northwellhealth and the house calls experiencehouse calls providers were remote and used telehealth...
TRANSCRIPT
Telehealth Innovation in the Era of COVID-19:
Northwell Health and the House Calls Experience
Karen Abrashkin, MDMedical Director, Northwell Health House Calls and Clinical Call Center
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July 21, 2020
Overview
1. Northwell Health Overview2. Northwell’s Telehealth COVID-19 Response3. Home-Based Primary Care4. Workflows and Tips5. Telehealth in Home-Based Primary Care Now and Next Steps
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Northwell’s Telehealth PlatformCare anywhere, any place, any time
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AmWell
AmWell Provider Additions by WeekAs of April 6th, 2020
5
553
5,393
413
2,093
1,210
883
189
3/2 - 3/6 3/9 - 3/13 3/30 - 4/ 33/16 - 3/20
935
3/23 - 3/27
52
4/6 - 4/11 Total
+875%
In Queue Complete
Northwell Health Daily Billed Telehealth Volume January 1 – April 28, 2020
6
0
500
1,000
1,500
2,000
2,500
3,000
3,500
3/29
/202
0
3/22
/202
0
3/15
/202
0
4/12
/202
0
4/19
/202
0
4/5/
2020
4/26
/202
0
TeleStroke Ambulatory TeleHEALTH
TelePsych
Hospital
Ambulatory TeleMED
House Calls Overview
Northwell Health House Calls is a value-driven, home-based primary care program that delivers care to homebound older adults in Manhattan, Queens, Nassau and Suffolk counties in downstate New York.
Our mission is to serve the highest need patients to achieve better care and health at a lower cost
Services provided include:• Intensive home-based primary care by
Interdisciplinary Care Team• Physicians, NPs, nurses, social workers, medical
coordinators• 7-days/24-hours response and real time alerts of ER
and hospital utilization• Longitudinal care through illness trajectory• Transitional care visits
Program Eligibility:• Homebound (Medicare criteria)• Medical necessity: multiple chronic medical
conditions in an advanced state• Generally over 65 years old
House Calls Patient Population
• Average Age: 86 years• Gender: 70% Female, 30% MaleDemographics
• 27% annually (death and discharge)Attrition
• 70% of patients who died, died at home Death at Home
• 2/3 of patients have 5 - 6 ADL dependencies
Activities of Daily Living (ADL)
• 2000 Unique Patients Annually Program Volume
High rates of:ü Hypertensionü Dementiaü Diabetesü CHFü COPD
Over 90% with completed advanced care planning discussionü 70% with DNR order
House Calls’ Clinical Delivery Model
Physician
Medical Coordinator
CareManager Physician
Medical Coordinator
CareManagerPhysician
Medical Coordinator
CareManager
Clinical Call Center
Community Paramedicine Program
Geography 1 Geography 2 Geography 3
24 /
7 / 3
65
Historically Difficult to Reach Group via Telehealth
Abrashkin KA, Patel V, Kozikowski A, Zhang M, Poku A, Pekmezaris R. Access to and Confidence in Using Technology Among Homebound Older Adults and Caregivers. J Am Med Dir Assoc. 2018 Nov;19(11):1023-1024. doi: 10.1016/j.jamda.2018.05.023. Epub 2018 Jul 10.
AIM = Advanced Illness Management, survey period 2014-2016
2018 Telehealth Pilot
Latus-Olaifa, O., Norman, G.J., Kurliand, M., Slaboda, J.C., Abrashkin, K.A., Smith, K.L., Pekmezaris, R. and Rhodes, K., 2019. Not Yet Ready for Prime Time: Video Visits in a Home-Based Primary Care Program. J Am GeriatrSoc. 2019.
