Post on 02-Jan-2016
Telehealth Alliance of Oregon
February 2015
Michelle Wernert
Health eXpress ExperienceTelehealth in Practice
Agenda• Why Telehealth – What’s the big deal?
• Disruptive Innovation and Telehealth• Health eXpress Overview• Health eXpress - 2014 in Review
• Community Partnerships• Lessons Learned
• Crossing the Chasm• On the Horizon
House calls circa 1930
Beginnings of Telehealth
The future…?
6
Pope Benedict XVI
Pope Francis
7
8
Coming full circle
12
A review of Health eXpress
A web enabled platform that connects consumers to quality health care providers securely where ever they are and at convenient hours.Health care providers can • Discuss symptoms• Diagnose conditions• Prescribe medications• Manage care more efficiently
13
Health eXpress Program Alignment
Improve Population Health• Improve timely access to care• Prevent escalation of symptoms• Decrease avoidable high acuity visits
Care Experience• Improve convenience for patients• Increase access to care• Connected care (EMR, follow-up)
Cost Containment and Affordability• Increase appropriate use of healthcare services• Support utilization of preventative care services
Why online care matters to employers
• Convenience - patients can access their provider from home and on their schedule
• High satisfaction scores- 81% rate online care better than in-person care
• Differentiation in benefit package- offering employees options and innovative solutions
Improves employee
satisfaction
• Allows employees flexibility • Lower absenteeism: average time savings 2 hours per
visit within the work day• Increase capacity – Same day, flexible appointments
Increases productivity and
capacity
• Direct savings of 45% to 50% per visit average• Better utilization of care - higher cost visits avoided (i.e.
late night ED visits because nothing else is available)• Support employees that are at risk or high needs
patients (diabetes management)
Reduces cost of care
15
How Health eXpress works• Patients access care logging in or walking into Kiosk• Electronic medical record is charted in Epic• Providers refer when appropriate• Patients and primary care providers (if agreed to by patient)
receive after visit summary to ensure connected care• Patients receive follow-up phone call and care through
Health eXpress when appropriate
16
Health eXpress Clinical Scope
Cough, cold & allergyFluRashOral lesionsDiarrheaBladder infection
Smoking cessationPinkeyeEar painAcneJoint painLow back pain
HeadacheBurnsSunburnsWellness servicesChildren’s servicesRx scripts
28% of IC and ED visits
National Institute of Health 2010
17
Health eXpress Service Models• Kiosk Service
• On site location in a private space• Walk in appointments• Clear high-definition video• Telepresenter Option
• Web/Mobile Service• On Demand• Available to anyone with a internet connection, web cam and microphone• Available on Android and iOS
KioskWeb Mobile
Current Hours Mon to Fri: 8am to 8pmWeekends: 9am to 5pm
18
Health eXpress Kiosk
8 Workstation Kiosks across Oregon
19
Meet the Provider Team
Kim TullThanh Nguyen
Our licensed, board-certified Providence Family Nurse Practitioners can provide diagnosis and treatment recommendations, which may include prescriptions or labs.
Larlene Dunsmuir Kimberly Rodda Kristen Harris Melissa Sanchez
Rated at 4.8 Stars by Health eXpress Patients
20
Launched in 2014• Web/Mobile for…
• Employer Group Subscriptions• Selfpay (Direct to Consumer)• Insurance Billing
• Providence Health Plan – Launched 1/2/2015• Kiosks at…
• PEBB & PGE expansion• Promotores Mobile Clinic• Safeway• Medford Hospital
• In partnership with CCOs
22
23
24
This option means that the user will have to go to MyAccounts, Edit Profile to enter their information later. It acts the same as selecting ‘no’.
25
26
Community Partnerships
Health eXpress Mobile Clinic• Partnership with the Parish Health Promoter
Program – “Promotores”• Provide a Nurse Practitioner consult as
appropriate via Telehealth• Provide health screenings to underinsured
population• Blood Pressure• Cholesterol• Lipids• Glucose
• Includes referrals to PCP care as well as financial assistance programs
27
Community Partnerships - Promotores2014• 12 clinics offered• Patients Screened = 220• Patients Health eXpress Visit = 79• Patients Referred to additional services = 38
Patient Satisfaction• 100% would recommend service• 100% patients understood next
steps in care or treatment
29
Community Partnerships
Health eXpress Medford• Partnership with the Oregon CCOs• Staffed kiosk located at the Medford
Hospital• 50,000 CCO Members
• ~400 to 500 per month seek care at ED for low acuity conditions that can be treated by Health eXpress
• CCO Members = $0• Selfpay = $49• Providence Health Plan = depends on plan• Launched November 2014
30
Community Partnerships
32
2014 in ReviewLessons Learned
33
