r. malin business models and economic issues of telehealth experiences of yorkshire
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Business Models and Economic Issues of
telehealth: Experiences of Yorkshire
Rebecca Malin
Head of Business Development and Investment
Airedale NHS Foundation Trust
The Local Context Airedale’s catchment area:
2012-13 = 3 Commissioners
2013-14 = 7 Commissioners
The bigger picture …
scale of financial
challenge
growing demand
unmet need
inappropriate
utilisation
stretched capacity
+ traditional
hospital dominated
medical model
designed
by default
=
… a system
designed by default
and more
out there…
so less in here
Our focus,
the patient experience
But how to change?
Introducing telehealth
• tele care
• tele coaching
• tele monitoring
teleconsultation
Airedale Teleconsultation • Prison health care
7 year programme
Live in 20 prisons
Up to 50% change in patient flow
>2200 consultations past 2 yrs
• Care in the community
• Care at home
• Stroke patients
• Occupational health
• Supporting end of life patients
• Nursing and Residential care homes
care in the community
nursing and residential care homes
Emerging evidence
)
Results:24 hr tele consults
to 25 COPD patients at home
Bed Days used
0
50
100
150
200
250
300
Year pre post Year pre post
-29.5%
-36.5%
Nursing and Residential
Care Home Results
(Hull University) 47% reduction in ED attendances for homes with Teleconsultation vs. 27%
45% reduction in hospital admissions for homes with Teleconsultation vs. 33%
Based on 13 Nursing and Residential
Care Homes
April –
September
2011*
April –
September
2012*
Difference
ED attendances (mean per home, per month) – care homes with
telemedicine in 2012 (n=13) 2.56 1.37 -47%
ED attendances (mean per home, per month) – care homes without
telemedicine in 2012 (n=67) 1.31 0.95 -27%
Hospital admissions via ED (mean per home, per month) – care
homes with telemedicine in 2012 (n=13) 1.44 0.79 -45%
Hospital admissions via ED (mean per home, per month) – care
homes without telemedicine in 2012 (n=67) 0.71 0.47 -33%
*Figures are rounded to two decimal points; percentage difference is calculated using unrounded figures.
Business Models
)
Which business
model?
To consider…
•Who is commissioning?
•Where is the pressure coming
from?
•Provide own clinical service
(how)?
•Own hub (how)?
•Technical infrastructure?
•Experience?
•Commissioners on board?
Models available
1. Full Telehealth Hub service?
2. Call triage only?
3. Use of technical infrastructure
only?
4. Training and consultancy
only?
5. Hub of Hubs?
Each model has different benefits
and cost savings
Region A
Nursing Homes 53
Patients Involved 1,105
Associated Admissions 2,928
Associated Bed days 29,199
> 25 Admissions per year
Data modelling
overview
Region B
Nursing Homes 116
Patients Involved 1,750
Associated Admissions 2,505
Associated Bed days 27,901
> 9 Admissions per year
Data modelling Region A
Total impact on costs (292,400) 995,348 702,948
Net impact associated with 53 Nursing Homes 1,050,571 565,177 1,615,748
PCT
Service
Provider
Net Impact to
health
Economy
Income Emergency Admissions 30% rate 156,480 (156,480) 0
Changes 70% left 365,120 365,120
Other Income saved ( OPD & A&E ) 15,458 (15,458) 0
Income impact 537,058 (171,938) 365,120
Costs Investment in telemedicine (225,080) (225,080)
Trust Cost savings 922,162 922,162
Total impact on costs (225,080) 922,162 697,082
Net impact associated with 53 Nursing Homes 311,978 750,224 1,062,202
20% reduction in short stay admissions (0-5 days) from nursing homes
50% reduction in short stay admissions (0-5 days) from nursing homes
Data modelling Region B
20% reduction in short stay admissions (0-5 days) from nursing homes PCT Service
Provider
Net Impact to
Health
Economy
Income Emergency admissions (above threshold) 30% rate 133,382 (133,382) 0
Changes Emergency admissions (below threshold) 70% left 311,224 0 311,224
Other income saved (Outpatients and A&E) 10,986 (10,986) 0
Impact on Income 455,592 (144,368) 311,224
Costs PCT investment in telemedicine (425,360) (425,360)
Service providers cost savings 421,704 421,704
Impact on Costs (425,360) 421,704 (3,656)
Net impact associated with 116 Nursing Homes 30,232 277,336 307,568
50% reduction in short stay admissions (0-5 days) from nursing homes
Total Impact on Costs (472,640) 462,647 (9,993)
Net impact associated with 116 Nursing Homes 666,050 102,019 768,069
What are the
challenges?
tariff
the importance of scale
evidence base
culture change
scheduling
collaborative working
(community teams, GPs)
technical
call to action
“…we need to have the courage to make changes and be less risk averse,
we need to take a longer term view on investments, and we need to ensure staff are
supported to introduce new ideas and technologies…”
Business Models and Economic Issues of
telehealth: Experiences of Yorkshire
Thank you