Today’s talk involves ……

1. MATRC 2nd Annual SummitMarch18, 2013Improving The Quality of Care: Reducing ReadmissionsBonnie Britton, MSN, ATAF Vidant Health Telehealth AdministratorSeth Van Essendelft, MBAVice President, Financial Services Vidant Medical Center

2. Today’s talk involves…… • Examining the “Boomerang Effect” • Discussing financial implications for Telehealth • Discussing Vidant Health’s Telehealth Program and outcomes • Questions and Answers

3. Who is in the audience?

4. Chronic Illness & the “Boomerang Effect”

5. Mr. Doe’s Hospital Admission • 81 y.o: CVD, HF, DM, Arthritis • Exacerbation of Heart Failure • Not following his diet • Not taking all of his medications (8 meds) • Not keeping PCP visits • Low engagement level • 8 HF ER visits and 6 hospitalizations < 12 mos.

6. Mr. Doe prepares for Discharge • Told he will be d/c home tomorrow • PCP not alerted that Mr. Doe was hospitalized • Given new prescriptions • Toldto schedule a PCP appt. in the next month

7. Educating Mr. Doe at Discharge • Patient education: • Smoking cessation • Diabetes care • Nutrition and cooking advice to him and his wife • Must take BP meds even if he feels fine • How to take his diuretics

8. Mr. Doe’s First Day Home • Forgets most of what was told to him @ D/C • Can’t remember much/feeling OK- • Not consistently compliant with diet, medication • Doesn’t make PCP appointment

9. The Boomerang Effect • Patient issues • Don’t understand their medications • Don’t understand how to follow prescribed diet • Can’t afford their medications • Can’t afford foods to follow their diet • Low engagement level

10. The Boomerang Effect • Hospital issues: • Focus: inside walls of the hospital • Post d/c service focus: HH & LTC • Incorrect or absent medication reconciliation • Extremely limited system of care transitions • Brief & fragmented patient education • PCP not contacted during hospitalization • Fragmented communication between clinics/specialists/hospital • Dictate to patients vs. engage them in their care

11. Vidant Health

12. Vidant Health’s Mission: To enhance the quality of life for the people and communities we serve, touch and support.

13. Portfolio of Tools Discharge Options Physician/Home SNF LTAC Rehab Home Health Hospice Palliative Care Patient Hospital Remote Monitoring

14. What if . . . Remote Monitoring Patient Doctor

15. Telehealth Can Alter the Path Telehealth Intervention

16. Health System Strategies • Expand access to care • Improve healthcare value • Continuum of care • Best utilize capacity • Connect with local employers • Improve physician network • Improve employer health plan cost position • Develop care models of the future

17. Challenges • Reimbursement • Reform penalties • Capacity utilization • It is all relative

18. Business Case • Overview and process • Expectations • Lessons learned • Adaptation varied • Operational details • Length of monitoring assumptions • Data requirements • Keep the big picture in focus

19. Financial Goals and Objectives • Stop Bonnie from beating on my door! • Pilot enhanced continuity of care model • Capture & quantify financial levers

20. Telehealth Back to the Future

21. Driving the Telehealth Bus! Hey Norton - you will get out of your telehealth program exactly what you put into it!

22. VH Telehealth Conceptual Model Diagnostic Transitions In Care Chronic Disease Mgt. Friends & Family September 2012

23. Transitions in Care Goals • Access to Telehealth and care management for hi-risk hi-cost patients • Reduce 30-day readmissions, hospital bed days and ER visits • Improve clinical outcomes • Improve the patient’s perception of care • Improve quality of health information

24. Transitions in Care Services • Population: In-patient CVD and Pulmonary patients PAM Level I & II Frequent ER visits/hospitalizations Medicare/self pay/un/underinsured • Services: In-home medication reconciliation Home Safety Assessment Daily Biometric data monitoring Weekly telephonic assessment, education, coaching • LOS: 3 months

25. Chronic Disease Management Goals • Access to Telehealth and care coordination for hi & medium-risk VMG patients • Increase patient access to care • Improve quality of health information and communication between hospital- home – PCP • Improve clinical outcomes • Improve the patient’s perception of care • Reduce health care costs

26. Chronic Disease Management Services • Population: Clinic based patients PAM Level I & II – VMG Patients PAM Level III with frequent ED/hospitalizations Transfer from Transition in Care Program monitoring • Services: In-home medication reconciliation Home Safety Assessment Daily Biometric data monitoring Daily telephonic assessment, education, coaching as needed Bi-weekly assessment, education, coaching • LOS: 6 months

27. VH Telehealth Family & Friends • Population: Graduates of TH TIC, TH CDM VH Employees Contracted Services (Nash, BasisHealth) • Services: Self management monitoring Biometric data monitoring Fee for service • LOS: TBD

28. Metrics • Clinical Data • LDL, BP, Pulse, Height, Weight, HgA1c, oxygen saturation • Patient Satisfaction • Financial Outcomes- 90 days pre TH, during TH, 30 days post TH • Hospitalizations • Bed Days

29. Demographics – Primary Insurance

30. Demographics – Patient Gender

31. Demographics – Patient Diagnosis

32. Demographics – Patient Age

33. Average Time Utilizing Remote Monitoring Services

34. Patient Satisfaction Surveys (N=325)

35. Hospitalalizations • Decreased by 69% Prior to During • Decreased by 76% Prior to Post

36. Hospital Bed Days Decreased by 67% Prior to During Decreased by 81% Prior to Post

37. Hospital Cost and ReimbursementTotal Patients approximately 700

38. Financial Benefits – Total Healthcare • Lower hospitalization cost • Readmission aversion • More effective and efficient care • Improved access to care at the appropriate levels • Greater patient satisfaction 38

39. Financial Benefits – Hospital System • Reduces readmissions penalties exposure • Capacity – increasing CMI & fewer lost admissions • Expands margins • Reduces bad debt losses • Improved discharge planning process • Reduces employer health plan costs • Creates value proposition • Created retail opportunities

40. Mr. Doe readmitted to Hospital with HF • At Hospital Discharge: • D/C with the same medications & education • Cardiologist & hospitalist make referral to TH • TH referral received by Telehealth Team • In-hospital enrollment • PCP visit appt. made • Home visit appt. made

41. Mr. Doe’s First Day with RPM • Patient conducts reading. Wt. increased by 2 lbs. • TH RN calls patient to review medication and diet compliance • See - Feel Change • TH RN provides nutrition counseling

42. Mr. Doe’s Fourth Day with RPM • Objective data: • Wt. increased by 4 pounds • O2 sat. decreased to 92% • BP slightly elevated @ 145/90 • Subjective data: • Reporting SOB and ankle edema

43. Mr. Doe’s Fourth Day with RPM • Actions • TH RN calls patient, conducts health assessment and provides education • Discovers patient ate Country Ham last night • Didn’t take his Lasix because he had no money • See - Feel Change • TH RN contacts PCP • PCP instructs pt. to come to clinic today

44. Take Home Points • Conducting in-home med. rec. & providing RPM services result in: • Early identification and tx of disease exacerbation • Reduced hospitalizations • Reduced bed days • Reduced ER visits • Reduced health care costs • Ending the Boomerang Effect • Active engaged patients

45. Questions and Answers

46. Bonnie Britton, RN, MSN, ATAFTelehealth AdministratorVidant Healthbonnie.britton@vidanthealth.com Seth Van EssendelftVice President Financial Services Vidant Medical Centerseth.vanessendelft@vidanthealth.com