CHANGE MANAGEMENT –ROOM 103“ENHANCING ACCESS TO HIGH QUALITY CARE BEYOND TRADITIONAL BRICKSAND MORTAR.”

Natasa Sokolovich, JD, MSHCPM, Executive Director Telehealth, UPMC

Donald Kosiak, MD, MBA, FACEP, CPE, Chief Medical Officer, Leidos

Moderator: Jonas Ekstrom, MD, Specialist in Internal Medicine, Sweden

Twitter: TelehealthNow@Sokolovichn

Describe the current healthcare challenges & opportunity to transform the healthcare experience through a collaborative care approach

3

Define Change Management & what it entails2

Introductions1

Agenda:

Share examples across two leading healthcare organizations

who have embraced healthcare transformation

4

University of Pittsburgh Medical

Center (UPMC):• Located in Pittsburgh, Pennsylvania

• Largest employer in Pennsylvania --60,000 employees

• $12 Billion Organization• 22 Hospitals with 17 post-acute care facilities

• 3500 Employed & 5500 Affiliated Physicians

• 500 clinical locations in W. Pennsylvania

• 265,000 inpatient admissions and observations annually

• 189,000 surgeries annually

• 3.9 million outpatient visits annually

• 690,000 emergency visits annually

• 2.5 Million Covered Lives through UPMC Health Plan

Leidos

• A science and technology solutions leader

• Working to address some of the world’s toughest challenges in national security, health, and engineering

• $5.06 billion annual revenue with 19,000 employees

• Vital missions for government and commercial sectors around the globe

Wikipedia Defines “Change Management” as:

Change management is a structured approach to

transitioning individuals, teams, and organizations

from a current state to a desired future state. The

current definition includes both organizational and

individual change management models, which

together are used to manage the people side of

change.

Or more simply put…

The coordination of a structured period of

transition from situation A to situation B in

order to achieve lasting change within an

organization.

BNET Business Dictionary

Ingredients for successful Change Management:

(skill * will) + sufficient time + a rigorous process =

change management success

Paradox: Change requires continuity and consistency.Britnell, Mark- “Transforming Health Care Takes Continuity and Consistency”, Harvard Business

Review, DECEMBER 28, 2015

DoctorsNurses

A globally shared set of healthcare goals:

• Move to value-based care

– Improve outcomes

– Reduce costs

– Increase patient satisfaction

• Hospitals into health systems

– Focus on illness prevention rather than treatment

• Implement technology

– Increases efficiency

– Empowers patients

DenmarkPittsburgh

What needs to change?

Integrated health data from multiple sources to support smart clinical workflows and empowering real-time decision support with the goal of engaging patients in achieving health

and wellness

Disparate health portals with static,

non-customized information that is

based on clinician supplied data

Providers Patients

Individuals using devices and wearables with data

uniquely stored on apps, tablets, and phones

FUTURE

Collaboration

patient needs and preferences

The untapped opportunity of a collaborative care approach:

care planning

X

behaviorspsychosocial

medical

educationSMS

reminders apps

wearables

tablet

web interface

EHR

e-visits

communityconnection

Improved health and outcomes

Reduced costs

Engaged patients

1

2

3

communication among providers

Collaborative Care

Approach

Price Transparency

The right data

Smart workflows

Empower Patients

Integrate technology

A collaborative care approach:

• Integrate technology- telehealth

• The right data at the right time

• Smart workflows

• Empower patients

• Price transparency

Potential Healthcare Savings Impact of Digital Healthcare Revolution:

13

• Routine

• Low Acuity virtual visits

• Specialty Care-Psych, Endocrine, Neurology

Telehealth

• Heart Disease-CHF

• COPD- Asthma

• DiabetesRemote Patient

Monitoring

• Lifestyle- Wellness Improvement

• Obesity

• Smoking Cessation

• Stress Management

Behavior Modification

$100B+

$200B+

Undefined-Significant

Financial Impact

Source: Goldman Sachs Global Investment Research

Anticipated Savings Opportunity

Factors involved in maximizing healthcare transformation:

Collaborative consumer-focused health care

Reimbursement Security Interoperability AdoptionComplexity

Where does change begin?

Where are payment the incentives?

What are the areas that can

drive immediate value/results?

Who is central to implementing the

change?

What is a reasonable timeline

to deliver measureable outcomes?

