Emerging Technologies That Support Transitions of Care. 8 June 2016 Elaine Remmlinger, Senior Partner, and Robin Settle, Partner

Transcription

1 Emerging Technologies That Support Transitions of Care 8 June 2016 Elaine Remmlinger, Senior Partner, and Robin Settle, Partner

2 Topics of Discussion Drivers of Transitions of Care Technology Perspective: Past and Current Technology Supporting Care Across the Continuum What s Next? June 2016 Kurt Salmon 2

3 Drivers of Transitions of Care

4 What Is Driving the Need to Manage Transitions of Care? Changes to reimbursement make it necessary to better coordinate care across the continuum HHS announced in January 2015 that 50% of Medicare reimbursement will shift to alternative payment arrangements by 2018 Post-acute care accounts for nearly 17% of Medicare dollars Medicare Shared Savings Program (MSSP) advances ACO formation Payors moving from fee-for-service to performance-based reimbursement New payor models, including bundles, Medicare Advantage and risk arrangements June 2016 Kurt Salmon 4

5 Additional Drivers Siloes of care delivery do not foster transitions Redundancies create unnecessary expense and inconvenience They damage a patient s trust They are complicated by a fragmented post-acute marketplace with limited technology June 2016 Kurt Salmon 5

6 Managing Populations Through Transitions Technology is required to support these transitions June 2016 Kurt Salmon 6

7 Technology Perspective: Past and Current

8 The Past (Pre Meaningful Use) Providers implement systems not connected to one another Limited automation for post-acute care Communication between care settings primarily paper-based, fax or not at all Limited digital patient/family engagement Physicians remote access challenging Clinicians tethered to the desktop Little interoperability; point-to-point interfaces dominate June 2016 Kurt Salmon 8

9 The Present Implementing/optimizing EHRs to meet Meaningful Use Added HIE functionality implementations challenging EHR vendors expand capabilities to include wellness, longterm care, home care New and evolving population health solutions still early Provider alliances expand geographic reach, leading to new demands for interoperability and connectivity Leveraging mobility, connectivity, social media, outreach and telehealth to improve patient engagement, encourage wellness, manage chronic diseases and avoid readmissions One-off and pilot programs not well coordinated or integrated Innovative programs/grants pursued June 2016 Kurt Salmon 9

10 Technology Supporting Care Across the Continuum

11 Multiple Technologies Support Transitions of Care Health Information Exchange Population Health Transitions of Care Telehealth Electronic Health Records June 2016 Kurt Salmon 11

12 Health Information Exchange (HIE) Meaningful Use accelerated the expansion of HIE using direct exchange Advancing to query-based exchange find and/or request information from other providers, often used for unplanned care Expanded use cases to support transitions of care ADT alerts from the ED Discharge alerts Referral management between providers Partnerships or new M&A provider communications To providers and now including payors June 2016 Kurt Salmon 12

13 HIE: From Local to National Networks Local and regional HIE supports standards but often with different interpretations Inconsistent experience in quality and quantity of data included in HIE Very expensive Long negotiations generally required Poor sustainability model Viewable data only and is often outside of normal clinical workflows The Argonaut Project Accelerate the development and adoption of HL7 s Fast Healthcare Interoperability Resources (FHIR) Enable Meaningful Use Stage 3 objective Coordination of Care Through Patient Engagement June 2016 Kurt Salmon 13

14 HIE: From Local to National Networks CommonWell Health Alliance In 2015, athenahealth, Cerner, CPSI, Greenway Health and McKesson agreed to deploy CommonWell services to health care provider sites nationwide McKesson s RelayHealth is the service provider Supports the standard exchange of data, regardless of vendor; CCDA only More than 60 provider sites are live on CommonWell services across 15 states The Sequoia Project Carequality Initiative is a framework for connecting HIE networks, vendors and payors Initial implementers of the framework: athenahealth, eclinicalworks, Epic, NextGen and Surescripts Intended to streamline information exchange creating principles of trust ; June 2016 Kurt Salmon 14

15 HIE: Future Direction Support of evolving standards New document types, additional data and images supported National patient identifier??? June 2016 Kurt Salmon 15

16 Representative HIE Vendors June 2016 Kurt Salmon 16

17 Population Health Focus Population Health Manage the care coordination process including transitions of care Discharge planning Referral management Data aggregation, risk stratification, registries, analytics and predictive modeling using data from multiple disparate IT platforms Market Trends Evolving market leaders with dedicated solutions EHR vendors use their product as the foundation, adding disparate solutions Other vendors taking advantage of market momentum (e.g., BI/Analytics, HIE, CRM) June 2016 Kurt Salmon 17

18 Population Health Vendor Marketplace Representative dedicated population health focused solutions Representative EHR vendors are adding/expanding population health capabilities June 2016 Kurt Salmon 18

