openingOpening

Today Join Us to a New Future

• John Bachman-Primary Care Online

• Steve Adamson-Retail Clinics

• Kurt Angstman-Diamond Project

• Tom Harman-Video/In house Communication For High Risk Patients

Let us Begin With an Expedition on the Planet Kruos

Online Consultations-Platform

The Story

• 1995 Patients could do histories on computers• 2003 Wrote a Review for Mayo Proceedings• Negotiations with GE 150,000 dollar contract • 2006 Medfusion for Department of Family Medicine

(AAFP/Mysis) 450 000 dollars– Practice Committee of Mayo– Negotiations 6 months

Ready to Launch

• July 2007 started with our own department employees

• It had lots of bugs– Online Consultations were done with IMH– Medfusion had issues

• Prescription module was terrible

• Diagnostic codes were primitive

• Functional but not very sophisticated

• Not many people were doing consultations

• The set up was for a small group

• Eliminated prescription refill, simple messaging

Cultural Change

• Fear everyone would use it immediately• We are already busy enough• This does not work so well we can wait.• Developed the term “Soft Start”• July until November met with Medfusion

weekly to go over issues• November felt good enough to enroll patients• March felt good enough to begin charging

So What Happened?

Cumulative Totals

0

500

1000

1500

2000

2500

3000

3500

Sept

Novem

ber

Janu

ary

Mar

ch May

July

Septe

mbe

r

Novem

ber

Months

Nu

imb

er

of

Pa

tie

nts

Total Registrations

Online Visits

Billings

TRAINING

PAUSE

GROWTH

First Year’s Financials

0

20

40

60

80

100

120

140

160

NUMBER

November February May August

MONTHS

MONTHLY ONLINE CONSULTS TOTAL AND BILLED

NOT BILLED VISITS

VISITS BILLED

PauseBillings run 52%

We have done 1167 Consultations in the past year

Training

Recovery

0

50

100

150

200

Number

November February May August

Months

Online Consultations 2008-2009

2008

2009

Registrations

0100200300400

Novem

ber

Decem

ber

Janu

ary

Febr

uary

Mar

chApr

ilM

ayJu

ne July

Augus

t

Septe

mbe

r

Octob

er

Month

Nu

mb

er

2008

2009

3122 Registrations and 1322 Online Consultations

Demographics (first year)

• Average age was 39– and 2/3 are on women

20-60 have done most

Age distribution

0

500

1000

1500

Agesunder 2

0-5 0-12 Under20

Under30

Under40

Under50

Under60

Under90

Online consultations

Nu

mb

er

Series1

We have made an impact on protocols

Communicating directly with doctors instead of nursing

1. We decrease phone tag,

2. We make money

3. We save time tracking down doctors,

4. We provide standardized education

5. We provide prevention services.

Protocols 201 in a year

Mary thinks she has a bladder infection!

A common problem.

The patient willcall for a visit . . .

Talking with the Appointment Desk

You need to see the Doctor.I will get your information for your visit and schedule an appointment.Patient will need to take the afternoon off to see the Clinician.The Doctor prescribes medication.Patient must go get prescription.There are costs to the patient for the office visit, parking, and time off work; there are costs to the practice for time by our office to set up and do

You need to chat with a nurse

Our Nurse is busy. Can she call you back?(Appointment Desk puts in Inbox & routes to Nurses).

Nurse phone protocolThe Nurse calls and talks with patient.Mary fails the protocol because she has had previous infections

Option 1

1. Tell her to come in. 2. Transfer call to Appt.

Desk.3. Appt. is scheduled.4. Patient comes in to be

seen.

Option 2

1. “I will chat with doctor.”

2. Put in Inbox & send to doctor.

3. Or go down hall to talk

Still not done . . .1. Doctor looks reads InBox message &

says that the nurse may do the protocol

2. The Nurse calls & talks with patient3. She says that she can treat the UTI4. She will call a prescription or fax it5. She talks about what to do

Look how much time was used by us

Patient may need to be called more than once

Appointment desk may need to be called more than once

Doctor must read InBox message or talk to nurse & then see patient

Did we make any money?

