn
Describe the current healthcare challenges & opportunity to transform the healthcare experience through a collaborative care approach
3
Define Change Management & what it entails2
Introductions1
Agenda:
Share examples across two leading healthcare organizations
who have embraced healthcare transformation
4
University of Pittsburgh Medical
Center (UPMC):• Located in Pittsburgh, Pennsylvania
• Largest employer in Pennsylvania --60,000 employees
• $12 Billion Organization• 22 Hospitals with 17 post-acute care facilities
• 3500 Employed & 5500 Affiliated Physicians
• 500 clinical locations in W. Pennsylvania
• 265,000 inpatient admissions and observations annually
• 189,000 surgeries annually
• 3.9 million outpatient visits annually
• 690,000 emergency visits annually
• 2.5 Million Covered Lives through UPMC Health Plan
Leidos
• A science and technology solutions leader
• Working to address some of the world’s toughest challenges in national security, health, and engineering
• $5.06 billion annual revenue with 19,000 employees
• Vital missions for government and commercial sectors around the globe
Wikipedia Defines “Change Management” as:
Change management is a structured approach to
transitioning individuals, teams, and organizations
from a current state to a desired future state. The
current definition includes both organizational and
individual change management models, which
together are used to manage the people side of
change.
Or more simply put…
The coordination of a structured period of
transition from situation A to situation B in
order to achieve lasting change within an
organization.
BNET Business Dictionary
Ingredients for successful Change Management:
(skill * will) + sufficient time + a rigorous process =
change management success
Paradox: Change requires continuity and consistency.Britnell, Mark- “Transforming Health Care Takes Continuity and Consistency”, Harvard Business
Review, DECEMBER 28, 2015
DoctorsNurses
A globally shared set of healthcare goals:
• Move to value-based care
– Improve outcomes
– Reduce costs
– Increase patient satisfaction
• Hospitals into health systems
– Focus on illness prevention rather than treatment
• Implement technology
– Increases efficiency
– Empowers patients
What needs to change?
Integrated health data from multiple sources to support smart clinical workflows and empowering real-time decision support with the goal of engaging patients in achieving health
and wellness
Disparate health portals with static,
non-customized information that is
based on clinician supplied data
Providers Patients
Individuals using devices and wearables with data
uniquely stored on apps, tablets, and phones
FUTURE
Collaboration
patient needs and preferences
The untapped opportunity of a collaborative care approach:
care planning
X
behaviorspsychosocial
medical
educationSMS
reminders apps
wearables
tablet
web interface
EHR
e-visits
communityconnection
Improved health and outcomes
Reduced costs
Engaged patients
1
2
3
communication among providers
Collaborative Care
Approach
Price Transparency
The right data
Smart workflows
Empower Patients
Integrate technology
A collaborative care approach:
• Integrate technology- telehealth
• The right data at the right time
• Smart workflows
• Empower patients
• Price transparency
Potential Healthcare Savings Impact of Digital Healthcare Revolution:
13
• Routine
• Low Acuity virtual visits
• Specialty Care-Psych, Endocrine, Neurology
Telehealth
• Heart Disease-CHF
• COPD- Asthma
• DiabetesRemote Patient
Monitoring
• Lifestyle- Wellness Improvement
• Obesity
• Smoking Cessation
• Stress Management
Behavior Modification
$100B+
$200B+
Undefined-Significant
Financial Impact
Source: Goldman Sachs Global Investment Research
Anticipated Savings Opportunity
Factors involved in maximizing healthcare transformation:
Collaborative consumer-focused health care
Reimbursement Security Interoperability AdoptionComplexity
Where does change begin?
Where are payment the incentives?
What are the areas that can
drive immediate value/results?
Who is central to implementing the
change?
What is a reasonable timeline
to deliver measureable outcomes?