19 Population Health Focused Use Cases Clinically Integrated Network Aggregate data from different EHRs Identify gaps in care Independent Practice Association Connect disparate systems Proactively coordinate care, reduce costs and improve quality Care Manager Use predictive risk stratification tool to identify patients to contact Promote chronic disease management Accelerate referrals June 2016 Kurt Salmon 19

20 Telehealth The exchange of medical information between a physician/caregiver in one location and a patient or provider in another using telecommunications Used for prevention, patient education, treatment and patient monitoring goes well beyond transitions of care Broader than telemedicine, which is clinically focused Rapidly growing 50% of hospitals today; up to 80% of employers by 2018 Lower cost and faster than office visit Types of telehealth solutions: Store and forward (asynchronous) Remote patient monitoring Mobile health solutions Real time (synchronous) Distance medical consultation June 2016 Kurt Salmon 20

21 Telehealth Market Trends Part of overall digital health/patient engagement programs Expands geographic reach of specialists and addresses provider shortage Wellness programs from employer-sponsored health plans Retail clinics/pharmacies and provider partners (e.g., CVS, Walgreens) National telehealth provider networks emerging Enabled by reimbursement varies by state and payor Virtual care facilities emerging June 2016 Kurt Salmon 21

22 Study Highlights: Telemedicine Technology Source: HIMSS Analytics 2016 Telemedicine Study Webinar, May 2016 June 2016 Kurt Salmon 22

23 Study Highlights: Reasons for Investment Telemedicine is beginning to evolve beyond providing care to those who need it most. While telemedicine technologies can be part of broader patient engagement initiatives (i.e., population health, ACOs), organizational reasons are still primarily focused on providing widespread care. Source: HIMSS Analytics 2016 Telemedicine Study Webinar, May 2016 June 2016 Kurt Salmon 23

24 Provider-Focused Use Cases Providers connect with other providers Routine, non-emergent care Specialty, routine (e.g., psychiatry, pediatrics, radiology) care to distant locations Specialty, urgent care (e.g., telestroke, telepsychiatry ) Consults with specialists Benefits Hastens delivery of care Allows staff sharing, better chronic disease management, and fewer and shorter hospital stays Expands patient base without investment in physical infrastructure Balances workloads between clinic sites Expands reach to rural locations Helps fill provider shortage gaps June 2016 Kurt Salmon 24

25 Consumer-Focused Use Cases Patients initiate a connection with providers via video Direct to consumer Available from mobile devices and at home Offered by pharmacy retailers Sponsored by employers National networks of telehealth providers Benefits Provides non-emergent care outside of emergency rooms Provides chronic disease management outside of the hospital Helps fill provider shortage gaps in specialties and rural locations Facilitates active participation of the patient June 2016 Kurt Salmon 25

26 Remote Monitoring Use Cases Patients send output from monitoring devices, leveraging commonly used technology Provides clinician with discrete data to monitor patient compliance Improves outcomes through early alerts Using telephone-based unit and a wireless transmitter, connects patients to an emergency call center Benefits Enhances communication with patients Enhances patient-provider relationships Monitors patients with multiple chronic conditions Post-discharge follow-up June 2016 Kurt Salmon 26

27 Patient Engagement Use Cases Patients use tools to encourage compliance Use tools already part of patient s routine Push educational materials to patient s personal health record Promote online appointment scheduling on a mobile device Provide automated alerts (e.g., scheduling reminders, alerts) Benefits Improves physician-patient relationship Enhances chronic disease management Enhances disease prevention Fills gaps in care in rural locations June 2016 Kurt Salmon 27

28 EHR Vendors Expanding Market Reach Extending capabilities beyond hospitals and physician practices Expanding interoperability Introducing care management, population health, referral management, risk stratification, predictive modeling Leveraging mobile technology to care for, monitor and connect patients Incorporating telehealth (e-visits, video visits, remote monitoring, e-consults) Advancing patient engagement (personal device connectivity, social media, educational content, outreach) June 2016 Kurt Salmon 28

29 EHR Vendor Use Cases Video Visits Connect patient and provider and consulting physicians Support rural and international locations Pre-schedule video visit E-Visits, Secure Messaging One-way communication Patient sends questionnaires, images, videos Physicians can , e-prescribe E-Consults Request for specialist consult with data, images attached Specialist replies with recommendations Remote Monitoring Capture data from wearables, medical devices June 2016 Kurt Salmon 29

30 What s Next?

31 What s Next? Convergence of vendor space Niche vendors grow market share in the short term with quick, easy deployment EHR vendors acquire and/or build capabilities to support transitions of care Digital health transformation and innovation are major competitive drivers Goes well beyond EHR Incorporates mobile technologies (including new open apps), cloud services, home technologies, wearables, patient engagement technologies Focus on predictive analytics, personalized medicine, semantic pattern matching Innovation will continue to become more agile, seamless and coordinated as technology standards (e.g., FHIR) and the market mature MU3 with FHIR will hopefully force easier data exchange June 2016 Kurt Salmon 31

32 Questions? Elaine Remmlinger Robin Settle June 2016 Kurt Salmon 32