HIMSS 16 Connected Health Experience

Mark Bogart, Director Business Development

Mobile Telehealth = Population Health

Learning from Customers

• Founded 2003 by Bayer HealthCare

and Panasonic Corporation

• Since 2003, an authorized supplier to

the Veterans Health Administration

• Now part of NSD Co., Ltd.

A leading, publicly traded

international IT services organization

3,500 employees

Impacting healthcare globally

About Viterion®

Viterion V100

Not for active, real time patient monitoring

Viterion Vitacast 1000SM

Pioneering with VA Home Telehealth—

Learnings over 12+ Years

• Remote monitoring works for multiple conditions at scale—

Hypertension, diabetes, obesity, COPD, heart failure, depression

• Everyday vital signs monitoring + off-the-shelf monitoring devices + qualitative information capture

Customized health questions, patient education, reminders

• Coordinated care for large populations feasible

• Evolved into care management tool, risk stratification, EHR integration, analytics

• Achieved major VA health promotion-disease prevention goals —patient self-management, preventing decompensation

VA Home Telehealth: Improved

Outcomes, Saved Money

FY2014 (latest report)

Bed days 42%

Hospital admissions 34%

Patient satisfaction at 85%

Saved $1,999 per year, per patient (2013)

5 year program growth: 43,000 patients 2010 >>

156,000 2014

VA largest user of US telehealth—but a closed system

2009-12 Study (4,999 patients in HT)

HT users vs matched non-HT cohort

Annual healthcare costs 4%--vs 48%

Annual Medicare cost 45% less

~ 7% lower mortality

Admission reduction savings $8.7 million (est.)

Supported 28% of patients in VA goal of

independent living

VA Home Telehealth: Improved

Outcomes, Saved Money

Technology Advances—Just in Time for

Changing Healthcare Models

Monitoring now increasingly, patient-centric, portable—wireless

tablets, BT/USB peripherals. Challenge—making it cost-effective.

The rise of Accountable Care Organizations (ACO) and shared risk

Reimbursements based on quality metrics, total cost of care reductions for a

patient population

• 700-800 ACOs cover 24 million lives in commercial, Medicaid and

Medicare models (423 cover 7.8 million lives)

• HHS, CMS drive to alternative quality/value-based payment

models in Medicare FFS

30% of payments end of 2016, 50% by 2018

ACOs: A Good Fit for Telehealth

~ 40-50% of ACOs in the Medicare Shared Savings Program (MSSP)

are physician-owned, funded and led (CMS)

Lean management, faster and simpler decision cycle

Focus on meaningful and targeted changes in quality and cost

Coordinate patient care across multiple settings: primary, specialty, hospital, clinic

Most likely to adopt fresh approaches

CMS expanding ACO models with Next Generation, increasing

risk/reward levels

MSSPs encouraged to move to risk/reward model for FY 2017

Expanded Chronic Care Management (CCM) rule in Year 2 includes

telehealth in non-face-to-face care

ACOs: A Good Fit for Telehealth

Telehealth included by CMS in June ‘15 Final

Rule as part of health IT in care coordination.

Increased Congressional pressure to expand

Medicare reimbursement (CONNECT Act)

Only 20% of ACOs are using telehealth or

telemedicine (eHealth Institute/Premier)

What’s Important to ACOs

Improve Quality, Lower Costs—And Prove It

• Of 333 ACOs in 2014 MSSP program, only 92 (28%)

earned shared savings bonus

• Disproportionately physician-led (Healthcare Finance)

• Drivers: maintain quality care, avoid cost, achieve

population health metrics

Greatest savings leverage: highest utilizers/highest risk chronic disease patients• 5% of ‘SuperUsers’=50% of health spending (NIHCM)

• Over half of high utilizers of emergency rooms (Healthcare Benchmarks)

Keeping them at home, out of the hospital/ER

Need resources which can deliver this leverage

MSSP—Calculating Minimum Savings Rate

CAPG, 7/15

Viterion’s Programs—Physician-Led ACOs

• Comparative 90-day experimental study design (pilot) Experimental group: Remote Telehealth Monitoring. N=60

Control group: coordinated care without telehealth. N=60

• No charge to ACO

• Theoretical framework: TElehealth in CHronic Disease

(TECH) and parameters for success Engagement of patients and health professionals

Effective chronic disease management, including subcomponents of self-

management, optimization of treatment, care coordination

Partnership between providers

Patient, social and health system context

Viterion Programs—Patient Criteria

Inclusion criteria Evaluated as high risk with chronic

disease(s)

Diabetes, hypertension, congestive heart

failure (CHF) or COPD

Multiple chronic conditions and medications

“Frequent Fliers” : multiple hospital

admissions and/or ER evaluations

Elderly who live at home or have travel difficulty

Age 50-90

>$50,000 annual expenditures

High risk patients

Consent to participate and to share Medicare

claims data

Exclusion criteria End-stage disease (e.g. ESRD)

Undergoing current cancer treatment

Current substance abuse

Psychological or neurological conditions which

would prevent effective use of monitoring

Unable to legally consent to participation

Viterion’s Programs—Physician-Led ACOs

1. ACO with ~300 physicians, 50K Medicare lives

Rural Southern state, relatively new ACO (approved by CMS 2014)

Phase 1 August 2015

Moving to phase 2 starting mid-2016

2. ACO with ~400 physicians, 25K Medicare lives

Suburban/rural Southwest state, early CMS ACO (2012)

Joint venture with local medical center

Starting mid-2016

Preliminary Key Findings

Coordination with and within practices vital

Recruiting patients who fit profile is complex

Appointment setting and follow up procedure setting

Daily monitoring and reporting; PHI sharing

Buy in from practices

Patient consent

Adjust plan to care coordination model

Adding required support

Viterion clinical nurse as liaison with physicians, patients

Data integration, analytics support required for benchmarking—utilization analysis

Preliminary Key Findings

Patients—Phase 1

Wide age range—average 65, youngest 37 and oldest 91

Urban, suburban and rural

Many isolated—home environment and support issues (social context)

More co-morbid with 2+ disease conditions

All were hypertensive

Asthma, CHF, COPD, chronic renal failure (on dialysis)

HIV

Behavioral health: depression, schizophrenia

Preliminary Key FindingsPatients—Phase 1

“I hope [the practice] decides to continue this program. I feel so much

better knowing someone is looking at me and watching out for me.”

“You have really helped me. I wasn’t sure what I was going to do when I

found out my food stamps were being cut. Thank you for taking time with

me.”

Positive feelings on remote monitoring—appreciative of extra care

Patient relief on being looked at every day—monitoring alleviates anxiety

about their health

Human factors: positive clinician relationship, building a strong

connection adds to motivation

Social needs are a factor

Preliminary Key Findings

Patients—Phase 1

Success to date in

Demonstrating cost avoidance

Positively impacting ER visits

Positively impacting hospital visits

Improving patient satisfaction

Key Findings—Technology

Vitacast 1000 tablet--proprietary software is new

design, unique to market

Patients overall pleased with compact design,

wireless access, simple touch screen function

menu and features, twin USB-A ports

Mobile data connectivity can be a problem

in rural areas

Telephone connectivity being evaluated

Key Findings—Technology

Peripheral—connectivity and vital sign entry

Bluetooth devices generally reliable in sending accurate data

Manual entry or USB cable connection

Patients need personalized information

Easy-to-follow leave-behinds at installation

In-person coaching on use

• Clinical staff relationships and understanding

How technology fits into care coordination

In-person program explanations, documents, patient FAQs for discussion

and ‘go-to’ person contacts

Improve

The Care Experience

Affordability

Population Health

See us at # 15206