Identify the short and long-term areas of greatest opportunity
CMS shift towards outcome-based rewards and penalties
Payments Tied to Risk Models
“Providers should compare ACO earnings not with today’s fee-for service
environment, but with future earnings if not participating in such alternative
payment models.”—CMS
More Emphasis on Value
Payments Tied to Quality
Source: The Advisory Board Company
Source: Fischbeck, Paul. "US-Europe Comparisons of Health Risk for
Specific Gender-Age Groups.” Carnegie Mellon University: September 2009
Healthcare Reimbursement Shift
17
Fee for ServiceACOs, Medical Homes, Bundled
Payments
Pay for Performance
Telemedicine/
Telehealth Programs:
Clinical Specialty Services: Billable Contracted
Acute-ED Services Tele-Emergency
Tele-Stroke
Tele-Burn
X X
In-Patient Tele Specialty
Services Tele-ICU Care
Tele-Pharmacy
Tele-Infectious Disease
Tele-Neurology
Tele-PM&R
Tele-MFM
X X
Outpatient-consults Extensive Specialist Services Rural Locations
Behavioral Health Services Psychiatric Consults X X
Tele-Remote Monitoring Congestive Heart Failure
Chronic Obstructive Pulmonary
Disease
Palliative Care
Payer _
Employer- On-site Clinics Virtual Primary Care visits Employee Benefit _
Direct to Consumer On-Demand, virtual visits Retail Payment Model
Value proposition
18
UPMC’s Telehealth Evolution:
19
• Expanded On-line
eDermatology visits
• On-line Chronic Care
Visits
• Remote Monitoring
• Teleconsult Center
expansion
• Integrate on-demand
Specialty visits
through PCP practices
• Tele-Stroke
• Tele-Psych
•UPMC
AnywhereCare
On-line Virtual Visits
• In-patient & Out-
patient Specialty
Services Expansion
• Tele-Maternal Fetal
Medicine
• Surgical
Oncology/Breast
Visits
• Infectious Disease
• Pre & Post
operative
visits
• Transplant
Behavioral &
Nutrition
Counseling
2016-2017
2014-2015
2013
• Pediatric
Specailty
• Inpatient
Dermatology
• Pre & Post
Operative
Visits
2012
• Teleconsult
Centers
• Health Plan-
Employer On-
site Care
• Physical
Medicine &
Rehabilitation
2006-2008
2011
UPMC’s Telehealth Program
20
6,575
9,706
11,767
15,816 16,900
8,450
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
FY12 FY13 FY14 FY15 FY16
FY16 Budget
Stroke
Burn
Cardiology
Adult Acute Specialty Services
21
2016 UPMC TeleStroke Locations:
UPMC Hospitals: Community Hospitals: Passavant St. Margaret McKeesport Northwest Horizon –
Greenville Horizon –
Shenango Bedford Cranberry Magee Mercy East
Armstrong County
Memorial Hospital
Mon Valley Meritus - MD Washington Hospital Jameson Heritage Valley – Beaver
Uniontown
Excela- Westmoreland
Hospital
Excela- Latrobe Hospital
Excela- Frick Hospital
Dermatology Preoperativ
e Evaluation
Center
Transplant – Behavior
Health
Transplant – Nutrition
Surgical Oncology
(Breast Consults)
Maternal Fetal
Medicine
Genetic Counseling
(Breast Oncology)
Mammograms
Psychiatry
22
UPMC Inpatient & Outpatient Telemedicine Services
Outpatient Services
Inpatient Services
UPMC Teleconsult Centers – Expanding Clinical Access through
New Models of Care Delivery
23
• Teleconsult Centers established across
three rural locations to expand virtual,
multi-specialty care to patients within
their communities
• Integrating new technologies to achieve
the goals of Triple Aim- “Expanding
patient access to high quality clinical care
at a lower cost”
• 3,013* TeleSpecialist visits completed
• High Patient Satisfaction- Average
Scores- 4.8 out of 5
• High Provider Satisfaction
* (3,013 visits completed through December 31, 2015)
Expanding Access to
High Quality Clinical Care
Enhancing the Patient Experience
UPMC Teleconsult
Centers
Reducing Costs
UPMC Teleconsult Centers- Overcoming Specialist shortages
through expansion of Clinical Services:
24
3,013 Completed
Patient Visits
4.8
0
1
2
3
4
5
All SpecialtiesOver
all
Su
rvey
Ou
tcom
es
…
Telemedicine Providers
Overall Patient Satisfaction
Survey Outcomes
Rating
Specialty Services
Cardiothoracic Surgery PEDS: GI
Cardiovascular-EP PEDS: Lipid Clinic
Cancer Genetic Counseling PEDS: Nutrition
Colorectal Surgery Plastics
Dermatology Pulmonary
Diabetes Management REI
