1 Where We Serve 2 1
Do we feed the Beast or Grow the Village ? • Statement of intent – Proactively shape our future – Integrate/partner with physician – Invest in information technology and tele ‐ health • Care without borders – Utilize technology to remove cultural barriers and geographic boundaries to care delivery • Innovate, leverage technology and change the model of care delivery – Medical home concepts utilizing team care and extensions of primary care models – Utilize technology to eliminate the disparity of medical care delivery – Use data for descriptive, prescriptive and predictive analytics • Coordinate care and make it patient centric – Centralized disease management – Care on demand – 24/7 – Delivery at multiple venues • Leadership – Bring physicians and nurses into non traditional administrative and partnering roles – Look outside health care for innovative leadership and change 3 Supply and Demand Incentives • There are not enough Doctors and Hospitals are not being utilized appropriately at the same time there is increasing demand – Aging population – More chronic diseases – living longer – Primary Care remains the foundation of our care model • Morph the physician centric model allowing for 24/7 access to primary care • Difficult to maintain Primary Care support in Rural and Inner City locations – we need to support primary care so the model can change – Specialties • Mal ‐ distributed – Centered around urban medical centers • Procedurally oriented • Tremendous variation in care delivery • Incentives are misaligned as is the clinical value system • Physicians and Hospitals are paid to utilize • Pay providers to keep people healthy and prevent events from occurring 4 2
What are the opportunities? – Leverage technology and process re ‐ engineering • Centralized 24/7 “eyes” on the acute care patient – floors and ICU – provider by the bedside 24/7 • Increasing access to specialty and primary care • Home monitoring thru virtual units and wearable technology – managing the 5/15 % 24/7 • Smart device connectivity for synchronous/asynchronous mobile care • Utilizing data and central triaging for appropriate alerting allowing for actionable information to reach the provider • Utilize analytics to add prescriptive and predictive interventions What are the business models? How do we “bridge the gap”? • Minimal FFS revenue opportunity • Decrease cost of care delivery secondary to decreased morbidity, complications and LOS – For every $1 spent on e ‐ ICU there is a $ 3.7 utilization savings • Risk – ACO, Bundled Payment, MA plans – full risk – Increased access decreases utilization and shifts care to less expensive venues – Virtual units – in patient and ambulatory prevents acceleration of events – Data – prescriptive and predictive analytics allows for actionable and rational intervention 3
SafeWatch | ConnectNow | CareEngage 7 4
SafeWatch | ConnectNow | CareEngage SafeWatch Augment care with centralized monitoring that provides another set of experienced eyes and intelligent systems. Puts the physician by the bedside 24/7 9 SafeWatch | onnectNow | HealthWell SafeWatch | ConnectNow | CareEngage TeleICU • Single tele-medicine hub in St. Louis • 450+ monitored beds in 15 hospitals across five states • Support 28 ICUs and 2 step- down units • 40+ board-certified critical care physicians • 16 neuro-critical care certified physicians • 60+ critical care nurses 10 5
SafeWath | ConnectNow | HealthWell SafeWatch | ConnectNow | CareEngage 11 SafeWatc | ConnectNow | HealthWell SafeWatch | ConnectNow | CareEngage Eliminating Ventilator Associated Pneumonia Ventilator Associated Pneumonia (VAP) Cases Percent Cases and VAP Bundle Compliance 100 20 90 18 80 16 70 14 60 12 50 10 40 8 30 6 20 4 10 2 0 0 12 6
SafeWatch | ConnectNow | CareEngag Eliminating Central Line Blood Infections Central Line Blood Stream Infections While we have yet to achieve All Nursing Units, All Mercy Communities our goal of zero, on average March 2010 to March 2012 we are performing 26% 18 16 better than the national Number of Infections 14 benchmark 12 10 8 6 ICU CLABSI 4 2 ICU CLABSI Linear (ICU CLABSI) 0 18 16 14 12 10 eICU monitors central 8 line insertions per the 6 4 hospital’s request 2 0 SafeWatch | ConnectNow |HealthWell SafeWatch | ConnectNow | CareEngage Saving Lives and Reducing Costs 1.60 Hospital Length of Stay APACHE Predicted 1.40 Actual/Predicted LOS 1.20 1.00 More than 1,500 0.80 0.60 patients have gone 20% reduction in LOS 0.40 saving $900/ICU day home that were not 0.20 expected to. 0.00 2009 2010 2011 2012 2013 Hospital Mortality Mercy is saving APACHE Predicted 1.60 approximately $25 Actual/Predicted Mortality 1.40 million annually by 1.20 reducing length of stay. 1.00 0.80 0.60 0.40 Mortality rates 25% below expected 0.20 0.00 2009 2010 2011 2012 2013 14 7