Identify the short and long-term areas of greatest opportunity

CMS shift towards outcome-based rewards and penalties

Payments Tied to Risk Models

“Providers should compare ACO earnings not with today’s fee-for service

environment, but with future earnings if not participating in such alternative

payment models.”—CMS

More Emphasis on Value

Payments Tied to Quality

Source: The Advisory Board Company

Source: Fischbeck, Paul. "US-Europe Comparisons of Health Risk for

Specific Gender-Age Groups.” Carnegie Mellon University: September 2009

Healthcare Reimbursement Shift

17

Fee for ServiceACOs, Medical Homes, Bundled

Payments

Pay for Performance

Telemedicine/

Telehealth Programs:

Clinical Specialty Services: Billable Contracted

Acute-ED Services Tele-Emergency

Tele-Stroke

Tele-Burn

X X

In-Patient Tele Specialty

Services Tele-ICU Care

Tele-Pharmacy

Tele-Infectious Disease

Tele-Neurology

Tele-PM&R

Tele-MFM

X X

Outpatient-consults Extensive Specialist Services Rural Locations

Behavioral Health Services Psychiatric Consults X X

Tele-Remote Monitoring Congestive Heart Failure

Chronic Obstructive Pulmonary

Disease

Palliative Care

Payer _

Employer- On-site Clinics Virtual Primary Care visits Employee Benefit _

Direct to Consumer On-Demand, virtual visits Retail Payment Model

Value proposition

18

UPMC’s Telehealth Evolution:

19

• Expanded On-line

eDermatology visits

• On-line Chronic Care

Visits

• Remote Monitoring

• Teleconsult Center

expansion

• Integrate on-demand

Specialty visits

through PCP practices

• Tele-Stroke

• Tele-Psych

•UPMC

AnywhereCare

On-line Virtual Visits

• In-patient & Out-

patient Specialty

Services Expansion

• Tele-Maternal Fetal

Medicine

• Surgical

Oncology/Breast

Visits

• Infectious Disease

• Pre & Post

operative

visits

• Transplant

Behavioral &

Nutrition

Counseling

2016-2017

2014-2015

2013

• Pediatric

Specailty

• Inpatient

Dermatology

• Pre & Post

Operative

Visits

2012

• Teleconsult

Centers

• Health Plan-

Employer On-

site Care

• Physical

Medicine &

Rehabilitation

2006-2008

2011

UPMC’s Telehealth Program

20

6,575

9,706

11,767

15,816 16,900

8,450

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

FY12 FY13 FY14 FY15 FY16

FY16 Budget

Stroke

Burn

Cardiology

Adult Acute Specialty Services

21

2016 UPMC TeleStroke Locations:

UPMC Hospitals: Community Hospitals: Passavant St. Margaret McKeesport Northwest Horizon –

Greenville Horizon –

Shenango Bedford Cranberry Magee Mercy East

Armstrong County

Memorial Hospital

Mon Valley Meritus - MD Washington Hospital Jameson Heritage Valley – Beaver

Uniontown

Excela- Westmoreland

Hospital

Excela- Latrobe Hospital

Excela- Frick Hospital

Dermatology Preoperativ

e Evaluation

Center

Transplant – Behavior

Health

Transplant – Nutrition

Surgical Oncology

(Breast Consults)

Maternal Fetal

Medicine

Genetic Counseling

(Breast Oncology)

Mammograms

Psychiatry

22

UPMC Inpatient & Outpatient Telemedicine Services

Outpatient Services

Inpatient Services

UPMC Teleconsult Centers – Expanding Clinical Access through

New Models of Care Delivery

23

• Teleconsult Centers established across

three rural locations to expand virtual,

multi-specialty care to patients within

their communities

• Integrating new technologies to achieve

the goals of Triple Aim- “Expanding

patient access to high quality clinical care

at a lower cost”

• 3,013* TeleSpecialist visits completed

• High Patient Satisfaction- Average

Scores- 4.8 out of 5

• High Provider Satisfaction

* (3,013 visits completed through December 31, 2015)

Expanding Access to

High Quality Clinical Care

Enhancing the Patient Experience

UPMC Teleconsult

Centers

Reducing Costs

UPMC Teleconsult Centers- Overcoming Specialist shortages

through expansion of Clinical Services:

