Integrated Care - Ileana Welte

Integrated Care
Ileana Welte – 3millionlives – Vice Chair

Transcript

1. www.3millionlives.co.uk Integrated Care Ileana Welte – 3millionlives – Vice Chair
2. www.3millionlives.co.uk Integrated Care WHO gives the following definition: Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency. There are 162 definitions of integrated care
3. www.3millionlives.co.uk An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. The concept unites the network of providers in a local delivery system and has special incentive payments based on savings. Accountable Care Organisations - US
4. www.3millionlives.co.uk Shared Care – Great Britain Shared care involves the establishment of partnerships between professionals and laymen where they share a common goal. For example: the improvement in the health of a patient where there is patient empowerment to take a major degree of responsibility for his or her care
5. www.3millionlives.co.uk What is integrated care really? Focus should be on integrating the citizen not just the services and providers. How can innovation support this?
6. www.3millionlives.co.uk Robert Bosch Healthcare – Overview Bosch has Healthcare roots  92% owned by Robert Bosch Foundation, a charity  Robert Bosch Hospital founded in 1936  Long-term view to improve health care quality and safety, as transformed by Bosch in other industries Comprehensive Solutions  Complementary Products: PERS1 – Bosch Carephones, Nurse Call systems  Reliable patient interfaces, peripherals, workplace application, and hosting systems Bosch Healthcare UK commitment  Commitment to widespread telehealth UK adoption  110 years as a UK LTD Since 1998  2007 – Bosch acquired Health Hero Network, Inc.  Extensive IP/patent portfolio for remote monitoring  Superior clinically validated outcomes, quality improvement and cost savings in multiple segments
7. www.3millionlives.co.uk Evolution of Systematic Patient-Centred Integrated Care Fit and healthy Critically ill Guided training (depends on fitness levels) Instruction on health conscious behaviour Motivation and instruction on active, healthy lifestyle Monitoring of symptoms and self assessment Acute state monitoring and emergency interventions At risk Chronic conditions - High-risk/ Complex Wellness Prevention Post acute Personal and environmental sensors Activities of Daily Living (ADL’s) Fixed term programs of monitoring of symptoms and self assessment Personal and environmental sensors Personal and environmental sensors Confidential | RBGB Healthcare | 10/7/2010 | © 2010 Robert Bosch LLC and affiliates. All rights reserved.
8. www.3millionlives.co.uk Understanding the role of Technology enabled care • Technology is a tool to enhance a robust integrate care coordination strategy. • Technology deployment has many stakeholders and all must have the willingness and incentives to participate in the process. • Technology must be engaging and easy to use to encourage self management and adherence and create a positive user experience for clinicians and patients. • The data collected must be triaged to the appropriate member of the care team and must be actionable upon receipt
9. www.3millionlives.co.uk These are the mechanics not the pathway Confidential | Cara (SAL) | 10/7/2010 | © 2010 Robert Bosch LLC and affiliates. All rights reserved. Collect Data Transmit Alerts Validate patient feedback Notify health team Intervene Integrated Trust/Hospital Community based providers • Assess • Treat •Educate •Measure results Regional /local monitoring center • Review Data • Care Mgmt Intervention • Improve Install & Engage • Inventory Management • Site Survey Call (telecom) •On-site Installation • Orientation & User Training • Engagement •Transmission of Data & Alerts •Adherence Calls to Patient if required •Alert Validation Calls to Patient •Posting of Validation Questions •Clinical team notification
10. www.3millionlives.co.uk Benefits of technology enabled care • Purpose - To build value for stakeholders by: – Using advanced clinical tools and analytics to provide consistent evidence-based care – Connecting patients to their local providers to help them remain independent and in their homes – Generating evidence of sustained positive clinical, quality and cost outcomes – Understanding how to surmount the barriers to successful outreach and implementation in large-scale projects – Creating economic opportunity through: • Innovation in healthcare delivery • Model for reimbursement
11. www.3millionlives.co.uk Case Study: Barnsley Barnsley Independent Living at Home Service – Telehealth and Telecare Hub • The Independent Living at Home Service provides support to vulnerable people living in their own homes • People who can benefit from the service are those with learning disabilities, physical disabilities, mental health issues and older and frail people • Aim is for people to live as independently and safely as possible in their own homes Telecare Service • The Independent Living at Home Telecare Service provides a 24 hour per day, 365 days per year monitoring and response service • Telecare supports the prevention agenda which can provide help to people with low level needs and help reduce the cost of long term care packages. • There are a variety of telecare packages available for a small weekly charge.
12. www.3millionlives.co.uk People in Control - Barnsley Telehealthcare Centre The Telehealthcare Centre works in partnership with NHS Barnsley and Bosch. The Centre provides pathways and signposting to other services to help people in a number of ways: Provides education and self care to help people live a better quality of life in their own homes Increase independence Reduces exacerbations Reduce visits to GPs and the Accident and Emergency Department
13. www.3millionlives.co.uk Barnsley Integrated Social and Health Home Assessment and Reablement Team (HART) People assessed as having a substantial or critical need by Adult Social Services may be entitled to a 1-6 week period of support to help them regain living skills and become independent at home and to reduce the costs that are associated with long term home care provision. There is no charge for the service.
14. www.3millionlives.co.uk Barnsley Telehealth Evaluation Phase 1 “Preliminary findings suggest that the intervention is very promising and is highly accepted by CHF patients.”, e.g.: • Low reported patient anxiety and difficulty with using Health Buddy or their communication with Specialist Heart Failure Nurses • Patients benefited from increased understanding of their condition, reassurance and in many cases perceived improvement in their health • 82% felt they could manage their condition better due to Health Buddy • Despite a modest number of patients, the Barnsley Telehealth Phase 1 project appears to have a significant impact on lowering costs and reducing hospitalizations and length of stay for patients with CHF. – Total costs – Length of stay (LOS) – Rate of hospital admissions
15. www.3millionlives.co.uk Barnsley Telehealth Evaluation Phase 1 - Results Table 1. Variable Means Means Prior to the Intervention After the Intervention COST £7,058.78 £2,089.94 LOS 5.27 2.75 Admissions Elective 1.04 0.41 Emergency 1.17 0.61 Non- emergency 0.28 0.03 In all cases we find differences with the intervention leading to better outcomes. Conclusion: We are working with Barnsley to further analyse the data in ways that better account for time exposure to the intervention.