Mandy Bell
Health Care Without Boundaries
Reimagining What’s Possible
Healthcare Needs
Healthcare Gaps
Avera’s roots stretch back to the frontier
of medicine of the Benedictine and
Presentation Sisters; who were called to
provide health care in Dakota Territory in
1897. This tradition of caring continues today:
“Avera is a health ministry rooted in the
Gospel. Our mission is to make a positive
impact in the lives and health of persons and
communities by providing quality services
guided by Christian Values.”
Answering the Call
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Avera Health
CRITICAL ACCESS
33HOSPITALS
80%HOSPITALS
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Over 440 sites in 29 states
2+ million lives impacted
Serves 13 percent of all Critical Access Hospitals in the nation
Avera eCARE
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INTERNATIONALAND
NATIONAL
• San Antonio, TX• Fort Wayne, IN• Troy, MI• Israel• India• Kenya
WORKFORCE
250+eCARE
Employees
LOCAL IMPACT
eCARE averages
100 externalguests per
month
eCARE Hubs
1993
Consult
2004
ICU Care
2008
Pharmacy
2012
Senior Care
2012
Correctional Health
2015
School Health
2009
Emergency
2017
Hospitalist
2017
Specialty Clinic
2015
AveraNOW
2017
Behavioral Health
Avera eCARE Service Lines
Acute & Post Acute Services
Ambulatory Services
Offering the most diversified telemedicine service in the U.S.
HOSPITALS & HEALTH SYSTEMS
Acute Care –All Ages
NURSING HOMES & ASSISTED LIVINGS
Seniors
SCHOOLS Children
CLINICSSpecialty Care –
All Ages
CORRECTIONAL FACILITIESInmates
Current Partners
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Improve Access to Care
ImproveWorkforce
Sustainability
Improve Care & Outcomes
Lower Costs
Guiding Principles
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And more
Experience
ER Nurse
Crisis
Assessment
SANE
Exam
Support
Board
Certified
Emergency
Physician
Debriefing
Services
Stroke
Neurologist
Burn
Surgeon
Access: 24/7 Emergency Specialty Care
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25% increase in delivery contribution margin
24% Decrease in Stays of >2 days at 39 Weeks
19% Overall Reduction in C-Sections
Vaginal Deliveries without Complications Increased by 26.8% at 38 Weeks
Patients Saved a Total of 58,186 Miles of Driving
$500-$1,000 estimated savings to payers per patient
125 mother’s served
T O D A T E
Improving Care: Gestational Diabetes
2x Increase in Daily Census
25% Reduction in ER StaffingCosts
“Tele-ED helps us to keep those young physicians
here, where they still get to have a family life, time
away, and not be tied to their phones.”
Supporting the Rural Workforce
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81.5% of clinicians believe that eCARE Emergency has helped with recruitment and retention
Proven Results
$342 Estimated Medicare
Cost Savings PBPM
SNF/LTC Outcomes
Lower Costs
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Healthcare WithoutBoundaries
Clinic Triage
Outpatient
Employee Assistance
Mobile Crisis
Emergency Room
Inpatient
School Health
Long Term Care
Group Homes
Behavioral Health, Anywhere
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Senior Living
Our program connects individuals and staff to RNs & providers at the eCARE for 24/7 support & urgent care.