Endocrine Surgery Reproductive Genetics
Foot and Ankle Surgery Rheumatology
Gynecologic Oncology Sleep Evaluations
IBD Thoracic Surgery
Infectious Disease Orthopedic Spine Surgery
Heart Failure Surgical Oncology: Breast
Evaluations
Maternal Fetal Medicine Urogynecology
MFM Diabetes Education Vascular Surgery
Neurology Voice Therapy
Neurosurgery Wound
PEDS: Allergy and Immunology
Total Trip Distance Cost of Travel Time Spent Traveling
603,412 miles $351,744.53 10,391 hours
Patient Savings & Time Avoidance
(June 2012 through December 2015)
25
Total Patient Savings (Miles, Dollars and Time): 3,013 Patients
Northwest, Bedford, and Hermitage
Teleconsult Centers
Teleconsult Center(s)- Ancillary Charges Summary (June 2012 through June 2015)
26
Teleconsult Center Economic Summary- Ancillary Charges
Locations: FY13 FY14 FY15 Total:
Northwest
Gross
Collections$32,720.13 $73,493.25 $107,596.75 $213,810.13
Facility Fees $2,950.00 $8,125.00 $19,325.00 $30,400.00
Bedford
Gross
Collections$16,400.75 $21,517.50 $18,045.88 $55,964.13
Facility Fees $425.00 $3,475.00 $7,175.00 $11,075.00
Hermitage
Gross
Collections$1,851.88 $20,336.13 $22,188.00
Facility Fees $775.00 $6,425.00 $7,200.00
Total Gross Collections: $49,120.88 $96,362.63 $145,378.76 $291,362.26
Expanding Specialty Care Services to rural America-
through Tele-Infectious Disease Coverage
27
* Volumes represented by Northwest inpatient consults
* Volumes represented by Northwest inpatient consults
14 6 6
11
7
10
9
15
21
29
41
17
36
32
14
31
40
33
24
37
43
30
34
23
29
0
5
10
15
20
25
30
35
40
45
50
No
v '1
3
Dec
Jan
'14
Feb
Mar
Ap
r
May Jun
Jul
Au
g
Sep
t
Oct
No
v
Dec
Jan
'15
Feb
Mar
Ap
r
May
Jun
e
July
Au
g
Sep
t
Oct
No
v
Dec
Tele-Infectious Disease Visit Volume by Month
TeleID Visits Completed Linear (TeleID Visits Completed)
13 1417
32
11
2317
1118 20 20
16 1622
18 2013 14
27
12
9
6
13
15
3
13
2013
8
21
21
1214
1015
0
5
10
15
20
25
30
35
40
45
50
Jul '
14
Au
g
Sep
t
Oct
No
v
Dec Jan
Feb
Mar
Ap
r
May Jun
Jul '
15
Au
g
Sep
Oct
No
v
Dec
VIS
ITS
New Follow Up
ID New vs. Follow Up Visit Totals
Inpatient Locations Outpatient Locations
UPMC Northwest UPMC Northwest Teleconsult CenterUPMC Bedford Teleconsult Center
Expanding Specialty Care Services to rural Patients-
through Telestroke Services
28
Increases Access to early tPA intervention when
Telestroke is offered across community Hospitals
Expanding Specialty Care Services to rural
Pennsylvania- through Teledermatology
29
Image is
captured and
sent to
Dermatologist
for Review
Over 1,150 Visits successfully completed, allowing earlier
detection of melanoma and access to Dermatologists
Completed Maternal Fetal Medicine Visits
(Date of Inception – December 31, 2015)
Northwest (Inception: 6/28/12) 710
Bedford (Inception: 2/28/13) 30
Hermitage (Inception: 3/11/14) 249
Altoona (Inception: 9/14/15) 24
Total Visits: 1,013
30
Telemedicine
4 %
Expanding Specialty Care Services- through Tele-Maternal Fetal
Medicine Visits
30 to
35%
Patient Satisfaction Ratings for Maternal Fetal Medicine
Average across all Teleconsult Centers 96.2%
In-person satisfaction rating 92.2%
Patient Who Would Have Forgone Care
Northwest 30%
Hermitage 35%
UPMC AnywhereCare Cumulative Visit Report 11/04/13 – 06/30/15
Total Visits
Submitted
Total Adult
Visits
Submitted
Total
Pediatric
Visits
Submitted
Clinically
Inappropriate
(NONEVISIT)
Total Visits
Completed
AnywhereCare Convenience
(24/7/365 On-Demand,
Virtual Visits )
7,464 7,415 49 1,366 6,093
AnywhereCare Continuity
(Established PCP eVisit)850 834 16 56 785
Total 8,314 8,249 65 1,011 6,878
UPMC AnywhereCare Visit Summary:
32
$86.64
savings/
episode
of care
Tele-SNF
Coordination
Employer-onSite
Enhancing Care
Remote Monitoring
Additional Opportunities:
33
• Reduce avoidable
Hospitalizations
• ED transfers
• Reduce Lost
work time
• Reduce Acute
Care Costs
• Decrease Acute
care costs
• Decrease
Readmissions
• Enhance
population health
Prioritize Opportunities
Maximize Value & Align
Incentives
Develop a solid infrastructure
Monitor and Evaluate
Outcomes
The Pathway to Success:
34
Step 1Step 2
Step 3 Step 4
Thank you!
