Enrolling Prevention Studies · MHIF CV Grand Rounds –Jan. 30, 2017 21 ROBERT DEBUSK, FAHAMD NANCY HOUSTON MILLER, LYNDA MURDOCK FAHA, FAACVPR, RN FPCNA 22 CLINICAL EVIDENCE Our

Enrolling Prevention Studies‣Galileo - PI: Paul Sorajja, MD

‣ RCT comparing Rivaroxaban + ASA vs clopidogrel + ASA in post TAVR patients‣ Objective: To compare death or first thromboembolic events‣ Subjects: High Risk patients receiving TAVR for on lContact: Stephanie Ebnet, phone: 612.863.6286

‣DalGenE - PI: Thomas Knickelbine, MD ‣ RCT comparing Dalctrapib (CETP inhibitor - raises HDL) vs Placebo‣ Objective: Compare time to MACE‣ Subjects post ACS with ADCY9 AA genotypeContact: Christine Majeski, phone: 612.863.3546, pager: 612.654.6444

‣CASCADE Registry- PI: Thomas Knickelbine, MD ‣ National Registry for patients with familial hypercholesterolemia‣ Objective: Promote awareness of FH prevalence, risk factors and optimal management ‣ Subjects: Patients diagnosed Familial hypercholesterolemia (FH)Contact: Christine Majeski, phone: 612.863.3546, pager: 612.654.6444

C A R D I O L O G Y G R A N D R O U N D S Title: Reimagining secondary prevention and cardiac rehabilitation using telehealth

Speaker: Adelanwa Adesanya, MS Co-founder Moving Analytics, Inc

. Date: Monday, January 30, 2017 Time: 7:00 – 8:00 AM

Location: ANW Education Building, Watson Room

OBJECTIVES At the completion of this activity, the participants should be able to:

1. Describe the importance of secondary prevention programs like cardiac rehabilitation and the factors behind their low utilization.

2. Discuss the role, benefits and key evidence supporting telehealth in secondary prevention. 3. Prepare a business plan including reimbursement pathways, cost, and return on investment for

telehealth in secondary prevention of heart disease.

ACCREDITATION Physician Allina Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Allina Health designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurse This activity has been designed to meet the Minnesota Board of Nursing continuing education requirements for 1.2 hours of credit. However, the nurse is responsible for determining whether this activity meets the requirements for acceptable continuing education.

DISCLOSURE STATEMENTS Moderator(s)/Speaker(s) Mr. Adesanya has disclosed the following relationship; Stock Shareholder: Moving Analytics, Inc.

Planning Committee Dr. Alex Campbell, Dr. Kevin Harris, Rebecca Lindberg, Dr. Michael Miedema, Dr. JoEllyn Carol Moore, Dr. Scott Sharkey, and Jolene Bell Makowesky have declared that they do not have any conflicts of interest associated with the planning of this activity. Dr. David Hurrell declares the following relationship –Boston Scientific: Chair, Clinical Events Committee.

PLEASE SAVE A COPY OF THIS FLIER AS YOUR CERTIFICATE OF ATTENDANCE

Signature: __________________________________________________________________________ My signature verifies that I have attended the above stated number of hours of the CME activity.

Allina Health - Learning & Development - 2925 Chicago Ave - MR 10701 - Minneapolis MN 55407

MHIF CV Grand Rounds – Jan. 30, 2017

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Reimagining cardiac rehabilitation using telehealth

Ade Adesanya, MSCo-Founder, Moving Analytics Inc.Cardiology Grand RoundsMinneapolis Heart Institute Foundation Monday, January 30, 2017

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C r i s i s


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Harsh Vathsangam, PhDCo-Founder & CEO

Nine years experience in big-data and software development for chronic disease management

Ade Adesanya, MSCo-Founder

Led the implementation of remote chronic care management programs at leading hospitals

including Mayo, NYU, VA

Nancy Houston Miller, RN, FAHA, FAACVPR, FPCNAChief Clinical Officer

Fmr. Assoc. Director of Stanford Cardiac Rehab, co-inventor MULTIFIT, Past AHA board member and co-founder of PCNA

Robert DeBusk, MD, FAHAMedical Affairs

Fmr. Director of Stanford Cardiac Rehab, Co-Inventor MULTIFIT, Past AHA board

member

Winner, 2015 Innovation award by

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NEED FOR SECONDARY PREVENTION


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Meet Joe

Age: 65Medical History• Recent MI• EF:30• History of Smoking• Diabetic

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R e f e r r a l t o C a r d i a c R e h a b

Class 1 indication for MI, PCI, CABG,

chronic stable angina, & chronic

systolic heart failure.

AHA/ACC Guidelines


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B E N E F I T S O F C R

13-24% Reduction in Mortality

31% decrease in hospitalizations

Increase in physical function & QOL

Ades, Philip et al "Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative." Mayo Clinic Proceedings (2016): n. pag. Web.

