Indiana Rural Health Association June 14-15, 2012 Indianapolis, IN

1. Telehealth Initiatives at St. Vincent HealthAlan Snell, MD,MMM- Chief Medical Informatics Officer Julia Smalley, MBA,MHA,RN- Project Director, Ascension HealthSherry Gray, MA- Director of the Rural and Urban Access to HealthJohn Greaney, MBA- Ex Director of Strategic Services, St. Mary’s Health System, Evansville Indiana Rural Health Association June 14-15, 2012 Indianapolis, IN

2. Comprehensive Approach Nurse video conferencing Daily health session Daily biometric monitoring Patient education (videos and written)

3. Readmission Study • CHF/COPD • Comprehensive care approach • Enrollment at time of inpatient discharge • Patient focused • 30 day monitoring • PAM survey Provider Home Health Nurse Case Mgt Nurse

4. Complex Chronic Diseases Patient Portal (PHR) • Multiple co-morbidities • Undefined length of monitoring • Fluctuating level of care • Integration • of PCP • Comprehensive Care Plan Provider EHRs Ancillary Services Home Services Community Services

5. Rural and UrbanAccess to Health Indiana Rural Health Association Annual Conference June 14, 2012

6. RUAHRural and Urban Access to Health Purpose: To connect our friends, family, and neighbors to a comprehensive, integrated delivery network of health, human and social services resulting in improved access and removal of barriers to needed resources. Meaning and Mission: The word ruah, in yiddish means “Breath of Life”. The Goal? …to breathe new life into a dying health care system so that will we can serve our most vulnerable community members

7. How RUAH addresses ACCESS • Health Access Workers • client advocates & “system navigators” • eCAP=electronic database focusing on community based care coordination • Laptops; portable scanners; smart phones • Pharmacy – access to low or no cost drugs through Medication Access Workers (MAC’s) (RXASSIST+; Dispensary of Hope; Vouchers ;etc.) • Creation of “Medical Homes” for the underserved • Reduction of inappropriate Emergency Room utilization • Access to Specialty Care for the underserved • Program enrollment (financial resource review and application assistance) • Assistance with supportive social services (“wrap around”) • Outcome Based Measurement Work -Pathway Model -Community “Hub” • Diversity – document translation, medical interpretation (in-person, OPI or Video), signage, diversity councils, LEP Assessment

9. OPI (Over the Phone Interpretation)

10. Ultimately: • -Un/underinsured community members can receive care “sooner vs. later” • -Consistent and familiar care is provided along with follow up & follow through: treatment is across time and not episodic • -Resources are used as effectively as possible, including: • Human • Providers, Practitioners, Care Coordinators, Administrative support, etc. • Financial • Reimbursement, Funding, Cost-Avoidance, “Write-Off’s” • Technological • Connecting Information in a timely, meaningful way • Relating to/among community members through adaptive devices, etc. • Support (wrap-a-round) Services • Connecting medical treatment, public health practices, & psychosocial principles • Vital connections are made • Integrate and coordinate care not duplicate and replicate care • “Best Practice” Learning's are shared; and solutions are not “re-created”

12. Basic Supply and Demand

13. Technology as a Means, not an End

14. Timely, Relevant, & Accurate

15. The Doctor Will See You Now

16. Accepting and Accelerating Change • Key Tests • Is the patient experience enhanced? • Does the process improve the physician’s ability to practice exceptional medicine? • Is the right patient getting connected to the right provider at the right time? • Does the process promote more proactive care and longer term complication and cost avoidance? • Is the “What’s in it for me?” clear for all major stakeholders?

17. Questions?