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CMS Telehealth Service Presentation

Telehealth Integrated Systems

for Personalized Patient Care

Palisades Medical CenterMay 13, 2010

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Presenting CMS Telehealth

• CMS Telehealth Introduction and Background

• The Health Management Situation

• How We Work with You

• Telehealth Services

• Telehealth’s Effectiveness and Results

• Questions and Next Steps

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CMS Telehealth--Principals

– Healthcare executive management and consulting for full spectrum of healthcare: hospitals, physician practice management, home healthcare, DMEs and insurance

– Founder, IT consulting firm; computer systems, software and networking integration expertise for HIT and manufacturing

– Marketing for telecare, telehealth and technology companies serving older adults; advisory services for eHealth companies

– Sales, account management and implementation strategies for imaging and electronics companies

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The Situation—Diseases & Chronic Illness

Chronic Illness = 45% (125 million) of Americans—and 75% over 65—have at least one chronic illness• 76% of Medicare spending is on patients with one or more chronic

diseases

• 75% of all healthcare costs

Congestive Heart Failure = 5.3 million• 47% of the patients are likely to be readmitted within 4-6 months

• Estimated cost (2008): $34.8 billion

Hypertension = 73 million Americans, 1 in 3• 35.1% have their blood pressure under control --64.9% do not

• Estimated cost (2008): $69.4 billion

Health and Human Services—AHRQ; Deloitte ‘Connected Care’ 2009

citing ‘Health Affairs; American Heart Association, 2008

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The Situation-Care Providers

• Compliance with CMS policies such as 30 day readmissions

• Financial implications of– post-discharge readmissions by diagnosis and payor– unnecessary ER admissions by payor

• Discharge planning, case management and homecare

• Better utilization of clinical time for patient care, where non-clinical personnel can be used

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The Situation-Readmissions• Research has shown that hospital readmissions are reducing

the quality of health care while increasing hospital costs (July 9, 2009, CMS Office of Public Affairs)

• Hospital comparative data show that for patients admitted to a hospital:– Heart attack treatment--19.9% will return to the hospital within 30 days

– 24.5% of patients admitted for heart failure will return to the hospital within 30 days

– 18.2% of patients admitted for pneumonia will return to the hospital within 30 days

• Good discharge plans can help reduce the rate of unplanned readmissions by– giving patients the care instructions they need after a hospital stay

– helping patients recognize symptoms that may require immediate medical attention

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Solutions• Encourage patient self-monitoring, education and care

plan adherence for patients and their families in order to improve better longer-term outcomes for patients with chronic diseases

• Improve patient compliance • Reduce unnecessary hospital readmissions and ER

visits • Proactively identify changes in conditions• Attract new patients• Improve staff productivity • Integrate valuable information into EMR and PHR

systems

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Why CMS Telehealth Was Created

CMS Telehealth solutions • Allow patients, especially seniors, the underserved, those

living in rural areas and patients with chronic conditions– to receive convenient and immediate healthcare, and to live

independently– by utilizing affordable systems that allow for remotely managing

health and wellness

• Enable care providers to more effectively, efficiently reach and treat patients for better outcomes

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About CMS Telehealth

• A NY/NJ based marketer and distributor of integrated follow-up and monitoring systems for healthcare providers

• We connect care providers and patients for better post-discharge and chronic condition management

• We work to assist you in improving outcomes via patient self-monitoring and education– Reducing 30 day readmissions– Providing information in between office visits– Help determine the right care at the right time

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How CMS Telehealth Works with You• Our team meets with each client to determine what the best solution is

for them based upon the specific needs of their patients• Our comprehensive and service/product solutions are robust, scalable,

and customized for each individual client and their patient needs• CMS Telehealth does its own marketing, distribution, installation and

maintenance of our products and services • The technology solutions and services we provide are

– Through established relationships with companies which have a proven track record in telehealth technology, often members of the Continua Health Alliance (which sets standards in device interoperability)

– Designed to be compatible with your IT requirements

• Our team continuously researches the newest technology that can be beneficial to clients and their patients

• A management member of our team is always available to our clients and their patients

CMS Telehealth combines the best of hands-on healthcare experience in all phases of healthcare operations, technology and customer service

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Our services connect you to the patient

Collect information post-discharge over phone or internet

Survey questions assess condition Customize questions and parameters Data is stored for review, trending and analysis Generates alerts when needed

Transmits patient self-testing directly Technologies utilize commonly used monitors Review secured website for status and trends Data is stored for review, trending and

analysis

…and to better patient outcomes

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How it works

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Uses phone or internet to collect patient post-discharge status information– Outbound live agent call to answer questions and receive information– Or--direct patient input via Interactive Voice Response (IVR) or the

internet– Contact method and frequency for patient set by client– Compiles trending reports for documentation

CaringTouch database includes template patient surveys by profile: COPD, CHF, cardiac, diabetes, rehab, more

Software runs on standard PC workstations and telephonesno capital investment

Software and database fully maintained by CMS Telehealth

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Setup is easy by patient

Select custom question series for each group

Select category or group characteristic

Set frequency

Set start/end dates and time

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Compile a series of questions and alerts

The CaringTouch template has over 400 questions to choose from—

or add your own

Utilizes ‘branching logic’

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Set alerts for CHF survey

Set thresholds and alert frequency

Clinicians define thresholdsThresholds automatically monitored by CaringTouch

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The email specifies the question and response that triggered the alertAlternatively: phone call and text/SMS message

AlertsWhen a threshold is

crossed

An alert is emailed to the designated

care provider

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Survey as completed

• Takes minutes

• Secure entry into CaringTouchdatabase for review and documentation

• Access 24/7

• HIPAA compliant

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Trending report

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Trending report

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Trending report

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Trending report

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CaringTouch™ Benefits

• Control, power, simplicity, security– Provider controls scheduling and alert thresholds– Real time reporting– Alerts are generated automatically– CMST maintains application and secure database