SafeWatch | onnectNow | HealthWell SafeWatch | ConnectNow | CareEngage Telesepsis Using EHR data, bedside process reengineering and centralized early warning alerts, patients at risk for sepsis are identified and treated at the first sign of deterioration. 15 BEFORE SEPSIS PROGRAM Diagnosis Cases Mortality Deaths Direct Cost per Case ($) Severe Sepsis 118 28.00% 33 Septic Shock 124 46.50% 58 Total 242 37.60% 91 $12,009 AFTER SEPSIS PROGRAM Diagnosis Cases Mortality Deaths Direct Cost per Case ($) Severe Sepsis 179 14.50% 26 Septic Shock 173 18.50% 32 Total 352 16.50% 58 $9,252 8
Virtual Units Tele ‐ health Impact Paradigm The Power of Central Monitoring And Process Reengineering Point of care EWIS SafeWatch Software Data Central Patient Driven Triage Monitoring Information Virtual Units Technology Facility – ICU, Acute Care EMR Actionable Driven Ambulatory E ‐ ICU Alerts Decision Home Monitoring Home Support Physician Exam in person or remotely Interviews etc. Intervention with Workflow Improved Outcomes Re ‐ engineering Decreased cost Process Innovation & Action taken SafeWatch | ConnectNow | CareEngage eAcute Tracks specific metrics critical to improving: • Average length of stay • Readmission rates • Cost per patient • Pharmacy costs • Patient satisfaction • Provider satisfaction • Care plan and core measure adherence Applies to SNF, PAC, LTACH and into the home 18 9
SafeWatch | ConnectNow | CareEngage ConnectNow Connect patients and providers regardless of their locations. SafeWatch | ConnectNow | CareEngage Telestroke • Alteplase/tPA only FDA approved drug treatment for stroke • 3.0 – 4.5 hour treatment window • Patients treated with tPA within 90 minutes have increased odds of short and long-term improvement. • Treated patients have lower long-term costs because of lower long term disability. • Only 1%-3% of stroke patients receive tPA when they have an acute stroke. 20 10
SafeWatch | ConnectNow | CareEngage 2010 – October 2013 Acute Ischemic Stroke Patients Receiving Alteplase Avg. monthly Annual Epic Teleneurology Facility ED Volume Go-live 2010* 2011* 2012 2013** Consults 2013 2013 date ( > 1350 visits) Hot Springs 31,000 Sep-10 2 6 21 20 20 Springfield 51,000 Jan-09 n/a 21 41 48 20 Lebanon 20,000 May-11 n/a 1 4 6 7 Rogers 22,000 Mar-08 1 4 13 23 28 Fort Smith 38,000 Sep-10 0 2 18 8 13 Washington 25,000 Jul-09 0 1 7 9 12 *Partial Year **Partial Year – Data complete through October 2013 discharges Program Highlights Source: Epic Electronic Health Record Charge and Medication Administrations Record data • Specialty access • Co-worker education • Community education & awareness • Stroke certification support & education SafeWatch | ConnectNow | CareEngage Nurse On Call • 24/7/365 access. • Extension of primary care. • Highly specialized nurses. • Advice on right level of care. • Emergency Department (ED) redirection rate. • Pediatrics 46%. • Adults 21%. • Decreased physician after- hours calls by 70%. 22 11
SafeWatch | ConnectNow | CareEngage eVisits Interactive patient/provider access online and via mobile app eVisits per Month Engagement with MyMercy 485 500 *Increase since last quarter 363 400 316 248 300 197 84 101 143 200 1,726,131 118 81 104 72 7.4% 100 VISITS 0 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 538,050 4.87% VISITS Total MyMercy Account Registrations 512,136 600000 500000 5:43 400000 300000 200000 FY2014, Q2, Oct – Dec, 2013 100000 0 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 23 5/15/80 – Medicare Advantage/ACO EHR data – prescriptive analytics Home monitoring on all Forming Virtual Virtual Units 240,000 40,000 10,000 20% of population Virtual Rounding on all Ambulatory Units 80% of the $’s Patient Pop. Patient Pop. Patient Pop. PHR Smart Phone Apps 5% spend 45% of the $’s EHR data – predictive analytics Selective Home monitoring Virtual Units Virtual Rounding ‐ selective 15% spend 35% of the $’s PHR Smart Phone Apps 80% are reasonably well EHR data Wellness Virtual Unit Impact PHR Cost $ 1,700,000 ‐‐ $ 14.17 pmpm Smart Phone Apps Rev $13,174,800 ‐‐ $109.79 pmpm Intensive outpatient Virtual Care Internist Advanced Advanced Practitioner Practitioner RN CM RN CM 12
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