2.  Examining the “Boomerang Effect”  Discussing financial implications for Telehealth  Discussing Vidant Health’s Telehealth Program and outcomes  Questions and Answers 2

3. 3

4. 4

5.  81 y.o: CVD, HF, DM, Arthritis  Exacerbation of Heart Failure ◦ Not following his diet ◦ Not taking all of his medications (8 meds) ◦ Not keeping PCP visits ◦ Low engagement level  8 HF ER visits and 6 hospitalizations < 12 mos. 5

6.  Told he will be d/c home tomorrow  PCP not alerted that Mr. Doe was hospitalized  Given new prescriptions  Told to schedule a PCP appt. in the next month 6

7.  Patient education: ◦ Smoking cessation ◦ Diabetes care ◦ Nutrition and cooking advice to him and his wife ◦ Must take BP meds even if he feels fine ◦ How to take his diuretics 7

8.  Forgets most of what was told to him @ D/C  Can’t remember much/feeling OK-  Not consistently compliant with diet, medication  Doesn’t make PCP appointment 8

9.  Patient issues ◦ Don’t understand their medications ◦ Don’t understand how to follow prescribed diet ◦ Can’t afford their medications ◦ Can’t afford foods to follow their diet ◦ Low engagement level 9

10.  Hospital issues: ◦ Focus: inside walls of the hospital ◦ Post d/c service focus: HH & LTC ◦ Incorrect or absent medication reconciliation ◦ Extremely limited system of care transitions ◦ Brief & fragmented patient education ◦ PCP not contacted during hospitalization ◦ Fragmented communication between clinics/specialists/hospital ◦ Dictate to patients vs. engage them in their care 10

12. 12 To enhance the quality of life for the people and communities we serve, touch and support.

13. Discharge Options Portfolio of Tools Portfolio of Tools Patient Hospital Physician/Home SNF Home Health Hospice Palliative Care Remote Monitoring LTAC Rehab 13

14. What if... Remote Monitoring Doctor Patient 14

15. Telehealth Intervention 15

16. 16  Expand access to care  Improve healthcare value  Continuum of care  Best utilize capacity  Connect with local employers  Improve physician network  Improve employer health plan cost position  Develop care models of the future

17.  Reimbursement  Reform penalties  Capacity utilization  It is all relative 17

18.  Overview and process  Expectations  Lessons learned ◦ Adaptation varied ◦ Operational details ◦ Length of monitoring assumptions ◦ Data requirements ◦ Keep the big picture in focus 18

19.  Stop Bonnie from beating on my door!  Pilot enhanced continuity of care model  Capture & quantify financial levers 19

20. Back to the Future 20

21. Hey Norton - you will get out of your telehealth program exactly what you put into it! 21

22. Diagnostic Transitions In Care Friends & Family September 2012 Chronic Disease Mgt. VH Telehealth Conceptual Model 22

23.  Access to Telehealth and care management for hi-risk hi-cost patients  Reduce 30-day readmissions, hospital bed days and ER visits  Improve clinical outcomes  Improve the patient’s perception of care  Improve quality of health information 23

24. 24  Population :In-patient CVD and Pulmonary patients PAM Level I & II Frequent ER visits/hospitalizations Medicare/self pay/un/underinsured  Services :In-home medication reconciliation Home Safety Assessment Daily Biometric data monitoring Weekly telephonic assessment, education, coaching  LOS :3 months

25. 25  Access to Telehealth and care coordination for hi & medium-risk VMG patients  Increase patient access to care  Improve quality of health information and communication between hospital- home – PCP  Improve clinical outcomes  Improve the patient’s perception of care  Reduce health care costs

26.  Population : Clinic based patients PAM Level I & II – VMG Patients PAM Level III with frequent ED/hospitalizations Transfer from Transition in Care Program monitoring  Services : In-home medication reconciliation Home Safety Assessment Daily Biometric data monitoring Daily telephonic assessment, education, coaching as needed Bi-weekly assessment, education, coaching  LOS :6 months 26

27. 27  Population : Graduates of TH TIC, TH CDM VH Employees Contracted Services (Nash, BasisHealth)  Services : Self management monitoring Biometric data monitoring Fee for service  LOS :TBD

28.  Clinical Data ◦ LDL, BP, Pulse, Height, Weight, HgA1c, oxygen saturation  Patient Satisfaction  Financial Outcomes- 90 days pre TH, during TH, 30 days post TH ◦ Hospitalizations ◦ Bed Days 28

29. Demographics – Primary Insurance 29

30. 30

31. 31

32. 32

33. 33

34. (N=325) 34

35. Decreased by 69% Prior to During Decreased by 76% Prior to Post 35

36. 36 Decreased by 67% Prior to During Decreased by 81% Prior to Post

37. 37

38.  Lower hospitalization cost  Readmission aversion  More effective and efficient care  Improved access to care at the appropriate levels  Greater patient satisfaction 38

39. 39  Reduces readmissions penalties exposure  Capacity – increasing CMI & fewer lost admissions  Expands margins  Reduces bad debt losses  Improved discharge planning process  Reduces employer health plan costs  Creates value proposition  Created retail opportunities

40.  At Hospital Discharge: ◦ D/C with the same medications & education ◦ Cardiologist & hospitalist make referral to TH ◦ TH referral received by Telehealth Team ◦ In-hospital enrollment ◦ PCP visit appt. made ◦ Home visit appt. made 40

41.  Patient conducts reading. Wt. increased by 2 lbs.  TH RN calls patient to review medication and diet compliance  See - Feel Change  TH RN provides nutrition counseling 41

42.  Objective data: ◦ Wt. increased by 4 pounds ◦ O2 sat. decreased to 92% ◦ BP slightly elevated @ 145/90  Subjective data: ◦ Reporting SOB and ankle edema 42

43.  Actions ◦ TH RN calls patient, conducts health assessment and provides education ◦ Discovers patient ate Country Ham last night ◦ Didn’t take his Lasix because he had no money ◦ See - Feel Change ◦ TH RN contacts PCP ◦ PCP instructs pt. to come to clinic today 43

44.  Conducting in-home med. rec. & providing RPM services result in: ◦ Early identification and tx of disease exacerbation ◦ Reduced hospitalizations ◦ Reduced bed days ◦ Reduced ER visits ◦ Reduced health care costs ◦ Ending the Boomerang Effect ◦ Active engaged patients 44

45. 45

46. 46