Community Health Network

1. Community Health Network Cost Effective Applications of Telehealth

2. Our History • Community Home Health began our telehealth program in 2007 with Heart Failure patients • We have utilized the same vendor for telemonitoring with devices since beginning of program • Currently, we have over 100 telemonitoring units in patients homes • We added an interactive voice response system (IVR) in 2011 with non-homecare patients

3. What is a Telehealth IVR system? • Telehealth IVR(Interactive Voice Response System) uses a computer generated voice to deliver a set of questions gathering patient ‘s self-reported data. • Branching logic enables real time delivery of follow-up questions and education based upon each patient’s specific responses. • Data collected is monitored by an RN for follow- up as appropriate.

4. Telehealth Programs Homebound/Homecare Non-Homebound/Community Health Network IVR (Interactive voice response) Heart Failure Clinics Primary Care Physician offices COPD Telemonitoring with devices • Advanced Heart Failure/Inotropes • COPD • High risk OB-congenital heart disease/Pre-eclampsia • Hospice • Palliative care IVR • Heart Failure • Hospice • Therapy • Pain management

5. Goals of Telehealth • Reduce re-hospitalizations and emergent visits • Improved symptom management • Increased communication with patients/caregivers • Increased patient/caregiver satisfaction • Reinforcing self care and behavior modification • Increased patient involvement with plan of care

6. How do we monitor homebound and non-homebound patients? • We utilize centralized monitoring for all telehealth programs • Staff consist of registered nurses trained in cardiac, HF, COPD, palliative care and symptom management • Defined processes/protocol for each program

7. Tools used to identify patients • Admission criteria for each program. • Screenings done at discharge from acute care facility and/or admission to homecare • Tool to identify high risk patients in the acute care facilities. • These patient then screened for resources after discharge including telehealth with homecare or IVR/HF clinic/PCP office

8. Patient Scenario • Patient enters acute care facility and is identified as a high risk patient utilizing screening tools. • Transition care nurse begins following patient during inpatient stay. • Transitional care nurse prepares patient for discharge and identifies patient does not meet criteria for or refuseshomecare. • Transitional care nurse makes referral to HF clinic with Telehealth IVR

9. Patient Scenario • Patient begins homecare episode • All HF patients screened using admission criteria • Patient begins telemonitoring with devices • Referral made to HF clinic • Patient begins care at HF clinic during homecare episode • Last 2 weeks of homecare episode patient is transitioned to IVR which patient will remain on for 6 weeks post discharge from homecare and followed by HF clinic

10. Patient Scenario • Patient is admitted to homecare with advanced HF on an inotrope • Patient is started on telemonitoring with devices. • Destination therapy: • Homecare and telemonitoring with devices • Transitions to hospice with telehealth • Discharged and followed by HF clinic • Bridge to VAD • Homecare and telemonitoring with devices until VAD received • Bridge to transplant • Homecare and Telemonitoring with devices

11. Benefits to Network and Patient • Seamless continuum of care for patient • Reduced hospitalizations • Increased satisfaction with care • Increased monitoring of high risk patient cost effectively

12. CHH Telehealth HF Outcomes

13. Patient Satisfaction: TH with Devices

14. Patient Satisfaction: IVR Telehealth

15. Patient quotes about IVR: “I have a lot of weight changes and a phone call catches it quickly and kept me out of the hospital” “For 2 months now I haven’t raced to the hospital because of this. I am learning changes I can make here at home. I wish it wouldn’t end” “It gave me the feeling that someone cared” “I liked the weight questions because it kept me on track weighing myself.”

16. Final Thoughts: Community Home Health and Community Health Network are committed to provide exceptional care: simply delivered. We continue to work to find ways to provide a seamless continuum of care in cost effective ways. Variations of telehealth is one way we are doing this.