1. ReDS Heart failure Vest at Triad HealthCare Network
NC ACO Council Meeting
November 15, 2018
Elissa Langley
Chief Operating Officer &
Kelly Peck
Manager of THN Patient & Community Care Transformation

2. What is THN? Physician-led accountable care organization (ACO)
Includes Cone Health employed physicians and the broader independent provider community
More than half of the network is in private practice
Physicians work together to provide coordinated, patient- centered, exceptional care
THN is clinically integrated to support coordination of services, improve measurable health outcomes, adopt evidence-based best practices, and to utilize cutting-edge technology to reduce variability in the care delivered
THN serves 100,000+ attributed patients thru its Next Generation ACO, Humana, United, Aetna, Cigna and HealthTeam Advantage contracts
THN Structure and Governance
1,200+ Affiliated physicians representing 300+ entities across four counties
~500 employed by Cone/Alamance Regional Medical Center
60% independent community physicians
44+ Electronic Health/Medical Record (EHR/EMR) platforms
400+ Primary Care Physicians (Adult and Pediatrics)
Facilities 6 Hospitals, 2 ASCs, 2 NHs, 3 Freestanding Ambulatory Care Campuses, including a Freestanding Emergency Department (ED), 3 Urgent Care Centers

3. Who is Cone Health?
Cone Health is an integrated not-for-profit network of health care providers serving people in Alamance, Caswell, Forsyth, Guilford, Randolph, Rockingham and surrounding counties.
Cone Health is comprised of more than 100 locations, including:
Six Hospitals – 1,228 acute care beds
Three Ambulatory Care Centers
Three Urgent Care Centers
Two Skilled Nursing Facilities
One Continuing Care Retirement Center
One hundred plus physician sites
Eight Centers of Excellence, more pending
THN Structure and Governance
1,200+ Affiliated physicians representing 300+ entities across four counties
~500 employed by Cone/Alamance Regional Medical Center
60% independent community physicians
44+ Electronic Health/Medical Record (EHR/EMR) platforms
400+ Primary Care Physicians (Adult and Pediatrics)
Facilities 6 Hospitals, 2 ASCs, 2 NHs, 3 Freestanding Ambulatory Care Campuses, including a Freestanding Emergency Department (ED), 3 Urgent Care Centers

5. ReDS™ Technology To Decrease Cost Of Heart Failure

6. ? Proprietary  - newer, easier, faster
Going to begin at the end and then explain

7. Heart Failure Worldwide 19 Million People, 1 Million Hospitalizations
Increased Prevalence Among The Elderly
Cost: $108 Billion Annually
United States
5.7 Million People
Significantly Impacts Quality Of Life
Cost: $32 Billion Annually, Direct & Indirect
Triad HealthCare Network
4,000 Patients And Highest Cost ICD
Cost $85M+ In Claims
I am sure that you are all aware of the financial burden of heart failure on the world, country and for us at THN patients with 85+ in claims

8. “Lung Water Matters”
HF Causes Fluid To Build Up In The Lungs Resulting In Severe SOB
Decrease Quality Of Life For Patients
Difficult For Provider To Assess
#1 Reason HF Patients Go To The Hospital
No Standard Way To Measure The Amount Of Fluid In The Lungs
Chest X-Ray
Invasive Implantable Devices
Clinical Assessment
Fairly Easy To Treat (Diurese) But No Standard Way To Measure When The Lungs Are “Dry”
The thing is with HF- the heart function is so poor that fluid builds up in the lungs- causing SOB, swelling and uncomfort for the patient
I often hear our HF specialist Dr. Daniel Bensimhon say “Lung Water Matters”

9. Cleared for market at the USA
Technology & Product
Cleared for market at the USA
Radar (RF) monitoring and imaging technology
Military see-through-wall technology
There are several stories about how DB found Sensible Medical- but my favorite is from the vendors perspective- (story here)
Sensible founders took Israeli military technology that is used to find survivors in rubble, miniaturized it to be able to read the ABSOLUTE, ACCURATE AND ACTIONABLE fluid in the right upper lung
ReDSTM System Technology

10. ReDS™ What Does It Measure?
Absolute Lung Fluid Content Located At Right Mid-lobe
Normal Lung Measures 20-35% Fluid Content (Default Target Range)
Lung Fluid Monitoring
Hospital
Home
Fluid Content [%]
Clinical trials proved that this technology can significantly decrease readmissions for HF and it was FDA approved. HOWEVER the vest was used for one patient/one vest – the patient took the vest home for 90 days – got a reading once per day.
Dr. Bensimhon had other ideas for this technology….
Direct and Absolute Lung Fluid Monitoring Measure % of fluid out of Lung Volume

11. Questions We Wanted To Answer
Are We Discharging HF Patients From The Hospital who Still Have Fluid In Their Lungs?
Can This Device Be Utilized For Individual Patients At The Point Of Care, Rather Than One Patient / Vest?
Can The Vest Prevent An Admission Once Symptoms Begin?
Can We Keep Patients Out Of The Hospital By Utilizing This Technology?
We had several questions we wanted to answer.

12. ReDS Success at THN Location Purpose Results Discharge From Moses Cone
Determine if patients are being discharged still congested
33% of patients discharged from Moses Cone are still volume overloaded
Advanced Heart Failure Clinic
Provider assessment
HF specialist correct at assessment 77% of the time
ARMC ED
Determine moderate congestion and treat in ED
Only 14% of HF patients presenting to ED are moderately congested
Skilled Nursing Facility
Avoid Admits from SNF with vest
10 assumed avoided admissions in 6 months
Home Health Setting (Randolph)
Avoid Readmissions
128 unique patients with 36 assumed avoided admits 25 baseline med changes

13. Questions We Wanted To Answer
Are We Discharging HF Patients From The Hospital who Still Have Fluid In Their Lungs?
YES
Can This Device Be Utilized For Individual Patients At The Point Of Care, Rather Than One Patient / Vest?
Can The Vest Prevent An Admission Once Symptoms Begin?
Can We Keep Patients Out Of The Hospital By Utilizing This Technology?

14. ROI
Initial $100K Investment In August 2016
36 Assumed Avoided Admissions At $10K = $360K Savings
Rural Hospital Penalized 3 Years For HF Readmissions, Avoided $800K Penalty In 2016 and 2017
ReDS™ Reading At Discharge May Help Identify The High Risk HF Patient
Decrease average all cause HF Readmissions from 19.6% to 15.1% at Moses Cone- never been penalized

15. None of this could have happened without all of the team engagement at each location