Support RNs and staff, reducing burnout and overtime
Increase confidence of resident and family, improving occupancy and length of stay
Decrease barriers to accessing care, improving resident experience
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91% of students who had an eCARE School
Health nurse video visit were able to stay in school instead of going home
• Nurse Extender Services
• Primary School Nurse Services
• Help managing chronic conditions (diabetes, asthma)
• Help with acute sickness or injury
• Case management for parent contacts regarding prescription refills, mental health needs and available resources
Services:
Benefits:
497 367
1497
2182
2015-16 2016-17 2017-18 2018-19
Video Encounters and # of Schools
79
17
28
Growth:
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▪ Online
▪ Mobile App
▪ Kiosks available in grocery stores
▪ Health Plan Benefit
▪ Colleges – Parent Pre-Pay
▪ High Schools
▪ Health coaching
▪ Coordinated care
▪ Specialty Pharmacy
▪ Respiratory Therapy (COPD)
▪ Gestational Diabetes
▪ Lactation Consulting
▪ Employee Assistance
Program (EAP)
▪ Physician LIGHT™ Program
▪ Cancer Navigation
Urgent Care
Campus Urgent Care
Health & Wellness
Women’s Health
Business Health
Cancer Care
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Health Care’s
Digital Disruption
Health Systems are Analog in a DIGITAL World
Millennials demanding Digital
• 71% want to use mobile app to book appointments
• 74% prefer to see doctor virtually
• 75% look at online reviews before selecting physician
• 42% have used synchronous video telemedicine
Health Systems using Analog• Only 17% have e-visits visits
widely available• Only 14% have video visits
widely available• Only 20% have implemented
online self scheduling• Only 47% have implemented
messaging between patient and providers
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15 Years Ago
10 Years Ago
Today
Rapid Change in Technology & Environment
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• How we interact
• How we shop
• How we watch TV
• How we read
• How we vacation
• How we work at home
• How we get around
Change in the last decadeChange in the Last Decade
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Expectations are Changing
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Large-scale Combination of Non-Acute Care and
Insurance
New Healthcare Platform, Products, and Experience
We are moving from a Hospital-Dominant Ecosystem to a Healthcare-Dominant Ecosystem
Health Care Innovations
Wearable technology combined with smartphone, tablet, or computer apps allow patients to monitor health data and transmit
them in real time to health professionals.
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Health Care Innovations
Smart homes outfitted with sensors to monitor sleep quality, medication use, falls, use of stove, toilet, and shower.
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AI in Healthcare – It’s Here
• Identifying DNA mutations in tumors
• Classifying Echocardiograms• Predicting Heart Attack & Stroke• Diagnosing Skin Cancer• Adjusting ICU Treatment• Detecting Breast Cancer Risk• Predicting Suicide Risk• Identifying End of Life for Referral
to Palliative Care
https://medicalfuturist.com/top-ai-algorithms-healthcare
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65 Enacted Telehealth Bills by 39 States in 2018
https://www.cchpca.org/sites/default/files/2018-12/2018%20Legislative%20Roundup%20FINAL.pdf?utm_source=Telehealth+Enthusiasts&utm_campaign=a85ee891fc-EMAIL_CAMPAIGN_2018_12_10_06_57&utm_medium=email&utm_term=0_ae00b0e89a-a85ee891fc-353229733 Copyright Avera eCARE 2019
Change is Hard
Inefficiencies and duplications
Technology costs and challenges
Reimbursement hurdles
Regulatory and security hurdles
Licensure and credentialing
Workflow and culture changes
Overcoming Barriers
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It’s been a long road…but maybe we’re at lift off?
$2.5
$28.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Medicare Claims for Telehealth$28.7M
500,000
2016 Medicare reimbursements under its Part B telehealth benefit
Billed services to Medicare alone in 2016
In Services billed over 2015
Of all Traditional Medicare Beneficiaries
33% Increase
https://www.healthcarelawtoday.com/2017/08/28/medicare-payments-for-telehealth-increased-28-in-2016-what-you-should-know/
2001: CBO Annual Estimate = $30 M
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0.25%
Developing the Structure of Avera eCAREBUSINESS MODEL
Relationships
Create collegiality culture among hub and site providers – become ‘part of the team’ and
make job easier
IT infrastructure
Build technology infrastructure to take virtualize care deliver
Workforce
Develop team of experienced providers
and support specialists & recruitment and
retention
Leadership Support
