2015 ga partnership telehealth ebberwein
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REMOTE PATIENT MONITORINGREMOTE PATIENT MONITORINGROI: The Business CaseROI: The Business Case
Georgia Partnership for TelehealthGeorgia Partnership for TelehealthGeorgia Partnership for TelehealthGeorgia Partnership for Telehealth
66thth Annual Spring ConferenceAnnual Spring Conference
March 2015March 2015
Joseph EbberweinJoseph Ebberwein
Longitudinal HealthLongitudinal Health
REMOTE PATIENT MONITORING
THE PROGRESSION:
• Remote Patient Monitoring
• Telehealth
• Chronic Care Management
• Virtual Care
• Population Health Management
VOLUME TO VALUE
HEALTHCARE TRANSFORMATION
NEW CARE DELIVERY MODELS:
• Accountable Care Organizations (ACOs)
• Medical Homes (PCMHs)
• Medicare/Medicaid Dual Eligible State Demonstration Projects
• Bundled Payments:
— Medicare Bundled Payment Care Initiatives (BPIC)— Medicare Bundled Payment Care Initiatives (BPIC)
— Insurer (Payer) Initiatives
• Self-Insured Employers
• Other Emerging Models:
— Shared Risk
— Shared Savings
— Capitated/Episodic Payment
IN HOME TECHNOLOGIES
• BODY
o Vital Sign Monitors
o Activity Monitors
o Sleep Monitors
o Mobile PERS with GPS
o Medication Adherence Monitors
• COMMUNITY
o Social Network
o Social Communication
o Physical & Cognitive Gaming
o Social Networking
o Gaming TechnologiesMonitors
o Medication Dispensers
o Urine Analyzer
• HOME
o Fall Detection
o Video Monitoring
o Environment Sensors
o Passive Monitoring Sensors
• 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.
VIRTUAL CARE
VIRTUAL CARE ELEMENTS:
• Remote Biometric Monitoring
• IVR:
— Patient Reporting/Bluetooth
• Telephony:
— Health Coach Prescribed Calls
VIRTUAL CARE TEAM:
• Nurse Care Coordinators
• Triage Nurses
• Specialty Nurses
— Cardiology
— Endocrinology/Nephrology
— Neurology— Health Coach Prescribed Calls
— SN Intervention Calls
• Bi-directional Video Visits (MD, RN & Patient)
• ADL Monitoring
• Medication Adherence/Reminders
• 24/7 RN Triage
— Neurology
— Oncology
— Pulmonology
— Geriatric
— Wound/Ostomy
• Pharmacists
• Health Coaches
• Behavioral Specialists
• Dieticians
THE RETURN ON INVESTMENTTHE RETURN ON INVESTMENTTHE RETURN ON INVESTMENTTHE RETURN ON INVESTMENT
RETURN ON INVESTMENT
REMOTE MONITORING EQUIPMENT ADVANCEMENT IN 10 YEARS
Cabled Equipment costing $7,000 to Wireless Peripherals costing $300
Monitoring Costs from $300/month to Tiered Costs ranging from $40-$130/month
RETURN ON INVESTMENT
TELEHEALTH PRODUCES ROI:
� HOSPITALS:
Current: Reduction in Readmission PenaltiesFuture: Bundled ReimbursementFuture: Bundled Reimbursement
� HOME HEALTH AGENCIES:
Current: Increase in Staff Capacity (Caseload)Reduction in SN Visits/Episode
Future: Bundled ReimbursementPenalties for Readmissions
� SKILLED NURSING FACILITY:
Current: Reduction in Wound Care CostsFuture: Bundled Reimbursement
Readmission Penalties
RETURN ON INVESTMENT
• TELEHEALTH:
– Increases Provider’s Care Team Capacity– Increases Quality Outcomes– Reduces Expenses of High Risk/High Cost Patients– Reduces Expenses of High Risk/High Cost Patients– Decreases Days in Skilled Nursing Facilities– Virtual Wound Care
– Reduction in PMPM Cost (SNF, HHA, Hospice)– Reduction in Provider Liability for Wound Mgt.
– Higher Reimbursement Rates from Commercial Payers– Decreases PMPM Spend by Reducing Acute Care Hospital
Admissions & Readmissions Rates – Increases Commercial Payer Contract Reimbursement
RESULTS
NATIONALLY PUBLISHED RESULTS:
• VETERAN’S ADMINISTRATION:
— Remote chronic care management— 17,000 high risk, high cost complex polychronic veterans— Results:— 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 utilizing Telehealth— 1,757 high cost, polychronic beneficiaries— 13.3% reduction in costs 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
Reduced Hospitalizations for Multiple Co-morbidities
Telehealth Intervention:• Post Hospital Discharge Program• Polychronic Disease Patients• 30 Day Program
Source: Advanced Telehealth Solutions
• 30 Day Program• Telephonic Intervention
STATE MEDICAID
TELEHEALTH RESULTS
OVERALL RESULTS *:
• Hospitalization Rate:
— 65% Reduction in Hospitalizations
• ER Visit Rate:
— 68% Reduction in ER Visits— 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
OPPORTUNITIESOPPORTUNITIESOPPORTUNITIESOPPORTUNITIES
PROVIDER OPPORTUNITIES
• HOSPITALS:
– Reduce Preventable 30 Day Readmissions for CMS Designated Diagnoses with Associated Penalties (CHF, AMI, Pneumonia, COPD, Hip & Knee Replacements)
• PHYSICIANS:
– Reimbursement for Medicare Care Management Fees� Chronic Care Management Fee (2015)� Medicare Transitional Care Management Fee� 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:
– Increases Staff Capacity, Lowers Cost Of Care– Increases Quality Outcomes– Reduces 30 Day Hospital Readmissions & ER Visits– Care Transitions to Home
Joseph F. Ebberwein
Longitudinal HealthLongitudinal Health
(888) 670-6787
www.LongitudinalHealth.com