10/10/2013 1 Telehealth Series 306 Telehealth: A Vital Link in Hospital, Physician, Home Health Patient Care Coordination Strategy Friday, November 1, 2013 8:00 AM to 9:30 AM 1 Brought to you by: Raj Kaushal MD Jennifer Bravinder RN, BSN Chief Clinical Officer Chief Clinical Officer Almost Family Inc. Cardiocom Program Objectives • Describe impact of telehealth – Care coordination, collaboration and communication • How success leads to growth – Outcomes of a national program – Aligning incentives with care partners • Explain best practices – Pre-launch and post-launch strategies – Explain natural progression of programs – Identify lessons learned – Propose what the future holds 2
Transcript
10/10/2013
1
Telehealth Series 306
Telehealth: A Vital Link in Hospital, Physician, Home Health Patient Care y ,
Coordination Strategy
Friday, November 1, 20138:00 AM to 9:30 AM
1
Brought to you by:Raj Kaushal MD Jennifer Bravinder RN, BSN
Chief Clinical Officer Chief Clinical OfficerAlmost Family Inc. Cardiocom
Program Objectives
• Describe impact of telehealth – Care coordination, collaboration and communication
• How success leads to growth– Outcomes of a national program– Aligning incentives with care partners
• Explain best practices– Pre-launch and post-launch strategies– Explain natural progression of programs– Identify lessons learned– Propose what the future holds
• Telehealth for Home Care EpisodeTelehealth for Home Care Episode
Monitoring Information • Monitored Seven Days per Week • 8:00 a.m. – 4:00 p.m. of Patient Time
Post Home Care Episode Care • Telephonic Outreach and Self Reported Information
• Frequency: Every Two Weeks for 3 Months and then Monthly
12
Months and then Monthly Clinician Specialty Training • Specialty HF Program Training &
Competency Integrate Information Into Clinical Decision Support
• Modify Care Management Practice• Utilization of PRN Physician Orders
10/10/2013
7
National Program OutcomesPatient Population Overview
Metric Total PercentageTotal Population 566Total Population 566Gender
Male 218 39%Female 289 51%
Unknown 59 10%Age
<65 59 10%<65 59 10%65-74 110 19%75-84 194 34%
>85 170 30%Unknown 33 6%
National Program Outcomes
12 6%
All Cause Readmission Rate for Patients Discharged with HF Diagnosis1
National average is 24.62%12.6%
Within 30 days
30.4% After 30 Days
57.0% No Readmissions
1 Calculated by readmissions within 30 days from the date of discharge of the admission, from patients discharged from the hospital with a principal discharge diagnosis of HF2 www.cms.gov
10/10/2013
8
National Program OutcomesHF Hospitalizations by Age Group HF Hospitalizations by Gender
Male44%
Female56%
<656%
65-7430%
75-8432%
>8532%
32%
How Success Leads to Growth
OutcomesOutcomes
Improved outcomes should provide competitive advantage
Disease Programs
Expansion beyond heart failure to COPD and diabetes
New Business
New opportunities and partnerships with
16
positive outcomes and services
Growth Will Naturally Follow Success
10/10/2013
9
Aligning Incentives
• Align objectives, strategies and technical plan with care partners by using telehealth as a common Iink in p y gthe short term and long term management
• Engaging physicians and health care providers as partners in care beyond the formal interactions with the health care system (office and hospital visits) is it l t i i h lth t f ti t
17
vital to improving health outcomes for patients
• Share risk & reward
Aligning Incentives
“The Affordable Care Act (ACA) is shifting the health care system in the U.S. away from the traditional fee-for-services to a pay-for-performance system. Moreover, CMS is moving to reimburse M di C tifi d H H lth b d l b dMedicare Certified Home Health based on a value-based purchasing model instead of a Prospective Payment Model. This is starting to eliminate the misalignment of incentives inherent in traditional Medicare, Medicaid and private insurance programs. There are many provisions and models in the ACA that would benefit from, provide opportunities to cover, and consequently encourage the adoption of telehealth and RPM technologies and services. The act created the Center for Medicare and Medicaid Innovations (CMMI), which is funded and tasked with exploring new care delivery and payment models and initiatives.”
