Better Care. Lower Costs. Impacts and Outcomes of Telehealth in Alaska

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1 Better Care. Lower Costs. Impacts and Outcomes of Telehealth in Alaska Stewart Ferguson, PhD Chief Technology Officer (CTO)

2 Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient s clinical health status. Source: The American Telemedicine Association (ATA) The ATA treats telemedicine and telehealth as synonyms and uses the terms interchangeably. 2

3 Types of Telemedicine Video-Teleconferencing (VTC) Synchronous Telemedicine Video-Based Live Store-and-Forward (S&F) Asynchronous Telemedicine Home Telehealth (HTM) Remote Patient Monitoring (RPM) May be Live or S&F or both 3

4 How Typical is Telemedicine? Currently about 200 telemedicine networks in U.S. 3,500 service sites in the U.S. Over half of all U.S. hospitals now use some form of telemedicine. 10,000,000 9,000,000 8,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000, Patients Served by Telemedicine in North America Source: The American Telemedicine Association (ATA) 4

5 Alaska Tribal Health System Medical Care Service Levels Alaska Native Medical Center tertiary care Referrals to private medical providers and other states for complex care 6 regional hospitals 4 multi-physician health centers 25 subregional mid-level care centers 180 small community primary care centers 5

6 AFHCAN Store and Forward Usage FY15 43,000 Telehealth Cases 1,500 Providers 26,000 Patients ,000 Telehealth Cases 4,300 Providers 99,000 Patients 6

7 Specialty Healthcare Clinics available by VideoTeleconference Oncology Cardiology Pediatric Endocrinology Pediatric Speech Language Pathology Adolescent Medicine (care delivered by Seattle Childrens Hospital) Breast Cancer Screening (care delivered by Mayo Clinic) Endocrinology Pulmonology HIV/Early Intervention Services General Internal Medicine Infectious Disease Neurology Dermatology Emergency Department Services Gastroenterology Hepatitis Nephrology Diabetes Rheumatology ENT OB/GYN Primary Care Many others are in development 7

8 Provider Reviews 76% 67% of encounters are rated as improving the quality of care for the patient (n=11,490). of encounters are rated as improving patient satisfaction (n=11,477). 8

9 Estimated Travel Savings from Telehealth for ALL Patients Annual Travel Savings (by Case Role) $12,000,000 $10,000,000 $8,000,000 $6,000,000 $4,000,000 $2,000,000 $0 Primary Care Specialty Care Medicaid now saves an estimated $10 to $11 for every $1 spent on specialty telehealth consultations Estimated annual savings from telehealth for all patients amounts to about $10m with a total savings of $63.4m since

10 Percent Appointment Availability With 5 Month or Longer Wait Time Telehealth Impact on Extended Waiting Times (> 4 months) 50% 45% 47% 40% 35% 30% 25% 20% 15% 10% 5% 0% Pre-Telemed (n=1216) 8% With Telemed (n=276) 3% With Telemed (n=210) Data courtesy of Phil Hofstetter 10

11 ANMC Turnaround Time 25% of cases are turned around in 60 minutes 60% of cases are turned around in the same day 11

12 Segment Care Management Models Based on Patient Care Needs 5% of patients. Usually with complex disease(s), comorbidities. Shift from high-cost services to lower-cost management. 15% - 35% of patients. May have conditions not under control. Avoid unnecessary higher-acuity, highercost spending. 60% - 80% of patients. Any minor conditions are easily managed. Keep patient healthy Source: Playbook for Population Health, The Advisory Board Company

13 Supports Provider Collaboration and Team-Based Care: Virtual Field Clinic Patient & Health Aide Case Manager PCMH GAMBELL, AK SAVOONGA, AK Norton Sound Regional Hospital NOME, AK Alaska Native Medical Center ANCHORAGE, AK Patient & Health Aide ENT Specialist & ENT Case Manager 13

14 Average Cost (during Year 1 post-discharge) Caring for Our Most Expensive and Most Vulnerable Infant Population $200,000 $180,000 $160,000 $140,000 $120,000 Year 1 Costs Post-Discharge (NICU) 70% Total Cost 100% Total Cost Respiratory System Congenital Anomalies Some of these Primary Diagnosis Groups include patients that account for 70% - 100% of all costs for NICU patients in Year 1 post-discharge $100,000 $80,000 Congenital + Respiratory $60,000 $40,000 $20,000 $ # Patients (with 1 full year of post-discharge data) 14

15 Caring for Our Most Expensive and Most Vulnerable Infant Population We estimate we would save 37% on the cost for care of these patients by: Reducing emergency visits and associated costs by 60% Reducing inpatient hospital admissions and associated costs by 50% Decreasing emergent travel and associated costs by 60% decreasing non-emergent travel and associated costs by 20% Most importantly this will improve access to care and improve the overall health of these children 15

16 Questions Stewart Ferguson Chief Technology Officer (CTO) 4000 Ambassador Drive Anchorage, AK