Beacon Collaborative Overview 2011

1. John Kansky Vice President - Business Development 317-644-1723 jkansky@ihie.org Beacon Collaborative Overview2011

2. Healthcare Quality, ARRA HITECH and IHIE For this story to make sense, it is necessary to explain some context: • Evolving national focus on healthcare quality • Increasing national focus on electronic health records (EHR) and health information exchange (HIE) • The Indiana Health Information Exchange (IHIE)

3. Healthcare Quality = Healthcare Future “Fundamental to any healthcare reform effort is the need for unbiased measurement of healthcare quality and efficiency.” - Dr J. Marc Overhage Founder, Indiana Health Information Exchange

4. ARRA HITECH – EHRs and HIE ARRA Funding($787 Billion) HITECH (~$34 Billion) Health Information Exchange ($2 Billion) • Regional Extension Centers • (all 50 states) Beacon Cooperative Agreement Program (17 awards nationwide) State HIE Cooperative Agreement Program (all 50 states) Government Support of HIE • The American Recovery and Re-investment Act included funding specifically aimed at promoting electronic health records (EHR) and health information exchange (HIE). • This sub-part of ARRA, known as the HITECH Act, includes several distinct funding opportunities. • The different funding opportunities each target different obstacles or barriers to the adoption and use of EHR and HIE

5. IHIE Statistics • Nation’s largest HIE • Founded in February 2004 • Based on the technology, knowledge, and experience of the Regenstrief Institute • ~70 employees • Annual revenues in excess of $5 million • Providing services to ~80 hospitals (24 health systems), 18,000 clinicians, and 5 payers, … • Serving an area with a population of about 4 million people

6. Quality Health First Program Provider & Patient-specific Reports Providers Patient Level Detail In Office Tests Rules Engine Clinical Data Clinical Data Sources Provider Level Summary Claims Payers Payer-specific Reports

7. Beacon Co-operative Agreement Program Leveraging HIE and EHRs, demonstrate improvement in the health of the population One of 17 Communities Nationwide All or part of 46 Indiana counties / ~45% of the state’s population - Dartmouth Atlas Hospital Referral Region 183 Funding: $16M (requested of $19.9M) over 3 years Each activity should be: • Sustainable – someone willing to pay what it costs • Replicable in other communities • Effective in at least one of the measured domains Collaboration with affected stakeholders, with ONC and with other Communities

8. Central Indiana Beacon Region

9. Beacon Speak – “move the needles” Beacon Communities are expected to make measurable improvement in selected health outcomes: • Quality • Diabetes: control HbA1c and LDL • Cholesterol: Control LDL Targets • Efficiency • Reduce ambulatory care sensitive admissions/re-admissions • Reduce redundant/inappropriate imaging • Reduce ambulatory care-related ED visits • Population Health • Increase colorectal and cervical cancer screening • Increase availability of adult immunization data

10. What the Beacon Effort Entails Objective 1: Expand Data Capture - More data sources, more data elements, and innovative ways of capturing data Objective 2: Improve Quality Measurement/Reporting - Measure efficiency, measure race and ethnicity disparities, begin public reporting of quality information

11. What the Beacon Effort Entails Objective 3: Expand QHF Participation - Increase the number of physicians and payers participating in Quality Health First Objective 4: Improve the Care of Patients (“move the needles”) - Establish specific health outcomes goals; Identify best practice methods/tactics to meet goals; execute all selected methods/tactics Monitor and Evaluate

12. To End…an Analogy Partners IHIE QHF Better Healthcare Outcomes Tactics Programs

13. Julia SmalleyClinical Consultant: Ascension Health Transformational Development317-332-6962jasmalle@stvincent.org • Effect of Telemonitoring on Reducing Readmissions • A Randomized Study of Short-term Post-Discharge Chronic Disease Management with Telemonitoring and Telephone Support

14. Facts Congestive heart failure (CHF) is the most common Medicare diagnosis related group accounting for more healthcare costs than any other disease condition. National readmission rate for patients with CHF is 21% Hospitals face increasing pressure to lower the cost of health care while at the same time improving quality Behavioral factors, such as noncompliance with medications, lack of timely physician follow up visits and social factors, such as social isolation, frequently contribute to early readmissions, suggesting that many such readmissions could be prevented. Total annual healthcare expenditure for both direct and indirect healthcare cost of CHF approach 28 billion dollars. (http://content.onlinejacc.org)

15. Goals & Objectives Reduce ambulatory care sensitive re-admissions for patients with Congestive Heart Failure and Chronic Obstructive Pulmonary Disease Multidisciplinary approach to treatment reduce the rate of re- admission for elderly patients at high risk Include hospitals representing diverse hospital size and geographical locations Monitor 3000 patients post-discharge for 30 days between December 2010 – December 2012.

16. Home Monitoring Vendor Selection Transformation Development Department at Ascension assisted in developing technology selection criteria Eight vendors were invited to bid, four presented to the selection committee and Care Innovation’s Health Guide was awarded the offer.

17. Care Innovations Health Guide • Allows for video conferencing with the nurse contact center. • Provides health educational learning sessions . • Monitor’s daily bio-metric readings • Interacts with the patient daily inquiring about health status.

18. Participating Site Hospitals • St. Vincent Indianapolis (86th Street & Heart Hospital) • St. Vincent Critical Care Access Sites • SV Jennings Hospital (North Vernon) • SV Mercy Hospital (Elwood) • SVFrankfort (Frankfort) • Columbus Regional Hospital (Columbus) • Wishard Hospital (Indianapolis) • Hancock Regional (Greenfield) • Additional sites to be added

19. Readmissions by Participating Hospital • Source: Indiana Hospital Association 2009 reported data

20. CHF/COPD Volume

21. Study Enrollment Process • Hospital Study Coordinator offers and completes study informed consent • Consents? • Not in study • N • Y • SVH Contact Center completes patient enrollment • Randomization into study group • (Randomized by Study Site and PrinDx) • Patient enrollment form completed • Physician notified • SVH Contact Center arranges device deployment • 50% • R • 50% • Complete Study Protocol

22. Home Deployment VRI (Valued Relationships, Inc.): NCC initiates patient installation with VRI Installations completed within 24 hours of discharge VRI schedules timing directly with patient VRI installs equipment and demonstrates device VRI connects patient and NCC with first video conferencing prior to leaving patients home VRI retrieves, cleans, decommissions and inventories equipment

23. Accomplishments to Date Establish baseline data for participating hospitals Obtain IRB approval (IU and St. Vincent) Integrate with hospital discharge planning Selected device vendor Prepared site hospital teams Selected/trained equipment management company Selected/trained 4 Registered Nurses Clinical protocols developed Communication materials developed (patient welcome video; physician letter, patient, and nurse resources)

24. Ongoing Processes Control Group & Intervention Group randomization Qualify patients & enroll in study Device deployment & retrieval in the home Daily interaction and monitoring of patients Disengage patients after 30 days Post study survey: instrument “Patient Activation Measure” (PAM). Univ. Oregon; Judith Hibbard Continue enrollment till Dec. 2012 or when we obtain 3000 patients (1500/group) Identify best practices, refine program Jan-Mar 2013- Program evaluation and dissemination of results to stakeholders and other Beacon programs

25. Questions?