35
www.upmc.com/Telemedicine
“When you have exhausted all possibilities, remember this - you haven't.” - Thomas Edison
Twitter: TelehealthNow@Sokolovichn
Virtual Healthcare
157 Sites
28 Sites 64 Sites105 Sites
34 Sites 4 Sites 9 Sites 2,000 + More than 900,000 SQ KM
10,500 Consults
Annually(Reimbursed equal to face to face)
Annual Patient
Savings:
$1,184,600 in travel
4,012,800 Miles
(16+ trips to the moon)
= Air Traffic Control
28 Hospitals49,000 (134 years) ICU days saved
ClinicianProvides around-the-clock, remote intensive
care monitoring of critically ill patients
Enabling Technology• Intelligent Monitoring• Continual Surveillance
• Smart Alerts
Meets Leapfrog requirements
• Immediate physician consultant
• Allows for additional coverage
Throughput
• Reduce LOS/Mortality
• Reduce ED wait for admit
• Triage support
• Staffing costs
Quality
• Ensures compliance
• APACHE
• Documentation support increases ICU CMI
24 Hour access to residency trained
hospital pharmacists
8 Years of providing services
140,000 Patients impacted
Order Entry & Review
Consultative Support
Clinical Decision Support
Regulatory Support
2,600,000 Orders Reviewed
32,000 Avoided Serious Safety Events
$68,250,000 Saved/Avoided
Interaction/ Review/
Clarification37%
Antithrombotic Therapy -
Anticoagulation
28%
Renal Dose Evaluation
27%
Kinetics Evaluation
7%
Pain Consult1%
Avoidance of Serious Safety Events
(Since Inception)
Physician Consultation
Transfer Support
Nursing Documentation
Support
Education
24 Hour access to board certified
Physicians and Critical Care Nurses
110 Partner Hospitals
7 Years of providing Services
33%18
Min36
Min
Aspirin Compliance Door to ECG Door to TPA
Door In –Door Out
Clinical Quality Impact – Cardiac
Right treatment, right transfer, right time
2X
Outcomes: Faster Care
15 Min
27Min
23 Min
Door to Doctor Door to CT 45 min TPA Eligible
Door In –Door Out
Clinical Quality Impact – Stroke
100%100%
4 Sites Live
1000+ Inmates Served
40% of Calls Result in
Avoided Transfer
$1,100,000+ in Transfer Savings
Cardiac/Chest Pain24%
Trauma/Laceration
19%
Abdominal/GI Complaint
17%
Skin Complaint12%
Neurological/ Syncope
8%
Joint/Limb Pain - 8%
Diabetic Reaction
2%Shortness of
Breath2%
Weakness/ Dizziness
2%
Behavioral Health Concern
2%
Other2%
Eye2%
Other8%
Encounters by Chief Complaint(Since Inception)
Our Differentiator
800,000+ patients touched
235 hospitals and clinics served
2,200 providers impacted
900,000 square kilometers covered
$170M in health care costs saved
Virtual Hospital
Collaboration
Efficiency
Innovation
Technology
Partners
Proven, Predictable, and Sustainable Results
THANK YOU!Natasa Sokolovich, JD, MSHCPM, Executive Director Telehealth, UPMC
Donald Kosiak, MD, MBA, FACEP, CPE, Chief Medical Officer, Leidos
Follow on Twitter: TelehealthNow@Sokolovichn