Weaving Telehealth into Practice
• Video added to program in 2014• Urgent and Emergent evaluation 24/7/365 in home• Remained in effect during COVID-19 Community Paramedicine*
• Social workers à patients/caregivers• Results: Didn’t work as planned (“Not Yet Ready for Prime Time”)• Lesson learnedDirect-to-Patient (2018)
• Facilitated telehealth model• For acute symptoms not requiring a community paramedic
response• New version post-COVID anticipated
Mobile Telemedicine Technician (MTT) (2019)
• Telehealth experience allowed for ability to rapidly respond to changing world
• New iteration of direct-to-patient modelCOVID-19 response,
Direct-to-Patient (2020)
*Abrashkin KA, Washko JD, Li T, Berkowitz J, Poku A, Zhang J, Smith KL, Rhodes KV. Video or Telephone? A Natural Experiment on the Added Value of Video Communication in Community Paramedic Responses. Ann Emerg Med. 2020 Jun 10:S0196-0644(20)30293-6. doi: 10.1016/j.annemergmed.2020.04.026. Online ahead of print.
Facilitated Telehealth ModelMobile Telemedicine Technician Program
Two EMTs driving in private vehicles were scheduled one day a week (Monday) to complete 10 visits vs regular schedule of 5 home visitsü Facilitated telehealth model used to double daily visit capacity
EMTs were supplied withü Software-enabled tabletsü Mobile Wi-Fi capabilitiesü Tools for assessment of patient vitals and physical examinations
Physicians were located remotely in an office or at home
Physicians used clinical judgment to select patients appropriate for visits with an emphasis on ü Unscheduled evaluation and treatment of acute conditions such as:ü Follow-up after a care plan change
EMTs pulled back to EMS during COVID-19ü Restarting in August 2020
MTT Model: Expanding Provider Access
A Practical Guide to Expanding Home-Based Primary Care with Telehealth:https://www.westhealth.org/resource/a-practical-guide-to-expanding-home-based-primary-care-with-telehealth/
COVID-19: Telehealth in House Calls
House Calls located in the first US epicenter of the COVID-19 outbreak
Deployed Direct-to-Patient model in early March 2020 and shifted operational structure.
House Calls providers were remote and used telehealth to connect with patients to prevent the transmission of COVID-19. Providers only entered homes for emergency issues.
Able to consent over 500 patients (44%) in the practice for telehealth and conducted over 900 visits via telehealth from March to June 2020.
Having experience with telehealth in the practice allowed for rapid deployment
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Telehealth and Home-Based Primary Care Workflows: https://www.westhealth.org/covid-19-resource-center/
House Calls Telehealth EncountersN
umbe
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isits
References
1. Abrashkin KA, Patel V, Kozikowski A, Zhang M, Poku A, Pekmezaris R. Access to and Confidence in Using Technology Among Homebound Older Adults and Caregivers. J Am Med Dir Assoc. 2018 Nov;19(11):1023-1024. doi: 10.1016/j.jamda.2018.05.023. Epub 2018 Jul 10.
2. Latus-Olaifa, O., Norman, G.J., Kurliand, M., Slaboda, J.C., Abrashkin, K.A., Smith, K.L., Pekmezaris, R. and Rhodes, K., 2019. Not Yet Ready for Prime Time: Video Visits in a Home-Based Primary Care Program. J Am Geriatr Soc. 2019.
3. Abrashkin KA, Washko JD, Li T, Berkowitz J, Poku A, Zhang J, Smith KL, Rhodes KV. Video or Telephone? A Natural Experiment on the Added Value of Video Communication in Community Paramedic Responses. Ann Emerg Med. 2020 Jun 10:S0196-0644(20)30293-6. doi: 10.1016/j.annemergmed.2020.04.026. Online ahead of print.
4. A Practical Guide to Expanding Home-Based Primary Care with Telehealth: https://www.westhealth.org/resource/a-practical-guide-to-expanding-home-based-primary-care-with-telehealth/
5. Telehealth and Home-Based Primary Care Workflows: https://www.westhealth.org/covid-19-resource-center/
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