Investment in technology and innovation, demonstrate
national value and impact, diversify revenues, be
passionate about impact of access to affordable quality
care
FundingBuild vision for investors
to show value and develop strong grant
writers
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Bringing the Services to Life
Sales & Contracting
Staffing & Training
Clinical Workflows
Pricing / Funding
Regulatory Compliance Plan
Metrics & Reporting
Project Management
Change Management Technology
Data Collection
ProcessImproveme
nt
Communications
Accelerating Change
Ward M, Merchant AS, Carter KD, Zhu X, Ullrich F, Wittrock A, Bell A. “Use of Telemedicine For ED Physician Coverage In Critical Access Hospitals Increased After CMS Policy Clarification.” Health Affairs (Millwood). 2018, 12, 37. doi: 10.1377/hlthaff.2018.05103 https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05103
Mohr, N. M., Young, T., Harland, K. K., Skow, B., Wittrock, A., Bell, A., & Ward, M. M. (2018). Emergency Department Telemedicine Shortens Rural Time-to-Provider and Emergency Department Transfer Times. Telemed J E Health. doi: 10.1089/tmj.2017.0262 https://www.ncbi.nlm.nih.gov/pubmed/29293413
Natafgi N, Shane D, Ullrich F, MacKinney C, Bell A, Ward M. (2017). Using Tele-Emergency to Avoid Patient Transfers in Rural Emergency Departments: An Assessment of Costs and Benefits. Journal of Telemedicine and Telecare. March 7, 2017. https://doi.org/10.1177/1357633X17696585
Mohr N, Vakkalanka JP, Harland K, Bell A, Skow B, Shane D, Ward M. (2017). Telemedicine use decreases rural emergency department length-of-stay for transferred North Dakota trauma patients [in press]. Telemed Journal of e-Health.https://doi.org/10.1089/tmj.2017.0083
VanOeveren L, Donner J, Antegrossi A, Mohr NM, Brown CA. (2017). Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry (NEAR) Study. Telemed Journal of e-Health 2017 Apr;23(4):290-7. https://doi.org/10.1089/tmj.2016.0140
Mohr NM, Harland KK, Chrischilles EA, Bell A, Shane DM, Ward MM. (2016) Emergency Department Telemedicine is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study. Academy of Emergency Medicine, 2016. http://onlinelibrary.wiley.com/doi/10.1111/acem.13120/abstract
Mohr NM, Harland KK, Chrischilles E, Donner J, Bell A, Shane DM, Ward MM. (2016). Telemedicine penetration and consultation among rural trauma patients in critical access hospital emergency departments in North Dakota. RTRC Research & Policy Brief, 2016 (1):1-4. http://ruraltelehealth.org/briefs/RTRC-NDTelemedTrauma-Brief-2016-sept.pdf
Potter AJ, Ward MM, Natafgi N, Ullrich F, MacKinney AC, Bell AL, Mueller, KJ. (2016). Perceptions of Benefits of Telemedicine in Rural Communities. Perspectives in Health Information Management. Summer 2016. http://perspectives.ahima.org/perceptions-of-the-benefits-of-telemedicine-in-rural-communities/
Ward MM, Ullrich F, MacKinney AC, Bell AL, Shipp S, Mueller KJ. (2016). Tele-emergency utilization: In what clinical situations is tele-emergency activated? Journal of Telemedicine and Telecare. 2016 Jan;22(1):25-31. https://www.ncbi.nlm.nih.gov/pubmed/26026189
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Build the Evidence Base
SOURCES: Brown, C. A., Bair, A. E., Pallin, D. J., Walls, R. M., & NEAR, I. I. (2015). Techniques, success, and adverse events of emergency department adult intubations. Annals of Emergency Medicine, 65(4), 363-370.e1. doi: http://dx.doi.org/10.1016/j.annemergmed.2014.10.036
Mohr, N. M., Young, T., Harland, K. K., Skow, B., Wittrock, A., Bell, A., & Ward, // M. M. (2018). Emergency Department Telemedicine Shortens Rural Time-to-Provider and Emergency DepartmentTransfer Times. Telemed J E Health. doi: 10.1089/tmj.2017.0262 https://www.ncbi.nlm.nih.gov/pubmed/29293413
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Set the New Standard
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Prepare the Next Generation
A Word of Caution
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After all, Technology Solves Little Alone
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Netflix didn’t kill Blockbuster.Ridiculous late fees did.
Uber didn’t kill the taxi business.Limited access and fare control did.
Apple didn’t kill the music industry.Being forced to buy full-length albums did.
Amazon didn’t kill other retailers.Poor customer service and experience did.
Who’s your customer?Where can you disrupt?
Technology by itself is not the disrupter, not being Customer-Centric is the biggest threat to any business
Digital Disruption Has Already Happened
How we interact
How we shop
How we watch TV
How we read
How we vacation
How we work at home
How we get around
Change in the last decadeChange in the Last Decade
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Mandy Bell | [email protected]
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