24

3,013 Completed

Patient Visits

4.8

0

1

2

3

4

5

All SpecialtiesOver

all

Su

rvey

Ou

tcom

es

…

Telemedicine Providers

Overall Patient Satisfaction

Survey Outcomes

Rating

Specialty Services

Cardiothoracic Surgery PEDS: GI

Cardiovascular-EP PEDS: Lipid Clinic

Cancer Genetic Counseling PEDS: Nutrition

Colorectal Surgery Plastics

Dermatology Pulmonary

Diabetes Management REI

Endocrine Surgery Reproductive Genetics

Foot and Ankle Surgery Rheumatology

Gynecologic Oncology Sleep Evaluations

IBD Thoracic Surgery

Infectious Disease Orthopedic Spine Surgery

Heart Failure Surgical Oncology: Breast

Evaluations

Maternal Fetal Medicine Urogynecology

MFM Diabetes Education Vascular Surgery

Neurology Voice Therapy

Neurosurgery Wound

PEDS: Allergy and Immunology

Total Trip Distance Cost of Travel Time Spent Traveling

603,412 miles $351,744.53 10,391 hours

Patient Savings & Time Avoidance

(June 2012 through December 2015)

25

Total Patient Savings (Miles, Dollars and Time): 3,013 Patients

Northwest, Bedford, and Hermitage

Teleconsult Centers

Teleconsult Center(s)- Ancillary Charges Summary (June 2012 through June 2015)

26

Teleconsult Center Economic Summary- Ancillary Charges

Locations: FY13 FY14 FY15 Total:

Northwest

Gross

Collections$32,720.13 $73,493.25 $107,596.75 $213,810.13

Facility Fees $2,950.00 $8,125.00 $19,325.00 $30,400.00

Bedford

Gross

Collections$16,400.75 $21,517.50 $18,045.88 $55,964.13

Facility Fees $425.00 $3,475.00 $7,175.00 $11,075.00

Hermitage

Gross

Collections$1,851.88 $20,336.13 $22,188.00

Facility Fees $775.00 $6,425.00 $7,200.00

Total Gross Collections: $49,120.88 $96,362.63 $145,378.76 $291,362.26

Expanding Specialty Care Services to rural America-

through Tele-Infectious Disease Coverage

27

* Volumes represented by Northwest inpatient consults

* Volumes represented by Northwest inpatient consults

14 6 6

11

7

10

9

15

21

29

41

17

36

32

14

31

40

33

24

37

43

30

34

23

29

0

5

10

15

20

25

30

35

40

45

50

No

v '1

3

Dec

Jan

'14

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

t

Oct

No

v

Dec

Jan

'15

Feb

Mar

Ap

r

May

Jun

e

July

Au

g

Sep

t

Oct

No

v

Dec

Tele-Infectious Disease Visit Volume by Month

TeleID Visits Completed Linear (TeleID Visits Completed)

13 1417

32

11

2317

1118 20 20

16 1622

18 2013 14

27

12

9

6

13

15

3

13

2013

8

21

21

1214

1015

0

5

10

15

20

25

30

35

40

45

50

Jul '

14

Au

g

Sep

t

Oct

No

v

Dec Jan

Feb

Mar

Ap

r

May Jun

Jul '

15

Au

g

Sep

Oct

No

v

Dec

VIS

ITS

New Follow Up

ID New vs. Follow Up Visit Totals

Inpatient Locations Outpatient Locations

UPMC Northwest UPMC Northwest Teleconsult CenterUPMC Bedford Teleconsult Center

Expanding Specialty Care Services to rural Patients-

through Telestroke Services

28

Increases Access to early tPA intervention when

Telestroke is offered across community Hospitals

Expanding Specialty Care Services to rural

Pennsylvania- through Teledermatology

29

Image is

captured and

sent to

Dermatologist

for Review

Over 1,150 Visits successfully completed, allowing earlier

detection of melanoma and access to Dermatologists

Completed Maternal Fetal Medicine Visits

(Date of Inception – December 31, 2015)

Northwest (Inception: 6/28/12) 710

Bedford (Inception: 2/28/13) 30

Hermitage (Inception: 3/11/14) 249

Altoona (Inception: 9/14/15) 24

Total Visits: 1,013

30

Telemedicine

4 %

Expanding Specialty Care Services- through Tele-Maternal Fetal

Medicine Visits

30 to

35%

Patient Satisfaction Ratings for Maternal Fetal Medicine

Average across all Teleconsult Centers 96.2%

In-person satisfaction rating 92.2%

Patient Who Would Have Forgone Care

Northwest 30%

Hermitage 35%

UPMC AnywhereCare & eDermatology

31

UPMC AnywhereCare Cumulative Visit Report 11/04/13 – 06/30/15

Total Visits

Submitted

Total Adult

Visits

Submitted

Total

Pediatric

Visits

Submitted

Clinically

Inappropriate

(NONEVISIT)

Total Visits

Completed

AnywhereCare Convenience

(24/7/365 On-Demand,

Virtual Visits )