Mary’s treatment is

delayed!

Look how much time Mary had to spend on this

Wait for nurse to call her back … could take several calls

Wait for doctor to review information

Travel to pharmacy to get prescription

How often does the appointment desk choose an appointment when it could be triaged? 20%

How often does a protocol need to be checked by a doctor? 20-30%

The digital way . . .

Mary has a bladder Infection!She will go to Primary Care Online

A common problem.

The doctor gets an e-mail notification

“You have a virtual Office Visit”

Doctor goes to Primary Care Online Secure Patient Portal

Results of symptom

assessment algorithms

Results of patient

symptom assessment

Doctor’s Actions1. Doctor noted a minimal fever & one UTI in

past six months.

2. Checks GDMS & finds Mary does not need any prevention items.

3. Doctor selects a generalized treatment plan for urinary tract infection-SMX-TMX.

4. In seconds treatment plan & prescription are confirmed by doctor, faxed to pharmacy & communicated to Mary.

30 minutes later Mary reads doctor’s note & UTI treatment plan

c

Which would you want?• Call

• Nursing time for protocol

• Clinician time to say ok

• Appointment desk

• Nurse faxes prescription

• Verbal instructions

• Time in hours

• Clinic loses money

• Go Online

• Clinician uses set protocol

• Clinician checks prevention

• Instructions that are written

• Prescription faxed automatically

• Time in minutes

• MMSI $35 charge - margin better then an exam

We have had impact on allowing people to contact us

without coming in

In one year

• 368 Mayo employees and Mayo dependents did not have to come in for a visit

• This was 40% of the consultations done by our employees or dependents!

• 70 non-employees did not have to come in for a visit

A study showed that patients did not return any higher then people seen in the office

Prescription Refills

Case Heartburn/Depression

Most VOVs have GDMS sent to the Clinician

So what?

So in October we saved a life

• Dr Furst ordered a colonoscopy based on GDMS from a prescription refill

• Detected a localized adenocarcinoma

Many Online Consultations allow us to be Thoughtful

• Standardization of care plans

• Time to think about issues

What has not worked out well?• The past two months we have experienced slow downs-

People do consultations and get error messages• It happens 8% of visits• It is a MEDFUSION issue as it affects their whole system

and occurs at peak times (5PM is a killer) • They are working on improving this

• Our administration is talking with them about reducing

our payments because of this poor service

How to be successful

Sustaining technologies

Listen to customer

Give people what they want

Seek higher margins

Target larger markets

Culture of control, oversight, and planning

Disruptive Technologies

Separate from the organization

Creativity is destructive

Find markets not served well and ignored

Revise as you move

Uncertainty

Show rising profit/value

This is disruptive technology

Status Quo

People gather data

Patients do medicine on the phone or office

Patients are left to initiate help

Disruption

Computer gathers data

People do medicine online

MessagingStandardized Medicine

Retail Clinics

House Calls Online

Chronic Disease Management

We have made major changes in past year

• Confusion of going to wrong site has been virtually eliminated

• People quitting too early in their online consult has improved

• Ease of questioning• Patients and staff have grown and learned• We do not have to tell people basics of how to do

consults as much• Methods of recording, informing patients, and

developing faster methods

So what is our biggest hurdle?Ourselves

Tyranny of the urgent. We are so busy with today that we do not anticipate tomorrow

How do we get people today to solve problems in the future?

Messaging

Wouldn’t it be nice to do things smarter and not work

harder?

We can with Online Messaging!

Messaging

– Oversight committee has approved– Batch results and send them online with

template messaging resulting in no phone tag or letters

– Potential to have all employees receive normal results this way

– Super fast, permanent record, easy to see if read

– NO TOM notes by patient care providers!

In summary our first year

We are moving to the right side of history and our patients are the

beneficiaries

It is making a difference every day

YES WE CAN!