Medicare patients hospitalized for

CABG or MI 2000-07 2007-12

Referral to CR 56% a 73% - 81% c

Participation in CR <20% b <20% d

References

a Brown, JACC 2009b Suaya, JACC 2007

c Beatty, JACC 2014d Beatty, Circ QCOR

2015

Referral to and Participation in Cardiac Rehab


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I M P L I C AT I O N S

Patients

Health Systems

Society

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7 0 % U T I L I Z AT I O N B Y 2 0 2 2

70% CR participation by 2020


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EVIDENCE FOR HOME CR

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C O M P O N E N T S O F H O M E C R

Exercise coaching Risk factor management

Medication Adherence

Psychosocial Support Education


Home‐ and center‐based forms of cardiac rehabilitation seem to be equally effective for improving clinical and health‐related quality of life outcomes. This finding supports the continued expansion of home‐based programs.

Cochrane Database of Systematic Reviews 2015, Issue 8 www.cochranelibrary.com

• N= 1289

• N= 598

• N= 194

• N= 212

• N= 686

• N= 1748

• N= 1192

Congestive Heart Failure

Hypertrophic Cardiomyopathy

Pulmonary Hypertension

Aortic Stenosis

Age 75 or Older

Women

Peak V02 < 14 ml/kg/min

5060 exercise studies in 4250 high risk patients, including:

Circulation 2012;126:2465‐2472

Adverse events in 1/625 studies (no

deaths)


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L I M I TAT I O N S O F H O M E C R

Objective monitoring Technology

Quality Control Financial Incentive

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ROLE OF TELEHEALTH IN CR


Heart, 2014

• RCT of 120 post‐MI patients• Smartphone‐based home CR (vs. center‐based CR)• Greater uptake, adherence, and completion of CR• Similar improvements in exercise capacity

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P A T I E N T C E N T E R E D C R C H E C K L I S T

Evidence Based Convenient & Affordable

Cost effective to implement High Quality


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R O B E R T D E B U S K , M DFAHA

LY N D A M U R D O C KN AN C Y H O U S T O N M I L L E R , R NFAHA, FAACVPR,

FPCNA

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C L I N I C A L E V I D E N C E

Our solutions were developed in collaboration with Stanford Medicine, validated through

multiple clinical trials and has improved the lives of over 70,000 patients in the Kaiser

Permanente System.

11%I M P R O V E M E N T I N

F U N C T I O N AL C APAC I T Y

70%S M O K I N G

C E S S AT I O N R AT E

19%R E D U C T I O N I N L D L

C H O L E S T E R O L

40%C AD

R E AD M I S S I O N SR E D U C T I O N

“Home-based cardiac rehabilitation and Lifestyle Modification: The MULTIFIT Model,” Miller et al.


A powerful and flexible

care management platform

Library of evidence-based

content for CAD, CHF, HTN, DM

and Smoking Cessation

Developed at Stanford University, backed by multiple clinical trials

With a suite of mobile apps to coach patients at home

Implementation, training and

technical support services

To make your program a success

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PAT I E N T C E N T E R E D M O D E L S

Hybrid

• Combination of home & center based CR

Population

• Home CR with remote coaching

Engagement

• Self management program with remote monitoring


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P R O D U C T E N G A G E M E N T

60%E N R O L L M E N T

R AT E S

80%C O M P L E T I O N

R AT E S

118M I N U T E S

E X E R C I S E D / W K / PAT I E N T

Age Range: 30 – 90 Average and Median: 57

90%S TAF F AN D PAT I E N T

S AT I S FAC T I O N

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ROI FOR CR


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M E D I C A R E / F F S R E I M B U R S E M E N T

TRADITIONAL HYBRID POPULATION

# of sessions 36 12 2

Reimbursement $3,600 $1,200 $200

Staffing 1:4 1:400 1:300

$100/session with CPT Code:

93797(8)

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T E L E - H E A LT H R E I M B U R S E M E N T

“Telemedicine parity laws require private payers in that state to reimburse the same way they would for

in-person medical treatment.”


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M I N N E S O TA PA R I T Y L AW

Meet with your insurance provider to agree to• Accept the cardiac rehabilitation CPT codes as a telemedicine

service• Method of telecommunication for telemedicine • Evidence, safety or efficacy of delivering a service• Documentation or billing practices to protect against fraud

Source: MN Senate File 1458 (2015). MN Statute Sec. 62A.672.

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VA L U E - B A S E D R E I M B U R S E M E N T

CMS Bundled PaymentsHospital responsible for 90 day readmissions


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F INAL THOUGHTS

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Meet Joe

Age: 65Medical History• Recent MI• EF:30• History of Smoking• Diabetic


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B E N E F I T S

Increased patient satisfaction and outcomes

Enhanced patient-provider relationship

Lower readmissionsAdditional revenues from more patient sessions

Increased attendance and graduation rates

Improved insight into patient behaviors to personalize care


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Ade Adesanya

[email protected]

832-851-4133

www.movinganalytics.com

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Q U E S T I O N S & F E E D B A C K

Documents

Enrolling Prevention Studies · MHIF CV Grand Rounds –Jan. 30, 2017 21 ROBERT DEBUSK, FAHAMD NANCY HOUSTON MILLER, LYNDA MURDOCK FAHA, FAACVPR, RN FPCNA 22 CLINICAL EVIDENCE Our