Amerinet Executive Education Series: Collective Learning on Contemporary Healthcare Issues Frontiers in TeleHealth www.amerinet- gpo.com
Dartmouth Atlas Report Summary: Hospital and Physician Capacity. Plus, a look at the Role of Telehealth in Addressing Capacity Issues. Craig Westling, MS, MPH Managing Director, Accountable Care and Professional Education The Dartmouth Institute for Health Policy & Clinical Practice
Health Care Capacity Where is the money spent? Two types of capacity determine the majority of health care costs: 1. Hospital Capacity Beds, imaging devices, procedure suites 2. Labor (hospitals and physician practices) Physicians, nurses, allied health professionals, admin staff Substantial unwarranted variation in capacity across regions. Does not reflect patient wants or needs Lower capacity is compatible with high quality and comparable outcomes
Regional Variation in Hospital Capacity Twofold variation in acute hospital beds per 1000 people
Changes in Physician Capacity Expanding modestly 1996-2006 Added 110,000 practicing physicians o 45,000 PCPs o 60,000 Specialists Workforce per 100,000 grew by 7% overall (faster than population) o 11% of primary care physicians o 4% for specialists
Regional Variation in the Physician Workforce Primary Care Physicians per capita vary by >2.5X
Regional Variation in the Physician Workforce Specialist Physicians per capita vary by >3X
Physician Capacity Is there an urban/rural dilemma? High physician levels are found in both highly and less urbanized regions Variation cannot be explained by differing patient needs Physicians prefer to settle in more affluent communities and close to where they trained Regions with high supply of PCPs have high supply of Specialists
Workforce and Variation Growth in workforce won t address variation For every 1 physician that settles in a low supply region, 4 physicians settle in a high supply region.
TeleHealth Promise: Eliminate time and space constraints TeleHealth tipping point: Usage costs are coming down Home and Wifi and mobile broadband Video calling is easy Wide adoption of smartphones with cameras Potential: redistribute critical knowledge (without the need to live in a place)
Questions? Craig.R.Westling@Dartmouth.edu Craig Westling, MS, MPH Managing Director, Accountable Care and Professional Education The Dartmouth Institute for Health Policy & Clinical Practice
Please Welcome Chris Coons Vice President, Outreach Services Wesley Valdes, MD TeleHealth Medical Director Intermountain TeleHealth Services Development www.amerinet- gpo.com
Intermountain TeleHealth Services Development Amerinet iqast Chris Coons Vice President, Outreach Services Wesley Valdes, MD TeleHealth Medical Director
TeleHealth is the combined use of telecommunications and computer technologies to improve the efficiency and effectiveness of healthcare services by liberating caregivers from traditional constraints of place and time. What is Telehealth? American College of Nurse Practitioners. N.d. web. http://www.acnpweb.org/i4a/pages/index.cfm?pageid-3470
Management Committee Central Operating COG Group Operations Council Shared Accountability SAO Organization Telehealth Guidance Council Virtual Virtual Tools Tools for Daily for Living Home and & Daily Homecare Living Virtual Primary Care Services Virtual Specialty Consultation Services Virtual Critical Care Services
System Executive Sponsor TeleHealth Medical Director Chief Technology Officer Decision Support & Planner Homecare CNO Virtual Home and Daily Living Care Team Lead Director of Medical Group Operations Virtual Specialty Team Lead Virtual Critical Care Team Lead Medical Director for Medical Group Medical Director for Insurance Company Chief Information Officer for Insurance Company Director of Capital Planning & Finance Director of Marketing & Communications Director of Data Security/Compliance & Business Ethics Director of Shared Accountability
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Infrastructure Clinical Processes / SAO Administrative, Compliance & Data Security
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Infrastructure Clinical Processes / SAO Administrative, Compliance & Data Security
TeleHealth Services Strategic Building Blocks Virtual Tools for Home and Daily Living Virtual Tools for Home and Daily Living provides technologies to assist patients and members in their homes and daily lives to manage their individual health status. It is the first line of prevention and implementation of shared accountability strategies.
TeleHealth Services Strategic Building Blocks Virtual Tools for Home and Daily Living Develop a comprehensive approach for the use of virtual tools to monitor in non-clinical settings. Identify and evaluate opportunities based on clinical best practices, convenience, and cost/benefit to the system. Evaluate daily living monitoring technologies and make recommendations for standards. Develop and evaluate business opportunities for virtual tool solutions in nonclinical settings. Submit research grants and participate in studies that support virtual tools for daily living and Homecare initiatives.
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services The Virtual Primary Care Services are being developed to increase convenience, access, and communication between primary care providers and patients from non-clinical settings (home, workplace, etc.). The purpose is to achieve early intervention and prevention of complications.
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services Develop a Virtual evisit service that will support 24/7 access to a primary care provider via audio and video from an individual s home, workplace, or mobile device. Evaluate evisit technology for ease of use for patients, doctors, and staff. Develop value added technology and processes for patients, payers, and physicians. Analyze other remote access business ventures. Develop tools and medical models to deliver evisit, ephysician, and Worksite Services.