Save Time - Go Online

PCOL

Convenience Clinics Potential for Mayo Clinic Rochester

Steven C. Adamson, M.D.

Today’s Meeting

• Convenience Clinics– What they are– Why they are– Who are their partners– How they may affect our care– How they may affect our ability to shape population-

based care– What we plan to do– What we are asking

Definition

• A retail health care clinic that provides a limited menu of common, low intensity primary care services outside of the standard medical facilities

• Low cost, open access• Often partner with other retail entities• Multiple insurance/payment options available

Consumer Driven

• No appointments• Short visits• Only the limited problem addressed• Convenient hours• Convenient locations• Fixed price

MCR Convenience Clinic Goals

• Primary Goals– Increase primary care access to employees and

community members– Maintain continuity of care– Decrease cost of care through more efficient use

of facilities and staff

MCR Convenience Clinic Goals

• Secondary Goals– Provide needed services to our patients at a time and

place that is convenient to their needs– Decrease ED volumes and low acuity patients – Increase potential access for community patients into

the Mayo Clinic practice

Why This is Different From Urgent Care?

• Defined package of services for the patient– Not care for all health concerns

• Defined work for the practitioner – Specified through protocols and templates

• Supplements rather than diverts the practice– Limited waiting time for patients

The Plan

• 2 locations (High traffic, Convenient, Pharmacy)• North & South (500-800 sq. feet)• ~500 sq. feet required for an exam room,

bathroom, waiting area• Single NP provider

Key Operational Considerations

• Registration of patients performed by the NP– Confirm identification for existing patients– Confirm identification for new patients (no existing

Mayo Clinic #).

Key Operational Considerations (Cont.)

• Registration of patients performed by the NP– Registration, S&P and other stakeholders are working

on processes in order to ensure due diligence– Reviewing expedited processes in other areas (ED,

Blood donor)– New registration is minimal

• Approximately 1-3 new patients per day in Urgent Care experience

Key Operational Considerations (Cont.)

• Patient Access– Currently provide follow-up in primary care services

(or others as needed) to ED patients– Patients registered through the convenience clinic

would not be guaranteed paneling within primary care services

– 4-7% open appointment access in primary care settings projected

Providers

• Staffing and Oversight– 2.9 NP FTE per location– Oversight by Family Medicine physicians and Director– Hiring by Family Medicine NP Manager and HR

Staffing Specialist– Protocols reviewed and revised by ALMC and MCR

NPs and physicians– Appropriate care for focused problems

List of Services

• Allergies (ages 6+)• Bladder Infections

(Females ages 12-64)• Bronchitis (ages 10-

65)• Cold/Flu• Ear Infections• Pink Eye

• Styes• Sinus Infections (ages

5+)• Strep Throat• Swimmer’s Ear• Vaccines (Flu,

Pneumonia)• Pregnancy Testing

(ages 18+)

List of Services (Cont.)

• Skin Conditions (athlete’s foot, cold sores – ages 12+, insect/tick bites – ages 12+, impetigo, minor skin infections & rashes, minor sunburn, poison ivy – ages 3+, ringworm, swimmer’s itch)

• Ear wash• Wart removal• Sports and/or college physicals (Future

opportunity)• Blood Glucose (Future opportunity)

Target Market Data

Mayo Population

Employees Enrolled

Dependents Enrolled Total Enrolled

Residual Population

Total Population

24,138 44,576 68,714 77,032 145,746

47% 53%

Total Population

Female Female Female Female Male Male Male Male

00-17 18-44 45-64 65+ 00-17 18-44 45-64 65+ TOTALS

18,121 28,019 18,564 9,415 18,870 28,080 17,695 6,982 145,746

Marketing Strategy

• Articulated as one of the many options available to access Mayo Clinic care

• Guidance as to the best choice for sample medical problems will be provided

Financial ConsiderationsCost Difference

Highest Charge DSS CostED Level 2 (Includes Facility Fee) 297.40$

CC Cost Based on 2.5 Visits/Hour 57.58$ 239.82$

Lowest Charge DSS CostE2 CPAM BA 128.79$

CC Cost Based on 2.5 Visits/Hour 57.58$ 71.21$

Financial ConsiderationsRevenue Difference

Losses Based on Service DSS CostLowest MCR Primary Care DSS CostNon-Medicare Gross Revenue 76.00$ E2 CPAM BA 128.79$