Health eXpress Visits TrendsVolume increased 3X Year over Year
Utilization vs. Satisfaction
2012
2013
2014
81%
81%
96%
96%
98%
98%
210
515
1591
# of Patients seen % Patient satisfaction rate % Patients believe service is same or better than a traditional visit
35
Where Would Patients Have Gone
Location Average Cost PCP $ 159 Urgent $ 193 Immediate Care $ 193 ER $ 1,557
45.96%
33.13%
16.98%
3.93%
If you had not used Health eXpress, where would you have gone instead?Done Nothing
Emergency Department
Primary Care Physician
Urgent/Immediate Caren = 483
36
2014 Top Medical Conditions
Primary Diagnosis (Top 10)
0 20 40 60 80 100 120 140 160 180
Number of Records
Sinusitis
Upper respiratory infection
Sore throat
Bronchitis
Dysuria
Conjunctivitis
Dermatitis
Rash
Stye, eye irritation, pink eye
Urinary tract infection
Total Prescriptions: 1,070% of Visits that Resulted in a Prescription: 67.3%
37
Top 10 Medications Prescribed
Medication Description 2014
0% 5% 10% 15% 20% 25%
% of Total Distinct count of Px Encounter CSN ID
Decongestants
Cough/Cold
Penicillins
Macrolide Antibiotics
Antiasthmatic
Dermatological
Ophthalmmic
Corticosteroids
Fluoroquinolones
Misc. Antiinfectives
Top 10 Medications
Percent of patients whose medical concern was addressed: 98.7%
38
Addressing Patients’ Concerns
CPT Code Primary Dx (grouped)
0 1 2 3 4
Number of Records
99999 Joint / Leg / Back painBronchitisDysuriaElevated blood pressureFeverMedication refillAbdominal painConjunctivitisIll feelingLump on neckScreening for HIVSnoringURI (upper respiratory infection)
Patients Evaluated and Referred Elsewhere
• Average Age: 41.5• Oldest Patient: 83• Youngest Patient: 1 month
• Overall Male: 29.1%• Overall Female: 70.9%
Our Providers can treat children to as young as they feel comfortable, recommended age is > 4 months old
39
Health eXpress DemographicsAge & Gender
AGE RANGE
Age0-17
Age18-30
Age31-50
Age51-65
Age66-80
Age81-100
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
% of Total Number of Records
12.23%
36.74%
18.15%
14.80%
2.45%
0.06%2.25%4.44%
7.53%
% o
f Vis
its
40
Web vs. Mobile Utilization
FEMALE MALE
0%
10%
20%
30%
40%
50%
60%
% of Total Number of Records
35.43%
21.36%
23.12%20.10%
Connection Type (web or mobile) (group)MOBILE WEB
% o
f Vis
its
Connection Type (web or mobile) (group)MOBILE WEB
• Female mobile users are the largest demographic
• Mobile is comparatively more popular with women than men
69% of selfpay visits are patients in the
Portland/Vancouver Metro area
41
Client Account PATIENT ZIP (Grouped by County)
0% 5% 10% 15% 20% 25%
% of Total Count of Number of Records
Self-Pay OR - Washington
OR - Multnomah
OR - Clackamas
WA - Clark
OR - Deschutes
OR - Yamhill
OR - Lane
OR - Jackson
25.65%
25.65%
9.42%
7.85%
3.14%
2.62%
2.62%
2.09%
Self-Pay Web/Mobile Visits DTC Patients by County
PDX Metro
Health eXpress DemographicsLocation
Average Wait Time: 3:40 minutesWait Time Target: < 4:00 minutes
42
Health eXpress Wait Time
Mar Apr May Jun Jul Aug Sep Oct Nov Dec0:00
1:12
2:24
3:36
4:48
6:00
Average Wait Times Over the Year
Average Visit Length: 10:46Key Factors in Longer Visits:• More complicated health issue• Technical IssuesProviders becoming more efficient with technology, lowering duration of visits. Average visit duration fell by 3 minutes over the year.
43
Health eXpress Duration of Visit
:00 :02 :04 :06 :08 :10 :12 :14 :16 :18 :20 :22 :24 :260
10
20
30
40
50
60
Conversation Duration
Minutes
# of
Vis
its
wit
h D
urati
on
Mar Apr May Jun Jul Aug Sep Oct Nov Dec0:080:100:110:120:140:150:170:18
Average Duration of Visits Over Time
44
Crossing the Chasm
• Finding and engaging clinical telehealth champions • Medical Liability • Provider Compensation Infrastructure• Reimbursement• Navigating Regulations
• Licensure• Medicare & Medicaid• FSMB Guidelines
• State by State adoption• Integration with EMR• Adoption
45
On the Horizon• Expansion
• Washington (EPIC) – Q1 2015• Health eXpress Regional Expansion• Additional Employer Groups• Additional Payers
• PHP Medicare Advantage• Primary Care • Specialty Care
46
Questions?
Health eXpress Service Models# Patient Technology Scheduled? Customers Notes
1 Web (Unstaffed)
American Well Website Platform
On-Demand Oregon: Selfpay, PEBB, Evergreen, PHP Insurance, Intel
The web application can include a Single Sign On
2 Mobile (Unstaffed)
American Well App (iOS or Android)
On-Demand Oregon: Selfpay, PEBB, Evergreen, PHP Insurance, Intel
The app does not include all features of the website
3 Employer Kiosk (Unstaffed)
Jabber / Cisco Scheduled 8 Kiosks: PEBB & PGE
Free to employees
4 Retail Kiosk (Staffed)
Jabber / Cisco Scheduled 2 Kiosks: Safeway, Jackson Care Connect, All Care Health Plan
Available in Medford (OR) as alternative to ER
5 Employee Clinic Kiosk (Staffed)
Jabber / Cisco Scheduled 2 Kiosks: PSVMC, PPMC
An extension of Employee Health