Scalable Frictionless Care Coordination: Taking the Risk Out of At-Risk Care

Presented by James R. Mault, MD, FACS at the CEO Roundtable on August 12, 2015

Welcome to the world of risk-bearing entity. This should be easy, right? The only thing you need to do is figure out how to take better care of more patients at a fraction of the cost! We know that good old-fashioned nurse case management can be quite effective at keeping high utilizers out of the hospital and ER. But even if you could recruit enough nurse case managers to cover the entire at-risk population, the labor cost would likely blow up the financial model. Fortunately, we can emulate numerous other sectors, including the shopping, banking and travel industries, who have all made the successful transition into the digital age by moving from analog synchronous to digital asynchronous with exception management. This presentation explores the power of scalable, technology-based asynchronous care coordination using exception management and charts the pathway to taking better care of vastly more patients at a fraction of the cost.

Transcript

1. 8/20/15 1 // © 2014 Qualcomm Life. All rights reserved. Scalable Frictionless Care Coordination: Taking Risk Out of At-Risk Care James Mault MD, FACS VP & Chief Medical Officer // The Future of Mobile and Wireless Pope Benedict XVI Pope Francis
2. 8/20/15 2 // Smart phone adoption is unprecedented 2X faster than internet, 3X faster than social media Sources: Pew Research, Ever Accelerating Rate of Technology Adoption, March 2014 Nielsen Telecom Research and Insights, Sept. 2011 50 40 30 20 10 0 1870 80 90 1900 10 20 30 40 50 60 70 80 90 2000 10 2014 Electricity (46) Telephone (35) Radio (31) Television (26) PC (16) Mobile Phone (13) The Web (7) 2014 Smart Phone (3 years) // FIRST COMMERCIALLY AVAILABLE YEAR // // # of years to reach 25% adoption in the US // // QTI Qualcomm Business Segments © 2014 Qualcomm Life. All rights reserved. 4 Technology Licensing A leader in Licensing Wireless Technologies 3G // 4G QTL Semiconductor Business World’s Largest Fabless Semiconductor Company Wireless Internet To Accelerate Time to Market
3. 8/20/15 3 // Qualcomm Inside… // © 2014 Qualcomm Life. All rights reserved. 6
4. 8/20/15 4 // Scripps Digital Medicine Center for Body Computing for Mobile Health Research & Education Trade Organizations WLSA Innovation Investments Qualcomm Life Pavilions Government Affairs Standards Chief Digital Officer & Sponsor Advisory Board mHealth Summer Institute Partner Founding Sponsor Sponsor Founding Sponsor Partner Founder & Board Chair Board Member Creator & Sponsor Founding Corporate Partner President & Board Chair $100 m Digital Health Venture Fund Founding Board Member Joint Venture Corporate Citizenship Founding Member Strategic Advisor Ambassador Health & Healthcare Industry Project Steering Board © 2014 Qualcomm Life. All rights reserved. 7 Board Member Board Member // $100 Million to Accelerate Wireless Health © 2015 Qualcomm Life. All rights reserved. 8
5. 8/20/15 5 // © 2015 Qualcomm Life. All rights reserved. 9 // Mobile Enables Frictionless Business Process It is the underpinning of new major business models globally 10
6. 8/20/15 6 // © 2014 Qualcomm Life. All rights reserved. 11 // © 2014 Qualcomm Life. All rights reserved. 12
7. 8/20/15 7 // Service Industries Over 20 Years…Then and Now… To Mobile Shopping Mobile Banking Mobile Reservations From In-store Shopping Banking Teller Travel Agents // 14 How Does Healthcare Compare? Facility based Inconvenient Delayed Manual Disconnected Episodic Unaffordable
8. 8/20/15 8 // Health Care Reform 2.0 Fee-for-Service Admission = Revenue ER Visit = Revenue Clinic Visit = Revenue Prevention = Expense Value-Based Care Admission = Expense ER Visit = Expense Clinic Visit = Expense Prevention = Revenue // Healthcare Moving out of Hospital, Into the Home © 2014 Qualcomm Life. All rights reserved. 16 SHIFT RIGHT >> COST OF CARE PER DAY $1,000 $10,000 $100 $10 $1 Acute Care Specialty Clinic Community Hospital ICU Community Care Assisted Living Skilled Nursing Facility Home Care Healthy, Independent Living Chronic Disease Management Specialty Pharmacy Home Health Nursing Doctor’s Office Care Coordination Complexity 0% 100%