(52.79)$ Highest CC Service CostStandard CC Fee 49.00$ Highest CC Cost Projection (2 Visits/Hour) 70.84$

(21.84)$

Cost Avoidance

• Primary Care Services & ED– Potential annual cost avoidance of $ 1.1

million• Based on calculation:

– 3.6 visits per hour– 46% employee population, 10% Government, 44%

Commercial– DSS Cost – CC Cost

Cost Avoidance (Cont.)

• Primary Care Services & ED–Potential annual cost avoidance of

$ 1.1 million• Based on Potential Population

– 600 ED visits &10,400 Primary Services

– Anticipated patient populations » 60% FM, 30% CPAM, 10% PCIM

Potential Positive Effects to ED and Primary Care Practice

• ~600-800 low acuity visits pulled from the ED • Opens 4-7% of the Primary Care Practice• Ability to panel new employee and community

populations

What has happened??!!

• Exceeded capacity the day we opened

• Initial site was intentionally equipped with 2 exam rooms

• This site has been double staffed for 75% of the hours to date

Second site

• Second site just opened and is within a grocery store in Rochester

• Also busy from the opening bell.

Effects

• Decrease in ER volume for the primary care practices

• No increase in subsequent utilization of services

• Has helped decrease per member per month costs

Future scope?

• At this point not sure likely will have a third site in Rochester at some point

• Also have discussed partnering with local large employers to provide services on a contract basis.

Questions??

Innovations from Mayo ClinicInnovations from Mayo Clinic

STFM December 2008STFM December 2008Kurt Angstman, MDKurt Angstman, MD

Consultant, Department of Family MedicineConsultant, Department of Family Medicine

Assistant Professor of Family MedicineAssistant Professor of Family Medicine

Medical Director, Mayo Family ClinicsMedical Director, Mayo Family Clinics

Mayo Clinic RochesterMayo Clinic Rochester

• I have no relevant financial relationships to I have no relevant financial relationships to disclose.disclose.

OBJECTIVESOBJECTIVES

• To identify the challenges of managing depression in the To identify the challenges of managing depression in the primary care settingprimary care setting

• To describe the DIAMOND initiative – a model for To describe the DIAMOND initiative – a model for depression management in primary caredepression management in primary care

• To discuss the roles of a PCP, care manager and To discuss the roles of a PCP, care manager and psychiatrist in the DIAMOND model.psychiatrist in the DIAMOND model.

• To present preliminary results of DIAMONDTo present preliminary results of DIAMOND

The Burden of DepressionThe Burden of Depression

• The leading cause of disability and premature The leading cause of disability and premature death among people aged 18-44 worldwidedeath among people aged 18-44 worldwide

• Expected to be the second leading cause of Expected to be the second leading cause of disability in people of all ages by the year 2020 disability in people of all ages by the year 2020

• Remains an undiagnosed and under-treated Remains an undiagnosed and under-treated condition.condition.

• only 46-57% of the 12 million cases in the United States are only 46-57% of the 12 million cases in the United States are receiving treatment for major depression receiving treatment for major depression

• only 18-25% is adequately treated.only 18-25% is adequately treated.

Depression Treatment in Primary Depression Treatment in Primary CareCare

• Primary care physicians are likely to see Primary care physicians are likely to see depression in their clinics compared to any other depression in their clinics compared to any other disorder except hypertension.disorder except hypertension.

• Diagnosis and management of depression poses Diagnosis and management of depression poses a challenge to a busy primary care practice.a challenge to a busy primary care practice.