7,464 7,415 49 1,366 6,093

AnywhereCare Continuity

(Established PCP eVisit)850 834 16 56 785

Total 8,314 8,249 65 1,011 6,878

UPMC AnywhereCare Visit Summary:

32

$86.64

savings/

episode

of care

Tele-SNF

Coordination

Employer-onSite

Enhancing Care

Remote Monitoring

Additional Opportunities:

33

• Reduce avoidable

Hospitalizations

• ED transfers

• Reduce Lost

work time

• Reduce Acute

Care Costs

• Decrease Acute

care costs

• Decrease

Readmissions

• Enhance

population health

Prioritize Opportunities

Maximize Value & Align

Incentives

Develop a solid infrastructure

Monitor and Evaluate

Outcomes

The Pathway to Success:

34

Step 1Step 2

Step 3 Step 4

Thank you!

35

www.upmc.com/Telemedicine

“When you have exhausted all possibilities, remember this - you haven't.” - Thomas Edison

Twitter: TelehealthNow@Sokolovichn

Virtual Healthcare

157 Sites

28 Sites 64 Sites105 Sites

34 Sites 4 Sites 9 Sites 2,000 + More than 900,000 SQ KM

10,500 Consults

Annually(Reimbursed equal to face to face)

Annual Patient

Savings:

$1,184,600 in travel

4,012,800 Miles

(16+ trips to the moon)

eICU CARE

24 hour monitoring of critically ill patients by an Intensivist and Critical Care Nurses

= Air Traffic Control

28 Hospitals49,000 (134 years) ICU days saved

ClinicianProvides around-the-clock, remote intensive

care monitoring of critically ill patients

Enabling Technology• Intelligent Monitoring• Continual Surveillance

• Smart Alerts

Meets Leapfrog requirements

• Immediate physician consultant

• Allows for additional coverage

Throughput

• Reduce LOS/Mortality

• Reduce ED wait for admit

• Triage support

• Staffing costs

Quality

• Ensures compliance

• APACHE

• Documentation support increases ICU CMI

24 Hour access to residency trained

hospital pharmacists

8 Years of providing services

140,000 Patients impacted

Order Entry & Review

Consultative Support

Clinical Decision Support

Regulatory Support

2,600,000 Orders Reviewed

32,000 Avoided Serious Safety Events

$68,250,000 Saved/Avoided

Interaction/ Review/

Clarification37%

Antithrombotic Therapy -

Anticoagulation

28%

Renal Dose Evaluation

27%

Kinetics Evaluation

7%

Pain Consult1%

Avoidance of Serious Safety Events

(Since Inception)

Physician Consultation

Transfer Support

Nursing Documentation

Support

Education

24 Hour access to board certified

Physicians and Critical Care Nurses

110 Partner Hospitals

7 Years of providing Services

33%18

Min36

Min

Aspirin Compliance Door to ECG Door to TPA

Door In –Door Out

Clinical Quality Impact – Cardiac

Right treatment, right transfer, right time

2X

Outcomes: Faster Care

15 Min

27Min

23 Min

Door to Doctor Door to CT 45 min TPA Eligible

Door In –Door Out

Clinical Quality Impact – Stroke

100%100%

4 Sites Live

1000+ Inmates Served

40% of Calls Result in

Avoided Transfer

$1,100,000+ in Transfer Savings

Cardiac/Chest Pain24%

Trauma/Laceration

19%

Abdominal/GI Complaint

17%

Skin Complaint12%

Neurological/ Syncope

8%

Joint/Limb Pain - 8%

Diabetic Reaction

2%Shortness of

Breath2%

Weakness/ Dizziness

2%

Behavioral Health Concern

2%

Other2%

Eye2%

Other8%

Encounters by Chief Complaint(Since Inception)

Urgent care for residents

35 Sites Live

55% of Video Calls Result in Avoided Transfer

Direct to Consumer

Seamless for the Patient

Our Differentiator

800,000+ patients touched

235 hospitals and clinics served

2,200 providers impacted

900,000 square kilometers covered

$170M in health care costs saved

Virtual Hospital

Collaboration

Efficiency

Innovation

Technology

Partners

Proven, Predictable, and Sustainable Results

donald.kosiak@leidos.com

www.averaecare.org

THANK YOU!Natasa Sokolovich, JD, MSHCPM, Executive Director Telehealth, UPMC

sokolovichn@upmc.edu

Donald Kosiak, MD, MBA, FACEP, CPE, Chief Medical Officer, Leidos

Donald.Kosiak@leidos.com

Follow on Twitter: TelehealthNow@Sokolovichn