CMMI Innovations Models and Initiatives, CMMI, CMS. Available online at: http://innovation.cms.gov/initiatives/index.html
Visioning & Strategic Planning is a Key Foundational Step
Organizational Readiness
• Evaluate state of preparedness– High turnover– Short staffedShort staffed– Appropriate leadership
• Understand time and dedication required• Accountable and qualified resources available
– Project team for operational planning– Patient management coverage– Inventory control– IT infrastructure
22
Readiness to Initiate and Operate is Basic Step to Success
10/10/2013
12
Vendor Partner Considerations
• Technology review • Software considerations
Access req irements• Access requirements• Feedback loop for healthcare providers• Budget considerations• Scalability• Program support• Remember the future
23
Plan for Scalability and the Future
Operational Planning
• Program design– Include short and long term goals– Align incentives with care partnersAlign incentives with care partners– Care coordination, collaboration and communication
• Incorporate program into the day-to-day operations– Redesign processes and workflows– Take advantage of technology and efficiencies
• Leadership to gain buy-in of new care delivery model• Involve all stakeholders• Define clear goals, timelines and deliverables
24
Most Successful Programs Engage All Stakeholders
10/10/2013
13
Measuring Success
• Success looks different for everyone• Ideas for goals and metrics
Clinical Satisfaction Operational FinancialImproved control of chronic conditions
Improved patient satisfaction scores
Increased staff productivity/efficiencies
Opportunity for new lines of business
Improved integration/care coordination
Improved provider satisfaction scores
Focused intervention and needs
Increased productivity
25
Reduction in hospitalizations/readmissions
Employee satisfaction and retention
Attracting new talents
Increased market share/referrals
Improved self-management skills
Increased trust and security in home environment
Positioning and market advantage
Decreased travel time
Post-Launch
• Engage all stakeholders• Ensure baseline numbers for success measures
Program s pport• Program support – Training support (video and audio education)– Key operating elements (standardization, patient and clinical
education)
• Future program expansion• Scalabilityy
26
10/10/2013
14
Natural Progression of Programs
Scalability and Standard of Care
Operational Goals & Care Continuum Changes
Standardization & Engaging all Stakeholders
27
Successful Programs Mature Over Time
Natural Progression of Programs
New Programs
• Adoption and buy-in
Mature Programs• Change in business goalsAdoption and buy in
• Engaging all stakeholders
• Standardization
– Clinical– Satisfaction– Operational– Financial
• Future program expansion
• New lines of business
28
Plan for Future and Scalability
10/10/2013
15
Telephonic Health System Mobile Flexibility
Remote Patient Monitoring
Two-Way Video Options
Natural Progression of Programs
Business goals, programs, patient needs
29
ENSURE VENDOR PARTNER CAN CHANGE AND SCALE WITH YOUENSURE VENDOR PARTNER CAN CHANGE AND SCALE WITH YOU
Business goals, programs, patient needs and access to care change over time
Lessons Learned
• Strong Clinical Champion have the best outcomes• Hospital-Physician-Home Health integrated delivery
of care approach produces the highest enrollees• Monitoring team communication with field clinicians
directly improves patient care• Focus needs to be placed on SBAR communication,
medication reconciliation and visit utilizationS d d l d ti ki• Success depends on sales and operations working closely together
10/10/2013
16
What the Future Holds
Requirement for All Engaged in Healthcare Delivery System:
1. Reduce Hospitalization – Hence Cost of Care2. Use Evidence-Based Protocols to Deliver
Measurable Outcomes3. Empower Patients at Home with Improved
Satisfaction, Independence & Self-Management
31
H H
Hospital to Home
What the Future Holds
• Requirement to extend services outside of traditional episodes of care (Continuum of Care)
• Expansion to other partnerships & payer sources• Expansion to other partnerships & payer sources (ACO’s, Bundles, etc.)