– About 50% are treated; 20-40% with substantial improvement in About 50% are treated; 20-40% with substantial improvement in 12 months12 months

– High drop-out rateHigh drop-out rate

– Barriers presentBarriers present• Access to mental health resourcesAccess to mental health resources• Competing demands for PCP’s timeCompeting demands for PCP’s time• Tracking/follow-upTracking/follow-up

DIAMONDDIAMOND• DDepression epression IInitiative nitiative AAcross cross MMinnesota innesota OOffering ffering

NNew ew DDirectionirection– Led by Minnesota non-profit organizationLed by Minnesota non-profit organization

• Institute for Clinical Systems Improvement (ICSI)Institute for Clinical Systems Improvement (ICSI)

– Introduces the collaborative model into primary care Introduces the collaborative model into primary care practices across the statepractices across the state

– Reimbursement offeredReimbursement offered only if practice changes and only if practice changes and implements key components of collaborative care.implements key components of collaborative care.

Interventions to Improve Depression Interventions to Improve Depression Management in Primary CareManagement in Primary Care

• Enhanced role of nurse/allied health Enhanced role of nurse/allied health worker (care management)worker (care management)

• Increased integration between primary and Increased integration between primary and secondary care (consultation – liaison)secondary care (consultation – liaison)

• Telephone managementTelephone management• Use of tracking system-RegistryUse of tracking system-Registry• Monitor patients with PHQ-9Monitor patients with PHQ-9• Guideline implementation/educational Guideline implementation/educational

strategies generally ineffectivestrategies generally ineffective

DIAMOND CareDIAMOND Care

• Fully integrated into PCP practiceFully integrated into PCP practice• Care managers are PCP employees- not Care managers are PCP employees- not

specialty or psychiatry employeesspecialty or psychiatry employees• Weekly review by psychiatristWeekly review by psychiatrist• Management recommendations are referred Management recommendations are referred

BACK to PCPBACK to PCP• Key component is communication between Key component is communication between

CM and PCPCM and PCP

Depression CareDepression Careby PCPby PCP

• Incorporation of PHQ-9 as “vital sign” for Incorporation of PHQ-9 as “vital sign” for depressiondepression

– Rooming personnel key in documentation Rooming personnel key in documentation – Provider can also add if needed based on clinical scenarioProvider can also add if needed based on clinical scenario

• Diagnose depressionDiagnose depression – confirms diagnosis via PHQ-9confirms diagnosis via PHQ-9– Initial vs. recurrent (prior therapies???)Initial vs. recurrent (prior therapies???)

Depression CareDepression Care

• Initiate treatmentInitiate treatment– No change from pre-Diamond optionsNo change from pre-Diamond options

• MedicationsMedications• PsychotherapyPsychotherapy• CombinationCombination

Integrate Care Managers into Integrate Care Managers into Depression TreatmentDepression Treatment

• Develop a patient-centric script that the Develop a patient-centric script that the primary care providers can use to describe primary care providers can use to describe the new programthe new program

• Encourage normalization of the new care Encourage normalization of the new care model- “this is the way we treat depression.”model- “this is the way we treat depression.”

• Encourage face to face meeting of a care Encourage face to face meeting of a care manager with the patient at the time of manager with the patient at the time of diagnosis- if possible.diagnosis- if possible.

• Present the care manager as an extension of Present the care manager as an extension of the primary care provider.the primary care provider.

Depression Care- DIAMONDDepression Care- DIAMOND

• PCP involved in depression carePCP involved in depression care– Questions from CM on care recommendationsQuestions from CM on care recommendations– Recommendations for medication changes are Recommendations for medication changes are

through PCPthrough PCP– More interaction between PCP and psychiatryMore interaction between PCP and psychiatry– Patient CAN be seen by PCP for follow up alsoPatient CAN be seen by PCP for follow up also

Care Managers Advantages for Care Managers Advantages for PCPPCP

• TIMETIME

• TIMETIME

• TIMETIME

Care Managers Advantages for Care Managers Advantages for PCPPCP

• Evaluation and coordination of services.Evaluation and coordination of services.– Intake to understand social networkIntake to understand social network

– Social services, etcSocial services, etc..