9. 8/20/15 9 // Virtual Care Stratification LEVEL 3 LEVEL 2 LEVEL 1 5% of Patients 45% of COC 20% of Patients 35% of COC 75% of Patients 20% of COC HIGHLY COMPLEX PATIENTS CASE MANAGEMENT HIGH RISK PATIENTS CARE COORDINATION HEALTHY OR STABLE CHRONIC DISEASE CARE COMMUNICATIONS // Traditional Care Coordination and Care Management © 2014 Qualcomm Life. All rights reserved. 18
10. 8/20/15 10 // Scalable, Connected, Team-Based Care © 2014 Qualcomm Life. All rights reserved. 19 Patient’s Family Patient Pharmacy Nurse Synchronous Communication Physician Asynchronous Communication // Synchronous 20 20 100 5% Encounter or Call time (mins) Encounters or Calls / day Encounters or Calls / week / FTE Health Concern Detection Synchronous vs. Asynchronous (Exception-Based) © 2014 Qualcomm Life. All rights reserved. 20 Case Management and Care Coordination Exception-Based Asynchronous Communication and wireless remote monitoring offers better care, to more patients, at a fraction of the cost of traditional synchronous-based care Asynchronous 0 500 2500 100%
11. 8/20/15 11 // Air-Traffic Control Dashboards for Healthcare © 2014 Qualcomm Life. All rights reserved. 21 // High Tech and High Touch Are Not Mutually Exclusive © 2014 Qualcomm Life. All rights reserved. 22 • The Human Element is essential to delivering patient care • Asynchronous Communication combined with Exception (Triage) Management identifies those patients that appropriately receive human attention when they need it • Allows for allocation of appropriate resources based on specific needs of each patient • Enables a Continuous Care Model that maximizes Patient and Family satisfaction
12. 8/20/15 12 // // Evolution of Sensors, Wearables, etc. Days Seconds 106 Real-time 24
13. 8/20/15 13 // Qualcomm Life Business Lines 25 Connecting Coordinating 2net and HealthyCircles are products of Qualcomm Life, Inc. ReferenceDesigns Creating © 2015 Qualcomm Life. All rights reserved. // © 2014 Qualcomm Life. All rights reserved. 26
14. 8/20/15 14 // Tricorder will be a reality in 2015… © 2014 Qualcomm Life. All rights reserved. 27 The $10 million Global Competition to Revolutionize Health Care • Accelerating the convergence of mobile, wireless, & health technology • Empowering consumers to take charge of their health • Healthcare in the palm of your hand // 28 Smart Medication Monitoring and Management © 2015 Qualcomm Life. All rights reserved. Smart Injector • Dose taken • Date/time log • Temperature • Expiration date • Wireless data transfer Smart Inhaler • Dose taken • Date/time log • Temperature • Expiration date • Wireless data transfer Data flowing back from “Smart” medications are presented in exception management dashboards for review by Pharmacists and other Care Team members
15. 8/20/15 15 // 29 Smart Medication Monitoring and Management © 2015 Qualcomm Life. All rights reserved. Smart Patch • Date/time applied • Duplicate patch? • Temperature • Expiration date • Wireless data transfer Smart Package • Pill removed • Date/time log • Temperature • Expiration date • Wireless data transfer Data flowing back from “Smart” medications are presented in exception management dashboards for review by Pharmacists and other Care Team members // 2net: Liberating Health Data via Wireless Networks © 2015 Qualcomm Life. All rights reserved. 30 Medical Devices
16. 8/20/15 16 // 31 Author   care  protocols   specific  to  your   organization,   providing   a   personalized   care   management  experience   for  your   patients. // HealthyCircles Connectivity and Communication Options: Phone (IVR) Web Portal Mobile Device Smart TV/Cable* *pending
17. 8/20/15 17 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// © 2014 Qualcomm Life. All rights reserved. What’s Working Pharma Embracing Mobile Mobile health technology accounts for 50% of all new patient initiatives for drugmakers1 Provider and Patient Acceptance 86% of providers believe mobile will be integral part of patient management over the next five years2 Interoperability Advances ONC’s interoperability plan and demand for open systems driving horizontal integration 1. Ernst & Young, Progressive Pharma 3.0, 2013 2. HRI Clinician Workforce Survey, PwC 2014 & HRI Consumer Survey, PwC, 2014 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// ONC - Shared Nationwide Interoperability Roadmap © 2015 Qualcomm Life. All rights reserved. 34
