Mercy Health System

Tele-Medicine

2012

UTILIZATION3,937 staffed beds574,666 ED visits (FY11)

6,566,057 outpatient visits (FY11)

160,382 inpatient discharges (FY11)

2

HOSPITALS25 acute care hospitals6 managed hospitals3 heart hospitals2 children's hospitals1 rehab hospital

AMBULATORY SERVICES233 clinic locations27 urgent care centers7 outpatient surgery centers4 retail clinics

MEDICAL STAFF & CO-WORKERS37,000 co-workers1,580 integrated physicians5,369 active medical staff (includes integrated and non-integrated physicians: OHH)

619 advanced practitioners

Hospital

Managed Hospital

Ambulatory Facility

Urgent Care

LEGENDMISSOURI STATS:>1.5 million people served1,071 integrated physicians413 primary care physicians9 acute care hospitals134 clinic locations

MISSOURI STATS:>1.5 million people served1,071 integrated physicians413 primary care physicians9 acute care hospitals134 clinic locations

What are we solving fora new model of care

• Access to Care– Primary Care– Specialty Care

• Provider Shortages– PCP and Specialty

• Cost pressures– Hospital will be a cost center and not a revenue

center• Patient Centeredness

– High service model

Tele – MedicineTele – MedicineVirtual CareVirtual Care

Care Model Care Model DeliveryDelivery

Population ManagementPopulation Management Center for InnovationCenter for Innovation

Medical DirectorOperations Director

Clinical Ops VPOperations Director

Medical DirectorOperations Director

Mercy’s Center for Tele Health and InnovationVirtual Care Center

Chief Innovation Officer

Centralized Centralized HUB ModelHUB Model

Decentralized Decentralized ConsultConsult

Store and Store and ForwardForward

CollaborationCollaboration

Chronic Care Chronic Care ManagementManagement

SchedulingSchedulingCall CenterCall Center

Nurse on Call Nurse on Call CenterCenter

Scheduling & Scheduling & referral referral

managementmanagement

Care Care CoordinationCoordination

Post Acute Post Acute CareCare

Care Care Delivery Delivery

InnovationInnovation

ResearchResearch

GrantsGrants

AnalyticsAnalytics

Epic Epic InformaticistInformaticist

Resources have a central feel andcentral supervision

Resources are distributed althoughScheduling and supervision are central

Resources may be either central or distributed

encounter is asynchronous and my involve images

and or consultation

Resources are distributed and are outside of Mercy

encounter is asynchronous and my

involve imagesand or consultation

E-VisitsE-Visits24/724/7

AsynchronousAsynchronous CareCare

Home HealthHome HealthSupportSupport EHR supportEHR support

Tele-Medicine Division

Tele – MedicineTele – MedicineVirtual CareVirtual Care

Centralized Centralized HUB ModelHUB Model

Decentralized Decentralized ConsultConsult

Store and Store and ForwardForwardAsynchronousAsynchronous

e-ICUe-LTAC

Tele-Sepsis

e-Hospital

Telemedicine core Telemedicine core infrastructureinfrastructure

Distributed SchedulingCredentialing/Licensing

HRFinance

Reimbursement managementAnalytics (CIC?)Epic expertise

Account ManagementCustomer relations/Call center

e-after care

Specialist/patientSpecialist/physician

15 SpecialtiesVideo Remote Interpretation

Selected as spine destinationTele-Stroke network

Imaging from Critical Access FacilitiesPediatric Cardiac Echo’s and EEG’s

RadiologyPathology

Dermatology

24-7e-visit support

Store + Forward patient visits

home monitoring

Medical Director Medical Director OfOf

Critical Care ServicesCritical Care Services& special projects& special projects

Connector

6

Inpatient hospital utilization management– Avoiding medically unnecessary admissions– Avoiding medically unnecessary discharge delays– Aligned hospitalist programs Outpatient utilization management Case and chronic condition (disease) management Primary care population management– Primary care e-visits– Specialist e-consults– Urgent care centers– Aligned provider incentive programs Mature PCP-driven group practice– Extended office hours– Incorporation of advanced practice RNs and/or PAs

into primary care “teams”– 24 hour on-call access for patients

Inpatient hospital utilization management– Avoiding medically unnecessary admissions– Avoiding medically unnecessary discharge delays– Aligned hospitalist programs Outpatient utilization management Case and chronic condition (disease) management Primary care population management– Primary care e-visits– Specialist e-consults– Urgent care centers– Aligned provider incentive programs Mature PCP-driven group practice– Extended office hours– Incorporation of advanced practice RNs and/or PAs

into primary care “teams”– 24 hour on-call access for patients

Mercy’s ACO Readiness:Mercy’s ACO Readiness:

Components of Milliman’s study on accountable care organization (ACO) models

Components of Milliman’s study on accountable care organization (ACO) models

Impact onMedicare – 8.25%Commercial – 9.61%

e-ICUe-ICU School School ClinicsClinics

Work site Work site clinicsclinics

After Care After Care ModelsModels e-Hospitalse-Hospitals Tele-Tele-

specialtyspecialtyMedical Medical HomeHome e-Hospitalse-Hospitals CommunityCommunity

clinicsclinicsAnalytics

EHR EHR supportsupport

Convenient Convenient carecare

Predictive Predictive ModelingModeling E-visit 24/7E-visit 24/7 Store & Store &

ForwardForwardConcierge’s Concierge’s

ServiceServiceNurse on Nurse on

CallCallTele-Home Tele-Home

HealthHealthHome Home

MonitoringMonitoringPalliative Palliative

CareCare

Virtual Care Services

AccessAccess

VolumeVolumeMarket shareMarket share

Care Care CoordinationCoordination

< 10%< 10% Shared Savings/Risk ContractsShared Savings/Risk Contracts >50%>50%

e-SNF

e-LTACHe-LTACH

Tele-medPrimary

Care

Community Community KiosksKiosks

Navigator Navigator ServicesServices

PHRPHR

VRIVRI

EHR Optimization

Family Family SupportSupport

Remote Remote RoundingRounding

Tele Tele Surgical f/uSurgical f/u

e-NICUe-NICU

ACO contractsMedicare Advantage – 30,000 lives

CMS – ACO – 250,000 lives

Traditional FFS contracts

Tele - SepsisTele - Sepsis Video Remote Video Remote InterpretationInterpretation

E-ICU & Tele-E-ICU & Tele-strokestroke

E-ICU + tele-stroke

• ICU mortality rates 20% below predicted• 30% reduction in ICU length of stay• 50% decrease in Central Line Blood Stream

Infections• >95% compliance with VAP bundle protocols

and corresponding significant decline in VAP cases

• Tele-stroke – trebled the appropriate use of tPa in Arkansas ER setting

Sepsis

• Mortality decrease with people in severe sepsis and septic shock of 50% and 60% respectively

• Compliance with sepsis bundles increased by 30-40%

• ICU LOS – decreased from 8.16 days to 3.43 days

• Over 9 months of the program – 100 lives were saved.

Video Remote InterpretationVRI

• In 2007, over 55 million Americans spoke a language other than English at home

• Represents nearly 20% of the population

• Increased from 14% of the US population in 1990 and 11% in 1980

•Less likely to have a “usual” source of medical care

•They receive preventive services at reduced rates

•They have an increased risk of non adherence to medication

•Children with asthma have an increased of intubation

•Higher rates of hospitalizations and medication complications

•Greater resources are used in their care and they have lower levels of patient satisfaction

Mercy Health System

Tele-Medicine

2012