• Frequent follow up and screeningFrequent follow up and screening– Screening for:Screening for:

• Chemical Dependency Chemical Dependency • Mood disordersMood disorders• Anxiety and other co-morbiditiesAnxiety and other co-morbidities

Care Managers Advantages for Care Managers Advantages for PCPPCP

• Weekly review with psychiatristWeekly review with psychiatrist– New patientsNew patients– Patients who are not improving as expectedPatients who are not improving as expected

• Relapse preventionRelapse prevention– KEY KEY componentcomponent– Review risk factorsReview risk factors– Review signs/ symptomsReview signs/ symptoms– Medication discontinuationMedication discontinuation

DIAMONDDIAMOND

• Win:Win:WinWin:Win:Win– Improved patient careImproved patient care– Improved efficacy of treatmentImproved efficacy of treatment– Improved specialty consultationImproved specialty consultation– Utilization of CM in the management of disease Utilization of CM in the management of disease

processprocess• Not dependent on PCP practice style, effectivenessNot dependent on PCP practice style, effectiveness

– Continued management by PCPContinued management by PCP

New role for psychiatryNew role for psychiatry

• Traditional consult liaison means seeing patients Traditional consult liaison means seeing patients identified by primary care providers.identified by primary care providers.

– One patient at a time One patient at a time – Patients wait 2-3 months to be seenPatients wait 2-3 months to be seen

• New modelNew model– Review patients with care manager & PCPReview patients with care manager & PCP

• Many more patients addressed in same time frame Many more patients addressed in same time frame (20+)(20+)

• Patient problems are addressed within days of Patient problems are addressed within days of presentingpresenting

• Can focus on those needing attentionCan focus on those needing attention

PatientsPatients

• Can have co-morbid mental health problemsCan have co-morbid mental health problems• Can opt out at any timeCan opt out at any time• Can ‘graduate’ if in remission for 2 monthsCan ‘graduate’ if in remission for 2 months

– ResponseResponse• > 50% decrease in PHQ-9> 50% decrease in PHQ-9

– RemissionRemission• PHQ-9 < 5 for eight weeksPHQ-9 < 5 for eight weeks

• If not better in 12 months, must graduateIf not better in 12 months, must graduate

DIAMONDDIAMOND

Preliminary resultsPreliminary results

Goals and Current StatusGoals and Current Status

Measure 6 months goal 3 months

PCP panel enrolled into DIAMOND

3 % 0.8 %

6 month response rate

50 % 46.9 % (ICSI ave.)

6 month remission rate

30 % 29.1 % (ICSI ave.)

Outcomes Outcomes Response (PHQ reduced 50%) Response (PHQ reduced 50%)

Remission (PHQ <5 for 2 months)Remission (PHQ <5 for 2 months)

0

10

20

30

40

50

60

70

Response Remission

Mayo 3 m

phase 1

ICSI collab

6 m target

Unutzer et al. Long-term Cost Effects of Collaborative Care for Late-Life Depression, Am J Managed Care Vol 14(2) p95-100 Feb 2008.

Cost savings using IMPACT model over time

Questions ??Questions ??

• angstman.kurt@mayo.eduangstman.kurt@mayo.edu

Mayo Clinic Home Connection

Thomas R Harman, M.D.