18. 8/20/15 18 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Proven roadmaps Death by Pilot Interoperability Challenges of Deploying Asynchronous Exception Management Matching technology to organizations Provider behavior change // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Transitional Care Management (TCM) © 2015 Qualcomm Life. All rights reserved. 36 In 2013, two new Transitional Care Management (TCM) CPT codes were implemented 99495 and 99496 CMS values code 99495 at 4.82 RVUs or ~ $1631 99496 reimburses at 6.79 RVUs or ~ $2311 Both codes require direct communication* with the patient and/or caregiver within 2 business days of discharge The code also requires at least moderate complexity decision making during the service period, and a face-to-face visit within 14 days (99495) or 7 days (99496) of discharge 1CMS.gov TCM Fact Sheet: August 21, 2013
19. 8/20/15 19 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Chronic Care Management (CCM) © 2015 Qualcomm Life. All rights reserved. 37 Effective January 1, 2015 Medicare began reimbursing eligible providers for remote chronic care management under CPT Code 99490 Average payment of $40.39 per patient, per month1 Total Medicare potential CCM reimbursement in 2015 $16.4 billion2,3,4 1CMS.gov Fact Sheet: Policy and payment changes to the Medicare Physician Fee Schedule for 2015. October 31, 2014. 2CMS.gov - 2012 Total Number of Medicare Beneficiaries 3CMS.gov - Country Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average 4CMS.gov - CY 2015 Medicare Physician Fee Schedule Final Rule // Uber-ization of Healthcare © 2014 Qualcomm Life. All rights reserved. 38
20. 8/20/15 20 // © 2014 Qualcomm Life. All rights reserved. Qualcomm Life’s Platform for Disruption Pharmacy Patient Patient’s Family Physician Nurse • Exception-based, asynchronous communication and wireless remote monitoring • Better care, to more patients, at a fraction of the cost of traditional synchronous-based care // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Roche Diagnostics’ CoaguChek XS System is a portable monitor that enables patients to self-test their PT/INR via a fingerstick in the comfort of their own homes. Roche selected Qualcomm Life’s cloud-based 2net Platform to seamlessly capture and transmit the patient’s data to their backend system for remote monitoring.
21. 8/20/15 21 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// 41 AirView Care Management’s connected respiratory patient management platform, leverages the 2net and HealthyCircles Platforms Dynamic tracking of respiratory rate, tidal volume, minute ventilation, usage Aggregation and visualization of data for exception management Wireless capture and transmission of custom Care Management checklist // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Walgreens Balance Rewards for healthy choices™ program integrated with 2net rewards patients for being engaged in their health care
22. 8/20/15 22 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// The human body is the next digital frontier // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// 2net™ Platform integrated with Cerner’s CareAware® device connectivity platform Medical device data capture Remote monitoring capabilities Care coordination
23. 8/20/15 23 // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// © 2014 Qualcomm Life. All rights reserved. 45 Where we’ve been…Where we’re going FROM • Non-mobile • In-hospital, In-Clinic • Few, $$$ sensors • Sparse analytics • Face-to-Face • Episodic care TO • Wireless / mobile • In-home / individual • More, $$ sensors • Near real-time analytics • Connected care TO • Wireless / mobile • Wearable • Many $ sensors • Multi-variable predictive analytics • Continuous, exception- based care // //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// Copyright ©2015 Qualcomm Life, Inc. All rights reserved. Qualcomm and 2net are trademarks of QUALCOMM Incorporated, registered in the United States and other countries. HealthyCircles is a trademark of MyTeleHealth Solutions, LLC, a wholly owned subsidiary of Qualcomm Life, Inc. Other product and brand names may be trademarks or registered trademarks of their respective owners. All QUALCOMM Incorporated trademarks are used with permission. Follow us on Twitter @QualcommLife Visit QualcommLife.com Thank You