TeleHealth Services Strategic Building Blocks Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination
TeleHealth Services Strategic Building Blocks Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination
TeleHealth Services Strategic Building Blocks Virtual Specialty Consultation Services Develop links to physician specialists with referring physicians and patients for consultation in hospital-to-hospital settings. These services are primarily delivered from TeleHealth suites located in hospitals or larger clinics.
TeleHealth Services Strategic Building Blocks Virtual Specialty Consultation Services Establish recommended technology checklist (TeleHealth Suites, connecting tools, etc.) for an optimal cost/quality TeleHealth experience. Establish the necessary legal boilerplate contracts to ensure compliance and consistency in all virtual consults. Recommend a model for technical support. Determine role of partnership with Utah TeleHealth Network. Develop with clinical programs and RVPs a strategic rollout of Intermountain TeleHealth Specialty Consultation Services.
TeleHealth Services Strategic Building Blocks Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination
TeleHealth Services Strategic Building Blocks Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination
TeleHealth Services Strategic Building Blocks Virtual Critical Care Services Virtual Critical Care Services provide technology that serves hospital patients with high acuity needs by using TeleHealth tools. These tools assist clinicians in monitoring, using best practices, educating, and providing standard levels of care to hospital patients.
TeleHealth Services Strategic Building Blocks Virtual Critical Care Services Develop TeleHealth solutions to improve and maintain hospital clinical outcomes. Develop a solution to address the limited availability of specialty physicians, providers, and support staff. Provide a tool to spread the integration of critical care protocols into hospitals. Develop a solution to keep patients and families in their own communities for hospital care. Conduct build vs. buy analysis for TeleHealth options.
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Infrastructure Clinical Processes / SAO Administrative, Compliance & Data Security
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination ICU Med/Surg ER/Telestroke Infrastructure Infrastructure refers to the standardization and coordination Virtual of Critical IT services, Care support, Services tools, and devices. Implement a centralized infrastructure to develop TeleHealth Services technologies Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Standards for evaluation of technology implementation, support, and maintenance Support SCO in reducing costs and prioritizing TeleHealth initiatives Infrastructure Coordinating interfaces of IT and Communication Platforms Development of strategic plan for Clinical Data Response Center and SMART Rooms Clinical Processes / SAO Administrative, Compliance & Data Security
TeleHealth integrates with Clinical Programs & SAO solutions Integrates Care Coordination and Disease Management in Patient Homes Provides a tool for achieving utilization management objectives, improving quality of care and patient service experience TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Infrastructure Clinical Processes / SAO Coordinate Text Text with Intermountain s clinical programs ICU Text and support structures to ensure TeleHealth strategies and Med/Surg/SMART technology are aligned with clinical Rooms process objectives and SAO. ER/Telestroke Avoids unnecessary visits, hospitalizations, transfers, and Virtual Critical Care Services Infrastructure Virtual Specialty Consultation complications Services Outreach to rural areas Pediatric and Adult specialties delivery Hospital to hospital specialty care delivery Improves the efficiency of care Clinical Processes / SAO Enables standardization of clinical services by rapid distribution of best practices through TeleHealth Supports Care Coordination and Disease Management in personalized primary care model Provides a tool for achieving utilization management objectives, improving quality of care, and patient service experience Administrative, Compliance & Data Security
TeleHealth Services Strategic Building Blocks Text Text Text Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Text Text Text Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Infrastructure Clinical Processes / SAO Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Clinical Administrative, Processes / Compliance SAO & Data Security Administrative, Compliance & Data Security Administrative, compliance & data security issues will be addressed and coordinated centrally to ensure standard implementation of policies. Develop policies, processes and procedures specific to TeleHealth Develop financial measures and payment methodologies Support TeleHealth workforce planning and education Coordinate branding and marketing of TeleHealth Develop Credentialing, Privileging, and Licensure standards Develop E-Signature and documentation management for TeleHealth
TeleHealth Services Strategic Building Blocks Text Text Text Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Infrastructure Clinical Processes / SAO Administrative, Compliance & Data Security Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Administrative, Compliance & Data Security Administrative, compliance & data security issues will be addressed and coordinated centrally to ensure standard implementation of policies. Develop policies, processes and procedures specific to TeleHealth Develop financial measures and payment methodologies Support TeleHealth workforce planning and education Coordinate branding and marketing of TeleHealth Develop Credentialing, Privileging, and Licensure standards Develop E-Signature and documentation management for TeleHealth
TeleHealth Services Strategic Building Blocks Virtual Primary Care Services evisit Video/Audio MyHealth, Messaging Virtual Clinics Virtual Tools for Home and Daily Living Remote Wound Care Monitoring Rescue Alert Mobile Apps Social Media Care Coordination Virtual Critical Care Services ICU Med/Surg/SMART Rooms ER/Telestroke Virtual Specialty Consultation Services Outreach to rural areas Pediatric and Adult specialties Hospital to hospital specialty care delivery Infrastructure Clinical Processes / SAO Administrative, Compliance & Data Security TeleHealth Guidance Council
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