• Flexibility and ease– Deployment: outbound calls, IVR, internet self-reporting– Use own staff to call or contract with CMS Telehealth– Comprehensive questions, templated and customized

• CMS Telehealth installs, maintains and trains staff on how to use software, calls and follow up– Hosting, customer updates, system updates, alerts all included

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How it works

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Transmits patient self-testing directly to care provider– Access via secure websites for reports--no additional software needed

– Information transmitted to PHRs (Google Health, MS HealthVault) and EMRs (where available)

Remote monitoring devices connect to a wide variety of leading, commonly used vital signs monitors– Weight scales, blood pressure cuffs, blood glucose meters, pulse

oximeters

Patient management tools permit checking and trending of information above and beyond verbal reporting– A second level of accuracy and education

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‘Healthcare Anywhere’

•Highly portable•Cellular connectivity without the phone•Monitors connect by cable or Bluetooth•FDA 510(k) cleared;ISO13485:2003, ISO 9001:2008 certified•Integrates to popular PHRs and enterprise level EMRs

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• Hub connects to 50+ monitoring devices• Data transfer by phone or PC• Integrates data with health management systems and PHRs• FDA 510(k) cleared; ISO 13485:2003 certified

• Works with standard phone or Ethernet connectivity

• Data entered manually to questions (push button prompts) or recorded via monitoring devices

• Multiple language queries

Other RVSPM Solutions

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Benefits

• Integrated home health monitoring– With Caring Touch, a ‘double check’ on patient status

and vital signs over time

• Monitoring systems fully compatible with widely available ‘off the shelf’ devices

• Systems encourage compliance longer-term• Enables information sharing with physicians,

medical home care, family, PHRs and EMRs• ‘One stop shopping’—CMS Telehealth single

point of contact for sales, service and training

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Telehealth Effectiveness and ResultsClinical studies of telehealth use combined with coordinated

care show:• Improvement of health outcomes through better ongoing assessment • Improved patient experience in self-management of care• Enhances follow up and records for regulatory compliance• Complements service offerings• Targets the right care at the right time

• 40% reduction in ER visits

• 63% reduction in hospital admissions

• 60% reduction in hospital bed days of care, with similar results in nursing homes

• 14% - 55% reduction in all cause hospitalizations

• 29% - 43% reduction in heart failure hospitalizations

• 80% reduction in readmission for CHF patients (12% reduced to 2%)

1-3: Letan, Better Health Care Together, Home Health News, January 20104-5: Chaudhry survey of 9 studies, cited by Institute for Healthcare Improvement, March 20096: Creason, CHF Telemanagement Clinic, cited by Institute for Healthcare Improvement, March 2009

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Cleveland Clinic study 2009 (N=250, ages 20-60s)

68% with hypertension, 26% diabetes, 6% heart failure

Average # of days between doctor’s office visits• Increased (less frequent visits)

– Diabetes: 71% — Hypertension 26%

• Decreased (more frequent visits)– Heart failure: 27%

"What we were really testing was the ability to care for a patient who has a chronic disease in a more continuous fashion, rather than the episodic model we have today, of seeing a patient once every 90 to 120 days. The promise of this new model of delivery is that we can manage patients in a more timely fashion to achieve better outcomes -- at an effective cost.” Dr. C. Martin Harris, CIO, Cleveland Clinic

“Cleveland Clinic program linking chronic disease patients directly to doctors online shows success,” The Plain Dealer, March 16, 2010; Medical Device Daily, March 26, 2010

Telehealth Effectiveness and Results

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Effectiveness and Results

Home health agency users:

• Advocate Home Health (IL): integrated into sleep apnea, COPD and DME programs

• Partnership with Kentucky Home Health Association to offer system to membership

• Almost Family Home Health (CT): 40 offices

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Effectiveness and ResultsConnector hub to monitors

Also: Whittier Institute for Diabetes, Community Health System-University of California, University College London Hospitals (NHS)

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Effectiveness and ResultsResearch and pilots:• MedApps: Meridian Health, Baptist Home Health Network • In-home data communicator and medical device hub

– Montefiore Medical Center (subsidiary CMO-The Care Management Company) test with 6600 seniors and disabled adults. Funded by Centers for Medicare and Medicaid Services (Care Management for High-Cost Beneficiaries Demonstration.

• Earlier tests in Wenatchee, WA and Bend, OR

– VHA (30,000 units total):• Four years of data from the VHA’s telehealth program: 19% percent

reduction in hospitalizations and 25% reduction in “bed days of care” for participating patients

• Veterans Administration of Central California Health Care System recently added to promote better medication adherence in chronically ill veterans

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Questions

• What are the hospitals' strengths by clinical services-inpatient and outpatient? Please prioritize on a scale of 1-5, with 1 being the greatest strength.

• Areas of concern to the team as it relates to post-discharge readmissions by diagnosis and payor? Please prioritize on a scale of 1-5, with 1 being the most important area to address. What are the approximate financial implications of each area of concern?

• Areas of concern to the team for unnecessary ER admissions by payor that can better be handled in a more efficient manner? Please identify on a scale of 1-5, with 1 being the most important area to address. What are the approximate financial implications?

• In the areas of discharge planning, case management and home care, what areas would the clinical staff like to see their clinical time reduced that can be handled by non-clinical personnel so that more clinical time can be spent with a patient? Please prioritize on a scale of 1-5, with 1 being the most important area to reduce. What would the financial implications be?

• Geographic areas that you are looking to attract new patients from? Please prioritize.

• Who are your immediate competitors and in what areas of services)?

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Next Steps