Mayo Clinic, Rochester

I have no relevant financial relationships to disclose at

this time

American TeleCare, ATI

• National Initiative to Provide Alternatives for Managing Complex Patients

• Initial Focused Program:Mayo Employees and Dependents

Outcome Results and Outcomes

73% Net reduction in healthcare cost – Pacificare Secure Horizon Patients• 95% Reduction in Inpatient utilization• 100% Reduction in ED utilization

0.5% annual admission rate - 310 consecutive advanced heart failure patients (many commercial disease management failure) 2 year period (Natl Avg 200-300% per year)

100% Reduction - Admissions for heart failure patients in 3 years – Allina - New Ulm

9:1 ROI - $2.9M program with 781 patients produced $26 million in 1st year saving

1,665 patients - CMS telehealth demonstration project, year 7, telehealth group improved across all clinical parameters

(New Ulm)

(VISN 8)

Reduce ER/Hosp/SNF Utilization - Centura Home Health Initial Study

• Initial study of 17 patients with heart failure

• 3 years – net 73% reduction in costs for these patients

Centura Hosp/ER Admits Before and After Telehealth

1

2

1

5

2

1

4

1 1

2

1 1

2 2

4

3

1

0 0 0 0 0 0 0 0 0 0 000

3

000-1

0

1

2

3

4

5

6

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Hosp/ER Admits Before Hosp/ER Admits After

MCHC Goals

Reduce Hospitalizations Reduce ER Utilization Improve quality of life Support established Primary Care

provider Adjunct to current health care

provider

Keys To Success

• Frequent contact

• Attention to patient’s interests

• Motivational change

• Patient example

Clinical DeliveryInteractive Video Augmented with Intelligent Monitoring

LifeView Interactive Video

Clinical Delivery

• Proactive MD led interdisciplinary team care• Live AV, stethoscope, peripherals• Real time intervention• Patient and provider empowerment

• 24/7 ACCESS• Appropriate people for the work to be done• Begin with 5/55 population

Methods

Technology enabled solutions: “Face to face” frequent, short video

visits Monitor vital signs Monitor symptoms

Education Mayo standards of care Midlevel provider and Physician team

Monitoring Patient Data

Just like an office visit, data collected is reviewed by NP

Action is using Mayo protocols

Monitoring

Clinician is able to select monitoring questions

Clinician determines frequency of monitoring

Information is individualized to each patient

Results reported on a “Dashboard”

Clinical Delivery Clinician Dashboard for Prioritizing Work Flow

Patient completes assessment questionnaire

CNA obtains vital signs

Clinician reviews results

Clinician develops plan

Patient completes monitoring questions

Vital Signs obtained

Clinician reviews results

Clinician develops plan

TELEHEALTH MONITORING:

DAILY

Office Visits Each Month

Clinical Delivery

Clinical Team Management - Telehealth Teams

NutritionNutritionSocial Services

Pharmacy

Support Services

Rehabilitation

Dedicated Clinical Teams

Physician Leader (350 – 500 pts)

Care Team - PA, NC, NP, etc. (50-75 pts ea)

Center of ExcellencePhysician Led Team

• Prospective fee for dedicated management of high need patients

• Manage panel of ~400-500 patients with interdisciplinary team

• Annual Practice revenue of ~$1.2-1.5M

• Chronic care specialist physician

• Optimize specialist MD’s

Reengineer Hospital Model

• Capture 3000+ advanced chronic patients in their home

• Re-capture medical beds for procedures

• Increase contribution margin

• Reduce ALOS & ICU demand

• Improve nursing efficiency, recruitment and retention

• SNF Reductions

• ED Acute care models

Patients Primary MD

• Integrate with chronic care practices

• Align with COE Team offloading complexities of chronic illness

• Additive prospective fees

• Focus on primary care

• Improved Patient Quality

Pt

ATI

American TeleCare

• Outcomes, operational, and business models

• TPO Network Management

• Centralized payor contracting

• Change & Knowledge Management

• Turn-key program administrative, clinical, and technical support

• Solutions, fulfillment, & communications

Clinical Delivery COE – Interconnected National Network

Leveraging Clinical Expertise

• Leading institutions collaborate to create new continuum of care for chronic illness

• Knowledge management with rapid diffusion of best practices

• Broad clinical network coverage

• Initial focus on high need patients then prevention

• Publications and research

• Develop and refine new clinical team and individual roles and specialization

• Clinical Trials

Glimpse of some programs