REMOTE PATIENT MONITORINGROI: The Business Case

Georgia Partnership for Telehealth

6th Annual Spring Conference

March 2015

Joseph Ebberwein

Longitudinal 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)

— Insurer (Payer) Initiatives

• Self-Insured Employers

• Other Emerging Models:

— Shared Risk

— Shared Savings

— Capitated/Episodic Payment

IN HOME TECHNOLOGIES

• BODYo Vital Sign Monitors

o Activity Monitors

o Sleep Monitors

o Mobile PERS with GPS

o Medication Adherence Monitors

o Medication Dispensers

o Urine Analyzer

• HOMEo Fall Detection

o Video Monitoring

o Environment Sensors

o Passive Monitoring Sensors

• COMMUNITYo Social Network

o Social Communication

o Physical & Cognitive Gaming

o Social Networking

o Gaming Technologies

• CAREGIVINGo 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

— SN Intervention Calls

• Bi-directional Video Visits (MD,

RN & Patient)

• ADL Monitoring

• Medication Adherence/Reminders

• 24/7 RN Triage

VIRTUAL CARE TEAM:

• Nurse Care Coordinators

• Triage Nurses

• Specialty Nurses

— Cardiology

— Endocrinology/Nephrology

— Neurology

— Oncology

— Pulmonology

— Geriatric

— Wound/Ostomy

• Pharmacists

• Health Coaches

• Behavioral Specialists

• Dieticians

THE 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 Penalties

Future: Bundled Reimbursement

HOME HEALTH AGENCIES:

Current: Increase in Staff Capacity (Caseload)

Reduction in SN Visits/Episode

Future: Bundled Reimbursement

Penalties for Readmissions

SKILLED NURSING FACILITY:

Current: Reduction in Wound Care Costs

Future: 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

– 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:

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

Source: Advanced Telehealth Solutions

Reduced Hospitalizations for Multiple Co-morbidities

Telehealth Intervention:

• Post Hospital Discharge Program

• Polychronic Disease Patients

• 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

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

OPPORTUNITIES

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 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 Health

Joseph.Ebberwein@LongitudinalHealth.com

(888) 670-6787

www.LongitudinalHealth.com