1. REMOTE PATIENT MONITORING
Telehealth Summit of South Carolina
Telemedicine 2014: Innovations and Applications
September 25, 2014

2. AGENDA
• Current Healthcare System Challenges
• Transformation from Volume to Value
• A Solution: Remote Patient Monitoring
• Proven Results
– Disease Management Project
– Hospital CHF Readmissions Program
– State Medicaid Project
• Opportunities
– New Care Delivery Models
– Providers (Hospitals, Physicians, Post-Acute)

3. THE CHALLENGES

4. THE CHALLENGES
• Prevalence & Costs of
Chronic Disease
• Incoming Tidal Wave of
Aging Baby Boomers
• Rising Cost of Healthcare
• Poor Quality Outcomes
• End of Life Costs
• Hospital Readmissions

5. THE FACTS
Cost of chronic disease:
• 133 million Americans (1/3 of total
population) suffer from at least one
chronic disease
• 70% of all deaths result from chronic
diseases
• 85% of every healthcare dollar goes to
treatment of chronic diseases
• 2/3+ of Medicare dollars are spent on
patients with 5+ chronic diseases
Source: Centers for Disease Control and Prevention

6. POOR QUALITY OUTCOMES

7. AGING BOOMERS
Boomers:
• 26% Total U.S. population
• 83 Million Members
• 10,000 baby boomers turn 65
every day
Source: Pew Research

8. THE HOSPITAL’S ‘REVOLVING DOOR’
Medicare Rehospitalization Rates*
•21.2 % in 30 days
Average Cost of Rehospitalization*
•$11,200
*Becker Hospital Review, Statistical Brief 2009

9. END OF LIFE COSTS
• Most Americans would prefer to
die at home-but only 24% of those
over 65 actually do.
Source: Dartmouth Atlas of Healthcare
• 1 out of 4 Medicare Dollars ($215 B) is
spent on services for 5% of
beneficiaries at end of life

10. IN-HOME CARE
HOME is:
• Patient Preferred Setting
• Patient Centered
• Lowest Cost Care Setting
• Safest

11. VOLUME TO VALUE

12. VOLUME TO VALUE
TRANSFORMATION
BEGINNING:FIRST PHASE: 2010-2016
Patient-Centered Care
• Care redesigned around the
patient
• Patient-focused multi-disciplinary
care teams
• Care teams integrated across care
continuum
• Population-based economic models
that reward value, not volume
THIRD PHASE: 2018-2025
Science of Prevention
• Low cost DNA sequencing allows
for discovery of biomarkers,
pathways, & earlier disease
detection
• Nearly perfect diagnostic accuracy
for personalized treatment
ENDING:SECOND PHASE: 2014-2020
Consumer Engagement
• Cost & performance information
available via web/mobile for
consumer shopping
• Consumers demand better care
• Value-based benefits, social
platforms, & gaming to engage
consumer
Source: Oliver Wyman, The Volume to Value Revolution, 2014

13. “The current system is stuck on fee-for-service,
and it’s a barrier to a better healthcare
model. But I think we’re at a historic time,
with a growing consensus that it’s time to
move away from fee-for-service. Once freed
from that tyranny, creativity is unlocked.”
George Halvorson
Chairman and CEO of Kaiser Permanente
Source: Oliver Wyman: The Volume to Value Revolution, 2013

14. VOLUME TO VALUE
HEALTHCARE TRANSFORMATION
NEW CARE DELIVERY MODELS:
• Accountable Care Organizations (ACOs)
• Medical Homes (PCMHs):
— Primary Care
— Specialty Care
• Dual Eligible Medicaid Demonstration Projects
• Bundled Payments:
— Medicare Bundled Payment Care Initiatives (BPIC)
— Insurer (Payer) Initiatives
• Self-Insured Employer
• Other Models:
— Shared Risk
— Capitation
— Shared Savings

15. REMOTE PATIENT MONITORING

16. REMOTE PATIENT MONITORING
THE PROGRESSION:
• Remote Patient Monitoring
• Telehealth
• Chronic Care Management
• Virtual Care with In-Home
Interventional Care
• Population Health Management

17. CHRONIC CARE MANAGEMENT
PRINCIPLES
• Patient-Centeredness
• Care Transition/ Coordination
• In Home Assessments
• Continuous Risk Stratification
• Physician-Led, Integrated,
Multidisciplinary Care Team
• Top of License Practice
• Remote Patient Monitoring
(Biometrics, ADLs, Medication
Adherence)
• Predictive Analytics
• 24/7 Triage for Intervention to
avoid ED/Hospitalization
• Patient/Family Engagement &
Activation for Self Management
• Evidence-Based Best Practices for
Chronic Disease Management
• Disease Specific Education
• Community Integration
• Palliative/Hospice Triggers

