2014 Palmetto Care Connections Annual Meeting Presentation

REMOTE PATIENT MONITORING

Telehealth Summit of South Carolina

Telemedicine 2014: Innovations and Applications

September 25, 2014

AGENDA

• Current Healthcare System Challenges

• Transformation from Volume to Value

• A Solution: Remote Patient Monitoring

• Proven Results – Disease Management Project

– Hospital CHF Readmissions Program

– State Medicaid Project

• Opportunities – New Care Delivery Models

– Providers (Hospitals, Physicians, Post-Acute)

THE CHALLENGES

THE CHALLENGES

• Prevalence & Costs of

Chronic Disease

• Incoming Tidal Wave of

Aging Baby Boomers

• Rising Cost of Healthcare

• Poor Quality Outcomes

• End of Life Costs

• Hospital Readmissions

THE FACTS

Cost of chronic disease:

• 133 million Americans (1/3 of total

population) suffer from at least one chronic disease

• 70% of all deaths result from chronic diseases

• 85% of every healthcare dollar goes to treatment of chronic diseases

• 2/3+ of Medicare dollars are spent on patients with 5+ chronic diseases

Source: Centers for Disease Control and Prevention

POOR QUALITY OUTCOMES

AGING BOOMERS

Boomers:

• 26% Total U.S. population

• 83 Million Members

• 10,000 baby boomers turn 65

every day

Source: Pew Research

THE HOSPITAL’S ‘REVOLVING DOOR’

Medicare Rehospitalization Rates*

•21.2 % in 30 days

Average Cost of Rehospitalization*

•$11,200

*Becker Hospital Review, Statistical Brief 2009

END OF LIFE COSTS

• Most Americans would prefer to die at home-but only 24% of those over 65 actually do.

Source: Dartmouth Atlas of Healthcare

• 1 out of 4 Medicare Dollars ($215 B) is

spent on services for 5% of

beneficiaries at end of life

IN-HOME CARE

HOME is:

• Patient Preferred Setting

• Patient Centered

• Lowest Cost Care Setting

• Safest

VOLUME TO VALUE

VOLUME TO VALUE

TRANSFORMATION BEGINNING: FIRST PHASE: 2010-2016

Patient-Centered Care

• Care redesigned around the patient

• Patient-focused multi-disciplinary care teams

• Care teams integrated across care continuum

• Population-based economic models that reward value, not volume

THIRD PHASE: 2018-2025

Science of Prevention

• Low cost DNA sequencing allows for discovery of biomarkers, pathways, & earlier disease detection

• Nearly perfect diagnostic accuracy for personalized treatment

ENDING: SECOND PHASE: 2014-2020

Consumer Engagement

• Cost & performance information

available via web/mobile for

consumer shopping

• Consumers demand better care

• Value-based benefits, social

platforms, & gaming to engage

consumer

Source: Oliver Wyman, The Volume to Value Revolution, 2014

“The current system is stuck on fee-for-service,

and it’s a barrier to a better healthcare

model. But I think we’re at a historic time,

with a growing consensus that it’s time to

move away from fee-for-service. Once freed

from that tyranny, creativity is unlocked.”

George Halvorson

Chairman and CEO of Kaiser Permanente

Source: Oliver Wyman: The Volume to Value Revolution, 2013

VOLUME TO VALUE

HEALTHCARE TRANSFORMATION

NEW CARE DELIVERY MODELS:

• Accountable Care Organizations (ACOs)

• Medical Homes (PCMHs):

— Primary Care

— Specialty Care

• Dual Eligible Medicaid Demonstration Projects

• Bundled Payments:

— Medicare Bundled Payment Care Initiatives (BPIC)

— Insurer (Payer) Initiatives

• Self-Insured Employer

• Other Models:

— Shared Risk

— Capitation

— Shared Savings

REMOTE PATIENT MONITORING

REMOTE PATIENT MONITORING

THE PROGRESSION:

• Remote Patient Monitoring

• Telehealth

• Chronic Care Management

• Virtual Care with In-Home

Interventional Care

• Population Health Management

CHRONIC CARE MANAGEMENT

PRINCIPLES

• Patient-Centeredness

• Care Transition/ Coordination

• In Home Assessments

• Continuous Risk Stratification

• Physician-Led, Integrated,

Multidisciplinary Care Team

• Top of License Practice

• Remote Patient Monitoring

(Biometrics, ADLs, Medication

Adherence)

• Predictive Analytics

• 24/7 Triage for Intervention to

avoid ED/Hospitalization

• Patient/Family Engagement &

Activation for Self Management

• Evidence-Based Best Practices for

Chronic Disease Management

• Disease Specific Education

• Community Integration

• Palliative/Hospice Triggers

PATIENT ENGAGEMENT

AARP. Beyond 50.09. Chronic Care: A Call to Action for Healthcare Reform.” AARP Public

Policy Institute April 2009 Adapted by Insignia Health

RISK STRATIFICATION

Source: Health Care Advisory Board, How to Prioritize Population Health Interventions, 2014.

