Post on 12-Apr-2017
HIMSS 16 Connected Health Experience
Mark Bogart, Director Business Development
Mobile Telehealth = Population Health
Learning from Customers
• Founded 2003 by Bayer HealthCare
and Panasonic Corporation
• Since 2003, an authorized supplier to
the Veterans Health Administration
• Now part of NSD Co., Ltd.
A leading, publicly traded
international IT services organization
3,500 employees
Impacting healthcare globally
About Viterion®
Viterion V100
Not for active, real time patient monitoring
Viterion Vitacast 1000SM
Pioneering with VA Home Telehealth—
Learnings over 12+ Years
• Remote monitoring works for multiple conditions at scale—
Hypertension, diabetes, obesity, COPD, heart failure, depression
• Everyday vital signs monitoring + off-the-shelf monitoring devices + qualitative information capture
Customized health questions, patient education, reminders
• Coordinated care for large populations feasible
• Evolved into care management tool, risk stratification, EHR integration, analytics
• Achieved major VA health promotion-disease prevention goals —patient self-management, preventing decompensation
VA Home Telehealth: Improved
Outcomes, Saved Money
FY2014 (latest report)
Bed days 42%
Hospital admissions 34%
Patient satisfaction at 85%
Saved $1,999 per year, per patient (2013)
5 year program growth: 43,000 patients 2010 >>
156,000 2014
VA largest user of US telehealth—but a closed system
2009-12 Study (4,999 patients in HT)
HT users vs matched non-HT cohort
Annual healthcare costs 4%--vs 48%
Annual Medicare cost 45% less
~ 7% lower mortality
Admission reduction savings $8.7 million (est.)
Supported 28% of patients in VA goal of
independent living
VA Home Telehealth: Improved
Outcomes, Saved Money
Technology Advances—Just in Time for
Changing Healthcare Models
Monitoring now increasingly, patient-centric, portable—wireless
tablets, BT/USB peripherals. Challenge—making it cost-effective.
The rise of Accountable Care Organizations (ACO) and shared risk
Reimbursements based on quality metrics, total cost of care reductions for a
patient population
• 700-800 ACOs cover 24 million lives in commercial, Medicaid and
Medicare models (423 cover 7.8 million lives)
• HHS, CMS drive to alternative quality/value-based payment
models in Medicare FFS
30% of payments end of 2016, 50% by 2018
ACOs: A Good Fit for Telehealth
~ 40-50% of ACOs in the Medicare Shared Savings Program (MSSP)
are physician-owned, funded and led (CMS)
Lean management, faster and simpler decision cycle
Focus on meaningful and targeted changes in quality and cost
Coordinate patient care across multiple settings: primary, specialty, hospital, clinic
Most likely to adopt fresh approaches
CMS expanding ACO models with Next Generation, increasing
risk/reward levels
MSSPs encouraged to move to risk/reward model for FY 2017
Expanded Chronic Care Management (CCM) rule in Year 2 includes
telehealth in non-face-to-face care
ACOs: A Good Fit for Telehealth
Telehealth included by CMS in June ‘15 Final
Rule as part of health IT in care coordination.