18. PATIENT ENGAGEMENT
AARP. Beyond 50.09. Chronic Care: A Call to Action for Healthcare Reform.” AARP Public
Policy Institute April 2009 Adapted by Insignia Health

19. RISK STRATIFICATION
Source: Health Care Advisory Board, How to Prioritize Population Health Interventions, 2014.

20. TECHNOLOGY ADOPTION DRIVERS
• Technology costs continue to drop dramatically
• Increased number of tech savvy older adults
• Increased adoption of voice recognition
• Increased interoperability
• Payers & providers utilizing technologies for population
health management

21. IN HOME TECHNOLOGIES
• BODY
o Vital Sign Monitors
o Activity Monitors
o Sleep Monitors
o Mobile PERS with GPS
o Medication Adherence
Monitors
o Medication Dispensers
o Urine Analyzer
• HOME
o Fall Detection
o Video Monitoring
o Environment Sensors
o Passive Monitoring Sensors
• COMMUNITY
o Social Network
o Social Communication
o Physical & Cognitive Gaming
o Social Networking
o Gaming Technologies
• CAREGIVING
o Caregiving Portals
o Caregiving Coordination
Platforms
Source: Center for Technology and Aging, The New Era of Connected Aging: A Framework for
Understanding Technologies that Support Older Adults in Aging in Place, 2014.

22. FUTURE TECHNOLOGIES
• BODY
— Smart Medication Management
— Smart Body Sensors
— Remote Monitoring Devices Populating EMR
— Remote Laboratory Diagnostics
• HOME ENVIRONMENT
— Fall Prevention
— Assistive Technologies
• COMMUNITY
— Social & Health Mobile Apps
— Patient, Provider, Caregiver Coordination Platforms
• CAREGIVING
— Local Community Networks for Aging In Place
— Robots
Source: Center for Technology and Aging, The New Era of Connected Aging: A Framework for Understanding
Technologies that Support Older Adults in Aging in Place, 2014.

23. • SOCIAL RISK
– Age, Gender
– Level of Social Support
– Social Relationships
– Transportation
• GEOGRAPHICAL RISK
– Average Income
– Housing Value
– Distance from health care
services
• BEHAVIORAL RISK
– Anxiety
– Depression
– Stress
– Mental Health Symptoms
• PATIENT ACTIVATION
– Health Understanding
– Health Literacy
– Engagement
– Confidence
• HOME ENVIRONMENT RISK
– Infestations
– Multi-level with Stairs
– Cluttered
– Insufficient Lighting
– Lack of Bathroom Assistive
Devices
A BROADER SET OF RISKS
Source: Advisory Board Company, How to Prioritize Population Health Intervention, 2013

24. VIRTUAL CARE
VIRTUAL CARE ELEMENTS:
• Disease Management Assessments
& Education
• Remote Biometric Monitoring
• IVR:
— Patient Reporting/Bluetooth
• Telephony:
— Health Coach Prescribed Calls
— SN Intervention Calls
• Bi-directional Video Visits (MD,
RN & Patient)
• ADL Monitoring
• Medication Adherence/Reminders
• 24/7 RN Triage
VIRTUAL CARE TEAM:
• Nurse Care Coordinators
• Triage Nurses
• Specialty Nurses
— Cardiology
— Endocrinology/Nephrology
— Neurology
— Oncology
— Pulmonology
— Geriatric
— WOCN
• Pharmacists
• Health Coaches
• Behavioral Specialists
• Dieticians

25. IN HOME INTERVENTIONAL CARE
INTERVENTIONAL CARE ELEMENTS:
• ED at Home
• In-Home Visits using Physician Protocols
• Respiratory Therapy Interventions
• Administration of IV Therapies:
— Diuretics
— Antibiotics
— Hydration & Electrolyte Replacement
— Cardiac Rhythm Management Therapies
— Steroids
• Administration of:
— Analgesics
— Oxygen
• Bi-directional Video Visits with In-Home Care
Team & Physician
INTERVENTIONAL CARE TEAM:
• Nurse Practitioners
• Nurse
• Respiratory Therapists
• Physical Therapists
• Occupational Therapists
• EMTs
• Paramedics