TECHNOLOGY ADOPTION DRIVERS

• Technology costs continue to drop dramatically

• Increased number of tech savvy older adults

• Increased adoption of voice recognition

• Increased interoperability

• Payers & providers utilizing technologies for population

health management

IN HOME TECHNOLOGIES

• BODY o Vital Sign Monitors

o Activity Monitors

o Sleep Monitors

o Mobile PERS with GPS

o Medication Adherence Monitors

o Medication Dispensers

o Urine Analyzer

• HOME o Fall Detection

o Video Monitoring

o Environment Sensors

o Passive Monitoring Sensors

• COMMUNITY o Social Network

o Social Communication

o Physical & Cognitive Gaming

o Social Networking

o Gaming Technologies

• CAREGIVING o Caregiving Portals

o Caregiving Coordination Platforms

Source: Center for Technology and Aging, The New Era of Connected Aging: A Framework for

Understanding Technologies that Support Older Adults in Aging in Place, 2014.

FUTURE TECHNOLOGIES

• BODY — Smart Medication Management

— Smart Body Sensors

— Remote Monitoring Devices Populating EMR

— Remote Laboratory Diagnostics

• HOME ENVIRONMENT — Fall Prevention

— Assistive Technologies

• COMMUNITY — Social & Health Mobile Apps

— Patient, Provider, Caregiver Coordination Platforms

• CAREGIVING — Local Community Networks for Aging In Place

— Robots

Source: Center for Technology and Aging, The New Era of Connected Aging: A Framework for Understanding

Technologies that Support Older Adults in Aging in Place, 2014.

• SOCIAL RISK

– Age, Gender

– Level of Social Support

– Social Relationships

– Transportation

• GEOGRAPHICAL RISK

– Average Income

– Housing Value

– Distance from health care services

• BEHAVIORAL RISK

– Anxiety

– Depression

– Stress

– Mental Health Symptoms

• PATIENT ACTIVATION

– Health Understanding

– Health Literacy

– Engagement

– Confidence

• HOME ENVIRONMENT RISK

– Infestations

– Multi-level with Stairs

– Cluttered

– Insufficient Lighting

– Lack of Bathroom Assistive Devices

A BROADER SET OF RISKS

Source: Advisory Board Company, How to Prioritize Population Health Intervention, 2013

VIRTUAL CARE

VIRTUAL CARE ELEMENTS:

• Disease Management Assessments

& Education

• Remote Biometric Monitoring

• IVR:

— Patient Reporting/Bluetooth

• Telephony:

— Health Coach Prescribed Calls

— SN Intervention Calls

• Bi-directional Video Visits (MD,

RN & Patient)

• ADL Monitoring

• Medication Adherence/Reminders

• 24/7 RN Triage

VIRTUAL CARE TEAM:

• Nurse Care Coordinators

• Triage Nurses

• Specialty Nurses

— Cardiology

— Endocrinology/Nephrology

— Neurology

— Oncology

— Pulmonology

— Geriatric

— WOCN

• Pharmacists

• Health Coaches

• Behavioral Specialists

• Dieticians

IN HOME INTERVENTIONAL CARE INTERVENTIONAL CARE ELEMENTS:

• ED at Home

• In-Home Visits using Physician Protocols

• Respiratory Therapy Interventions

• Administration of IV Therapies:

— Diuretics

— Antibiotics

— Hydration & Electrolyte Replacement

— Cardiac Rhythm Management Therapies

— Steroids

• Administration of:

— Analgesics

— Oxygen

• Bi-directional Video Visits with In-Home Care

Team & Physician

INTERVENTIONAL CARE TEAM:

• Nurse Practitioners

• Nurse

• Respiratory Therapists

• Physical Therapists

• Occupational Therapists

• EMTs

• Paramedics

PROVEN RESULTS

THE PROOF

NATIONALLY PUBLISHED RESULTS:

• Veteran’s Administration:

— Remote chronic care management

— 17,000 high risk, high cost complex polychronic veterans

— Results:

63% reduction in hospital admissions

88% reduction in nursing home bed days of care

— Current Program includes 65,000 veterans

• CMS:

— Care Management for Beneficiaries Demonstration Project

— Remote chronic care management

— 1,757 high cost, polychronic beneficiaries

— 13.3% reduction per patient per quarter

— $542 reduction per patient per quarter

Source: Center for Technology and Aging, Dual Eligible Brief, 2012

RESULTS

Source: Advanced Telehealth Solutions

CHF Study:

• 83 heart patients

• 4-5 chronic diseases

• 6 month study

RESULTS

Source: Advanced Telehealth Solutions

Reduced Hospitalizations for Multiple Co-morbidities

Telehealth Intervention:

• Post Hospital Discharge Program

• Polychronic Disease Patients

• 30 Day Program

• Telephonic Intervention

STATE MEDICAID PROGRAM

Telehealth Project

Source: Advanced Telehealth Solutions

Project Details:

• On Going Program since July, 2004

• Total Number of Program Beneficiaries-

— 1,530 (7/2004- 6/2014)

— Polychronic Disease Patients

— Medicaid Waiver Telehealth Program

Monitoring Reimbursement

STATE MEDICAID

TELEHEALTH RESULTS

OVERALL RESULTS *:

• Hospitalization Rate:

— 65% Reduction in Hospitalizations

• ER Visit Rate:

— 68% Reduction in ER Visits

RESULTS BY CHRONIC DISEASE *:

• CHF- 59% Reduction in Hospitalizations

• COPD- 63% Reduction in Hospitalizations

• Diabetes- 63% Reduction in Hospitalizations

• Hypertension- 69% Reduction in Hospitalizations

Source: Advanced Telehealth Solutions * Per 1000 Days

SC MEDICAID PROGRAM

SC MEDICAID REMOTE PATIENT MONITORING

• Began in 2009

• Available to Community Choices participants

• Telemonitoring of Body Weight, Blood Pressure, Oxygen Saturation,

Blood Glucose Levels, & Heart Rate Information

• Enrollment Criteria:

— Primary diagnosis of Insulin Dependent Diabetes Mellitus,

Hypertension, Chronic Obstructive Pulmonary Disease, and/or

Congestive Heart Failure

— 2+ Hospitalizations &/or ER Visits in The Past 12 Months

— Patient must have a Primary Care Physician

• Reimbursement- $10 per day

OPPORTUNITIES

NEW CARE DELIVERY MODELS

OPPORTUNITIES FOR TELEHEALTH: • In:

– ACOs

– PCMHs

– Dual Eligible (MCOs, Demonstration Projects)

• For Reimbursement Models for:

– Risk Sharing

– Shared Savings

– Capitation

• Telehealth:

– Increases Care Team Capacity

– Increases Quality Outcomes

– Reduces Expenses for High Risk/High Cost Patients

– Decreases Days in Skilled Nursing Facilities

– Allows for Higher Reimbursement Rates from Commercial

Payers

– Decreases PMPM Spend by Reducing Acute Care Hospital

Admissions & Readmissions Rates

– Increases Commercial Payer Contract Reimbursement

PROVIDER OPPORTUNITIES

• HOSPITALS:

– Reduce Preventable 30 Day Readmissions for CMS Designated

Diagnoses with Associated Penalties (CHF, AMI, Pneumonia &

Additional Diagnoses 10/1/14)

• PHYSICIANS:

– PCMHs (See Previous Slide)

– Reimbursement for Medicare Care Management Fees

Chronic Care Management Fee (2015)

Medicare Transitional Care Management Fee

Medicare ESRD Care Management Fee

– Managed Care Contracts (Medicare Advantage, Medicaid,

Commercial Payers)

Chronic Care Management Fees

Incentive Based Contracts

• POST ACUTE PLAYERS:

– Increases Staff Capacity, Lowers Cost Of Care

– Increases Quality Outcomes

– Reduces 30 Day Hospital Readmissions & ER Visits

“Do not follow where the path may

lead. Go instead where there is no

path and leave a trail.” Ralph Waldo Emerson

Katherine Piette

Longitudinal Health

[email protected]

(888) 670-6787

www.longitudinalhealth.com