Increased Congressional pressure to expand
Medicare reimbursement (CONNECT Act)
Only 20% of ACOs are using telehealth or
telemedicine (eHealth Institute/Premier)
What’s Important to ACOs
Improve Quality, Lower Costs—And Prove It
• Of 333 ACOs in 2014 MSSP program, only 92 (28%)
earned shared savings bonus
• Disproportionately physician-led (Healthcare Finance)
• Drivers: maintain quality care, avoid cost, achieve
population health metrics
Greatest savings leverage: highest utilizers/highest risk chronic disease patients• 5% of ‘SuperUsers’=50% of health spending (NIHCM)
• Over half of high utilizers of emergency rooms (Healthcare Benchmarks)
Keeping them at home, out of the hospital/ER
Need resources which can deliver this leverage
MSSP—Calculating Minimum Savings Rate
CAPG, 7/15
Viterion’s Programs—Physician-Led ACOs
• Comparative 90-day experimental study design (pilot) Experimental group: Remote Telehealth Monitoring. N=60
Control group: coordinated care without telehealth. N=60
• No charge to ACO
• Theoretical framework: TElehealth in CHronic Disease
(TECH) and parameters for success Engagement of patients and health professionals
Effective chronic disease management, including subcomponents of self-
management, optimization of treatment, care coordination
Partnership between providers
Patient, social and health system context
Viterion Programs—Patient Criteria
Inclusion criteria Evaluated as high risk with chronic
disease(s)
Diabetes, hypertension, congestive heart
failure (CHF) or COPD
Multiple chronic conditions and medications
“Frequent Fliers” : multiple hospital
admissions and/or ER evaluations
Elderly who live at home or have travel difficulty
Age 50-90
>$50,000 annual expenditures
High risk patients
Consent to participate and to share Medicare
claims data
Exclusion criteria End-stage disease (e.g. ESRD)
Undergoing current cancer treatment
Current substance abuse
Psychological or neurological conditions which
would prevent effective use of monitoring
Unable to legally consent to participation
Viterion’s Programs—Physician-Led ACOs
1. ACO with ~300 physicians, 50K Medicare lives
Rural Southern state, relatively new ACO (approved by CMS 2014)
Phase 1 August 2015
Moving to phase 2 starting mid-2016
2. ACO with ~400 physicians, 25K Medicare lives
Suburban/rural Southwest state, early CMS ACO (2012)
Joint venture with local medical center
Starting mid-2016
Preliminary Key Findings
Coordination with and within practices vital
Recruiting patients who fit profile is complex
Appointment setting and follow up procedure setting
Daily monitoring and reporting; PHI sharing
Buy in from practices
Patient consent
Adjust plan to care coordination model
Adding required support
Viterion clinical nurse as liaison with physicians, patients
Data integration, analytics support required for benchmarking—utilization analysis
Preliminary Key Findings
Patients—Phase 1
Wide age range—average 65, youngest 37 and oldest 91
Urban, suburban and rural
Many isolated—home environment and support issues (social context)
More co-morbid with 2+ disease conditions
All were hypertensive
Asthma, CHF, COPD, chronic renal failure (on dialysis)
HIV
Behavioral health: depression, schizophrenia
Preliminary Key FindingsPatients—Phase 1
“I hope [the practice] decides to continue this program. I feel so much
better knowing someone is looking at me and watching out for me.”
“You have really helped me. I wasn’t sure what I was going to do when I
found out my food stamps were being cut. Thank you for taking time with
me.”
Positive feelings on remote monitoring—appreciative of extra care
Patient relief on being looked at every day—monitoring alleviates anxiety
about their health
Human factors: positive clinician relationship, building a strong
connection adds to motivation
Social needs are a factor
Preliminary Key Findings
Patients—Phase 1
Success to date in
Demonstrating cost avoidance
Positively impacting ER visits
Positively impacting hospital visits
Improving patient satisfaction
Key Findings—Technology
Vitacast 1000 tablet--proprietary software is new
design, unique to market
Patients overall pleased with compact design,
wireless access, simple touch screen function
menu and features, twin USB-A ports
Mobile data connectivity can be a problem
in rural areas
Telephone connectivity being evaluated
Key Findings—Technology
Peripheral—connectivity and vital sign entry
Bluetooth devices generally reliable in sending accurate data
Manual entry or USB cable connection
Patients need personalized information
Easy-to-follow leave-behinds at installation
In-person coaching on use
• Clinical staff relationships and understanding
How technology fits into care coordination
In-person program explanations, documents, patient FAQs for discussion
and ‘go-to’ person contacts
Improve
The Care Experience
Affordability
Population Health
See us at # 15206