Telehealth s Role in a Medical Home Model. Learning Objectives 4/9/2012

Transcription

1 Telehealth s Role in a Medical Home Model Susan Makela, BSN, MPA Director Upper Peninsula Telehealth Network Marquette General Health System Learning Objectives Identify the role telehealth plays in the Medical Home model. Stimulate thoughts on using telehealth technologies in healthcare going forward. 1

2 Development early 90 s Early grant success (State & Federal) Deployment by 1995 Between launched 27 locations with 128 systems. Across the UP: 110 different rural clinics Average 2.4 providers for each clinic Terms Telehealth: the use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health related education, public health and health administration (HHS) Telemedicine: is the use of two way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications l equipment that includes, l at a minimum, audio and video equipment. Distant or Hub site: site a which the physician or other licensed practitioner delivering the service is located at the time the service is provided. Originating or Spoke site: location of the patient at the time the service being furnished occurs. Asynchronous or Store & Forward transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forward) via telecommunication to another site for consultation. (Medicaid) mhealth: the practice of medical and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDA s, for health services and information Telemedicine Programs: Delivery System Hub to Spoke Specialty Services UPTN University of Arizona Home Health Services Columbia project; Outreach Home Health in Texas Hospice Services Hospice of Michigan, Prince Edward Island School based University of Kansas, Eastern Carolina University 2

3 Telemedicine Activity IATV programs - N. America # of programs Year Source: Telemedicine Today Telemedicine Why failed: Lack of sustaining financial support. Complex tl telecommunications ti solutions. Lack of technological standards. Technology focus Why resurfaced: Political climate Economic constraints Technological advancements. Funding opportunities Why do we need telemedicine? Many reasons including Rising healthcare costs Shortage of healthcare professionals, including lack of specialists and facilities in rural areas Greater incidence of chronic conditions which require regular monitoring (e.g., diabetes) Increase in population (October 31, 2011 marked the birth of the 7 billionth person!) Need for efficient care of the elderly, homebound, and physically challenged patients 3

4 U.S. Healthcare Issues Fragmentation Accessibility Affordability Transition from supply driven demand, volume rewarded, reactive, fuller hospital fragmented care methods to Value rewarded, proactive, community need driven delivery with emptier Hospitals Reform no matter how you slice it Two things go up: (1) Quality (2) Patient Satisfaction One thing will go down: (1) Reimbursement Patient Centered Medical Home Primary care physician patient relationship in which Dr. is responsible for coordinating and managing the care a patient receives in multiple settings across the continuum of care. Patient in turn, accepts greater responsibility for managing their condition with support of their healthcare team. 4

5 PCMH BCBSM Domains of Function: Telehealth 10.0 Patient Self Management Support 4.0 Individual Care Management Patient Primary Care Physician (continuum of care) 9.0 Preventative Service 5.0 Extended Access 4.0 Individual Care Management 4.2 Integrated multi disciplinary providers At least 3 Non physicians: RN, CDE, nutritionist (RD), RT, PharmD, MSW, NP, PA Practice unit teams hold regular meetings Travel teams If not employees of PCMH practice ongoing relationship with and communication with the practice team members 4.9 Group visit option 5.0 Extended Access Pts. have 24 hour access to a clinical decisionmaker by phone, and clinical decision maker has a feedback loop within 24 hours or next business day to the patient s PCMH. Telehealth and EMR hand and hand 5.9 Interpreter services 5

6 9.0 Preventative Service Primary inhibiting the development of disease before it occurs. Secondary screening, measures that detect disease before itissymptomatic is symptomatic. Tertiary already affected by disease and attempt to reduce resultant disability and restore functionality Self Management Support Motivational interviewing Health literacy/barriers Use of teach back techniques Support patients as they work towards goals Medical Home model is the Base for Accountable Care Organization (ACO) Healthcare providers take greater responsibility for reducing healthcare costs for a given population of patients, while maintain or improving quality of care 1

7 Quality + Service/Cost New reform discussion are: Moving the health care sector toward rewarding for VALUE (defined as QUALITY+SERVICE/COST), not volume. There may be a unique opportunity to influence health hcare reform and develop reimbursement policy that is more valuebased, more conducive to reducing unwarranted variations, and strives for greater accountability Telehealth Technology Solutions Home Monitoring Pulse Oximeter Peak Flow meters Blood glucose 2

8 Key Points Equipment: Know how you want to use (fit the equipment to the need not the other way around. Review options of equipment, ask questions (what do you mean by xxxx, who determined this, what measurement did you use, etc.) Process: Champions Incorporate into RWDB Reimbursement (billing/coding) Credentialing Scheduling Infrastructure: Internet connections Bandwidth There is HELP (TRC) Resources h l h g Telemedicine Outcome Studies informationtechnology/uk study telehealth interventions can slash mortality ratesby nearly half.html mes%20research.pdf /02/ _derm_research.html Archives of Internal Medicine (2011) Volume: 171, Issue:6, Pages Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes. 1

9 Phase 1 Education to practitioners on the concepts of Medical Home. Regional CME distance education offering via telehealth. Started October Recorded and archived on demand. Leadership Summit: Board of Trustees, Executives, Medical Directors/CMO from across the region convened in Marquette in March to discuss collaborative strategies for the future of healthcare in our region Meaningful use ACO PCMH Champions Chief Medical Officer and our Chief Operating Officer work very close together to assure an understanding in our region of the challenges and opportunities we face as a region. Willingness to collaborate and continuously communicate the vision President and CEO of MGHS and our VP Government Relations constantly keeping the pulse on issues impacting our region. Phase 2 Implementing Telehealth into office practices Evaluate practitioner willingness to participate in PCMH Evaluate Healthcare organizations willingness to provide multi specialties to the patients with central management by PCP Evaluate telehealth equipment needs to accomplish 2

10 Questions? 3