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
MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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)
MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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
MHIF CV Grand Rounds – Jan. 30, 2017
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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.
MHIF CV Grand Rounds – Jan. 30, 2017
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.”
MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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F INAL THOUGHTS
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Meet Joe
Age: 65Medical History• Recent MI• EF:30• History of Smoking• Diabetic
MHIF CV Grand Rounds – Jan. 30, 2017
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MHIF CV Grand Rounds – Jan. 30, 2017
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MHIF CV Grand Rounds – Jan. 30, 2017
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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
MHIF CV Grand Rounds – Jan. 30, 2017
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Ade Adesanya
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