26. PROVEN RESULTS

27. THE PROOF
NATIONALLY PUBLISHED RESULTS:
• Veteran’s Administration:
— Remote chronic care management
— 17,000 high risk, high cost complex polychronic veterans
— Results:
 63% reduction in hospital admissions
 88% reduction in nursing home bed days of care
— Current Program includes 65,000 veterans
• CMS:
— Care Management for Beneficiaries Demonstration Project
— Remote chronic care management
— 1,757 high cost, polychronic beneficiaries
— 13.3% reduction per patient per quarter
— $542 reduction per patient per quarter
Source: Center for Technology and Aging, Dual Eligible Brief, 2012

28. RESULTS
Source: Advanced Telehealth Solutions
CHF Study:
• 83 heart patients
• 4-5 chronic diseases
• 6 month study

29. RESULTS
Source: Advanced Telehealth Solutions
Reduced Hospitalizations for Multiple Co-morbidities
Telehealth Intervention:
• Post Hospital Discharge Program
• Polychronic Disease Patients
• 30 Day Program
• Telephonic Intervention

30. STATE MEDICAID PROGRAM
Telehealth Project
Source: Advanced Telehealth Solutions
Project Details:
• On Going Program since July, 2004
• Total Number of Program Beneficiaries-
— 1,530 (7/2004- 6/2014)
— Polychronic Disease Patients
— Medicaid Waiver Telehealth Program
 Monitoring Reimbursement

31. STATE MEDICAID
TELEHEALTH RESULTS
OVERALL RESULTS *:
• Hospitalization Rate:
— 65% Reduction in Hospitalizations
• ER Visit Rate:
— 68% Reduction in ER Visits
RESULTS BY CHRONIC DISEASE *:
• CHF- 59% Reduction in Hospitalizations
• COPD- 63% Reduction in Hospitalizations
• Diabetes- 63% Reduction in Hospitalizations
• Hypertension- 69% Reduction in Hospitalizations
Source: Advanced Telehealth Solutions* Per 1000 Days

32. SC MEDICAID PROGRAM
SC MEDICAID REMOTE PATIENT MONITORING
• Began in 2009
• Available to Community Choices participants
• Telemonitoring of Body Weight, Blood Pressure, Oxygen Saturation,
Blood Glucose Levels, & Heart Rate Information
• Enrollment Criteria:
— Primary diagnosis of Insulin Dependent Diabetes Mellitus,
Hypertension, Chronic Obstructive Pulmonary Disease, and/or
Congestive Heart Failure
— 2+ Hospitalizations &/or ER Visits in The Past 12 Months
— Patient must have a Primary Care Physician
• Reimbursement- $10 per day

33. OPPORTUNITIES

34. NEW CARE DELIVERY MODELS
OPPORTUNITIES FOR TELEHEALTH:
• In:
– ACOs
– PCMHs
– Dual Eligible (MCOs, Demonstration Projects)
• For Reimbursement Models for:
– Risk Sharing
– Shared Savings
– Capitation
• Telehealth:
– Increases Care Team Capacity
– Increases Quality Outcomes
– Reduces Expenses for High Risk/High Cost Patients
– Decreases Days in Skilled Nursing Facilities
– Allows for Higher Reimbursement Rates from Commercial
Payers
– Decreases PMPM Spend by Reducing Acute Care Hospital
Admissions & Readmissions Rates
– Increases Commercial Payer Contract Reimbursement

35. PROVIDER OPPORTUNITIES
• HOSPITALS:
– Reduce Preventable 30 Day Readmissions for CMS Designated
Diagnoses with Associated Penalties (CHF, AMI, Pneumonia &
Additional Diagnoses 10/1/14)
• PHYSICIANS:
– PCMHs (See Previous Slide)
– Reimbursement for Medicare Care Management Fees
 Chronic Care Management Fee (2015)
 Medicare Transitional Care Management Fee
 Medicare ESRD Care Management Fee
– Managed Care Contracts (Medicare Advantage, Medicaid,
Commercial Payers)
 Chronic Care Management Fees
 Incentive Based Contracts
• POST ACUTE PLAYERS:
– Increases Staff Capacity, Lowers Cost Of Care
– Increases Quality Outcomes
– Reduces 30 Day Hospital Readmissions & ER Visits

36. “Do not follow where the path may
lead. Go instead where there is no
path and leave a trail.”
Ralph Waldo Emerson

37. Katherine Piette
Longitudinal Health
Katherine.Piette@LongitudinalHealth.com
(888) 670-6787
www.longitudinalhealth.com