Remote Monitoring Shows Significant Population Health Benefits · •Strong predictor of CV health...

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Remote Monitoring Shows Significant Population Health Benefits

Session 16, February 12, 2019

Laurie Poole, VP, Clinical Innovation, OTN (@poolelaurie)

Dr. Andrew Watson, Payer-provider physician executive, UPMC (@arwmd)

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Laurie Poole, RN, BScN, MHSA

Has no real or apparent conflicts of interest to report.

Dr. Andrew Watson, MD, MLitt., FACS

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Overview of OTN’s Remote Monitoring Program in Ontario (Telehomecare)

• Overview of UPMC’s Remote Monitoring Program

• Questions and Discussion – projected 20 minutes

Feel free to tweet questions to @arwmd, @poolelaurie

Agenda

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• Demonstrate how UPMC and OTN utilized remote patient monitoring to improve patient engagement and outcomes for chronic disease management.

• Analyze the approach taken to ensure implementation of remote

care technology.

• Discuss how remote care succeeds in inspiring patient engagement where other approaches fall short.

Learning Objectives

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OTN is a not-for-profit organization funded

by the Government of Ontario

• Far Reaching Membership

• 3,199 organizations and 26,125 healthcare providers

• Partner with Provincial & Federal Delivery Organizations

• A catalyst for the use of virtual care in Ontario

Ontario Telemedicine Network

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3,587COPD/CHF PATIENTS

ENROLLED IN IN-HOME

MONITORING

3,151HOSPITAL VISITS AVOIDED

BY PATIENTS ENROLLED IN

IN HOME MONITORING

$71MEST. ANNUAL SAVINGS

TO THE HEALTHCARE SYSTEM

Results and Value at Scale

Fiscal Year 2017/8 (April 1, 2017 to March 31, 2018)

896,529

21,315CLINICAL HOME VISITS

156,921LEARNING EVENTS

PATIENTS SERVED

28,663OTNHUB USERS

33,643eCONSULTS

2 dayseCONSULT AVERAGE RESPONSE

TIME

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Chronic Disease

Management Programs

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Remote Monitoring in Canada

• Canada Health Infoway has been a

key proponent in advancing Remote

monitoring with funded initiatives in

almost all of the provinces and

territories

• Ontario’s (OTN) program is the largest

across Canada

• Since 2007, 18,000 patients with Heart

Failure or COPD have been enrolled

in OTN’s Telehomecare Program

9On

tario T

ele

medic

ine

Netw

ork

Otto and ulla video --- do we have a French captioned version?

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Fundamentals of Telehomecare Program

6 month program for patients with COPD or CHF

Supports

patients in their

own homes

through health

coaching and

monitoring

Derived from

evidence based

guidelines and

annually

reviewed

Delivered by

clinicians with

training in self-

management

support and

health coaching

Complementary

to the care

provided by the

most responsible

provider (MRP)

Engages &

empowers the

patient to better

manage their

health

independently

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Telehomecare Governance

Ontario Ministry

of Health

• Funding

• Health system

alignment

• Benefits evaluation

OTN

LHIN (Health Regions)

• Health system alignment

• Sustainable funding

• Oversight

• Health system integration

Host Organization

• Coach & monitor patients

• Liaises with Circle of Care

• Engagement & adoption

• Change Management

• Project management

• Training & support

• Quality improvement

• Engagement & adoption

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Telehomecare Outcomes

64% 67%

81%

58% 58%

73%

CW LHIN TC LHIN Central LHIN

Reduction in hospital admission and emergency department visits

Hospital Admission Emergency Department

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Successes and Challenges

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UPMC

• 5 million citizens

• $20B Global company

• Primary and subspecialty

• Population health system

@arwmd

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• Telemedicine is a critical piece of population health

• UPMC designed a remote monitoring platform and integrated it –to serve diverse needs

• We are seeing positive early results with CHF and post-partum hypertension (mortality and pop-health measures)

Overview

@arwmd

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UPMC Dynamic Model – Population Health

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DeliveryHospitals

Physicians / Nurses

PaymentCare management

Wellness / prevention

Value

Innovation Telemedicine

@arwmd

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Three Domains of Telemedicine

Synchronous Live video to

cell phones

ASYNCHRONOUS

RPM (INBOUND

DATA)

TraditionalRural

clinics, emergent

@arwmd

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Remote Monitoring Continuum

• Multiple approaches to connect with patients / members

• Different methods and goals for program usage

• Pop health at scale is cost control

• Ease of use

BYOD

Tablet

Full Kit + Tablet

@arwmd

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RPM design ”Platform as a service”

OPERATIONSCentralized / scalable

Kit logistics / DME

Legal / Marketing

CALL CENTERInbound filter

Manage alerts

HARDWAREBYOD, tablet,

peripheralsIT INTEGRATION

Vivify portal documentation

Alerts / notes into message router

Epic, HPN, Cerner, dB, McKesson

BYOD and reporting@arwmd

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• Defined clinical needs

– Value driven areas

• Business need

• 3 approaches to RPM

– Clinical need to business

– Business request

– ($$ and reverse engineer a RPM program)

• Growth areas – payer, specialty pharmacy, readmissions, HTN

• Kits / Peripherals

– CHF

• Tablet only

– AIC (also has BYOD)

– COPD

• BYOD

– AIC, PCORI, GDM

– PP HTN, CPS

– Hospice, ALS

Clinical Work – Population Health

@arwmd

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• Defined clinical needs

– Value driven areas

• Business need

• 3 approaches to RPM

– Clinical need to business

– Business request

– ($$ and reverse engineer a RPM program)

• Growth areas – payer, specialty pharmacy, readmissions, HTN

• Kits / Peripherals

– CHF

• Tablet only

– AIC (also has BYOD)

– COPD

• BYOD

– AIC, PCORI, GDM

– PP HTN, CPS

– Hospice, ALS

Clinical Work – Population Health

@arwmd

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• Nationally #1 cause of PP Readmissions (50%)

• Leading global cause of maternal and perinatal mortality

– 2-8% Preeclampsia

– 16% of maternal deaths related to HTN in pregnancy

• Increasing prevalence: Obesity epidemic

• Strong predictor of CV health issues later:

– HTN, DM, hyperlipidemia – CV problems

Post-partum hypertension intro23

@arwmd

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Clinical Outcomes – CHF and PP HTN

Congestive Heart Failure – our UPMC cohort is very sick

- Tracking ED, Obs, Readmissions, Unplanned care, mortality

- 2/3 UPMC insurance ( = population health)

- approximately 2,000 patients / members

- > 92% satisfaction, average age 72, recommend to others 95%

PP HTN

- for 6w after discharge

- 54% did not need a 1w office follow-up visit (canceled)

- 93% came to 4-6w PP check (pre baseline was 50%)

- 76% UPMC HP

- 14% to ER or readmitted (1/3 non-BP issues)@arwmd

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• RPM platform (PAAS) design is an art, as is the monitoring itself

– Very early industry

• Business model is not perfect – BUT THERE!

– Clinical to value or value (money) to clinical

– Hospital impact is an issue

• RPM is a critical pop health tool of the near future

– Recall early laparoscopy

– Medical homes / payer LOB

Implications

@arwmd

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• Laurie Poole, lpoole@otn.ca, @poolelaurie

• Dr. Andrew Watson, @arwmd, LinkedIn

• Please complete online session evaluation

Questions