Chronic disease management: Doctor’s office to remote patient monitoring November 2, 2015 Presenters: Rusty Williams - Vice President and Chief Information Officer Sherrie Petersen - Director,

CAST Video

In Our Time Together… The history of & remote patient monitoring Lessons learned Human component of Shifts in healthcare environment Facing concerns head on Remote patient monitoring can enhance data metrics Using predictive analytics Changing the perception of aging in place

History of the Evangelical Lutheran Good Samaritan Society’s service

The Evangelical Lutheran Good Samaritan Society Serving in more than 240 locations in 24 states. Caring daily for more than 27,000 people. Employing more than 22,000 staff members.

History of  2004 – Began discovery at University of Virginia  2008 – Successes in alpha and beta studies  2009 – Need for large scale research and evidence  2010 – Converging technologies Developed research proposal Secured grant funding and partners Began conducting formal research  2011 – Enrolled 400 research participants in Q1  2011 (June) – Enrolled home care clients  2014 – Research and grant completed

What is  Provides an opportunity for people to stay in the place they chose to call home  Who is that? All of us. Young, old and in between. We all want to be at home whether we are recovering from an illness or hospitalization, managing chronic disease or aging in place.  Collects and analyzes information  Vital signs, sleep patterns, movement, medication adherence, and activity  Information provided to formal and informal caregivers  Early detection and earlier intervention

 Multiple Chronic Illnesses  Diabetes (53%)  Cardiovascular Disease (60%)  Respiratory Disease (32%)  Mental Illness (30%)  Frequent users of health care system  Variety of ages  Multiple languages  English, Spanish, Somali, Lao, American Sign Language  Caregivers  Formal  Informal Who Serves

Technology of Telehealth Technology Blood pressure Pulse Weight Oxygen saturation Glucose levels Sensor Technology Sleep quality and quantity Sleep habits Bathroom usage Movement trends Door opening and closing

Recognition of:Can lead to early intervention and detection of: Sleep irregularities Activity pattern changes Bathroom visits Vital sign changes – Weight – Blood pressure – Oxygen saturation – Heart rate – Blood sugar Cognition changes Congestive heart failure (CHF) Chronic obstructive pulmonary disease (COPD) Pneumonia Dementia Diabetes Depression Medication adherence Medication reactions

LivingWell Center and remote patient monitoring

There are 525,960 minutes in a year, the average person only spends 120 of those minutes with their provider. – Centers for Disease Control and Prevention

Primary Care Physician Model

LivingWell Center  Remote patient monitoring services  Registered nurses and non-clinicians  Inbound and outbound calling capabilities  7 days a week, including holidays  8:00 a.m. – 4:30 p.m. (CST)  Based in Sioux Falls, SD  Expanding services: Wellness coaching Advance care directive Integrated video

 Data to support baseline assessments  Wellness coaching with goal setting  Proactive identification of health and safety concerns  Reduce readmissions and emergency department visits  Patient engagement enhancement  Dual eligible beneficiary community costs lessened  Increased patient satisfaction  Improved health and well- being of population  Informal caregiver’s peace of mind Service Benefits

Lessons learned from research and early deployment of the service

Published Research Caring for the Ages: Proactive Technology-Enhanced Home Monitoring for Chronic Disease Management is Already Reality (2012) Seniors Housing & Care Journal: Technology-Enhanced Nurse Monitoring in Assisted Living: Results from Focus Groups with Housing Managers (2013) Journal of Gerontological Nursing: Testing Telehealth Using Technology-Enhanced Nurse Monitoring (2014) Journal of Telemedicine and Telecare: Impact of Telehealth Services on Client Satisfaction in Home Health Care Agencies (2015) Telemedicine and e-Health: Client Satisfaction with Telehealth in Assisted Living and Home Health Care (2015)

Research Outcomes The value of the sensor technologies is not consistent across stakeholder groups. Nurses who do the monitoring in Sioux Falls see tremendous value in the technology because it improves clinical systems and processes (e.g., care coordination). Assisted living housing managers do not see as much value in the technology because staff are present at the AL site 24/7. Similarly, home health care clients see greater value in the technology compared to assisted living residents.

Lessons Learned

The Missing Piece: Medical Home/ Physician Office

Human component of

“You have kept my mom at home for another 4 years.” is a comfort, it really is!” “We would’ve lost Mom... You gave me my mom for another Mother’s Day.” “The system has already saved my life,…”

“Living well with telehealth” Video

The difference is in utilization… Of agencies reporting that they have a telehealth program, less than 25% of their units are in use on any given day. According to the National State of Industry Report from Fazzi Associates (2014):

Average daily utilization of service and telehealth equipment 93%