The Home Intensivist Practice

Linking Patient Needs to Care Expertise

• The Opportunity

• LifeView Care and Advanced Care Management (ACM™) Program

• Traditional Care v. ACM Model

• The Solution

• Discussion

You’ve got to fish where the You’ve got to fish where the fishes is?fishes is?

Where The Fishes IsWhere The Fishes IsHHIGH NEED PATIENTS REPRESENT THE GREATEST IGH NEED PATIENTS REPRESENT THE GREATEST

OPPORTUNITY TO SAVEOPPORTUNITY TO SAVE

Based on Commercial Lives @ Blue Cross Blue Shield/ WellPoint Based on Commercial Lives @ Blue Cross Blue Shield/ WellPoint

LOW RISK MEMBERS

OPTIMIZE RESOURCES IN

ACUTE EPISODES OF CARE,

POPULATION CARE

LOW RISK MEMBERS

OPTIMIZE RESOURCES IN

ACUTE EPISODES OF CARE,

POPULATION CARE

MODERATE RISK MEMBERS

DM AND EDUCATION, RISK

AVOIDANCE

MODERATE RISK MEMBERS

DM AND EDUCATION, RISK

AVOIDANCE

WELL MEMBERS

PREVENTION AND EDUCATION

WELL MEMBERS

PREVENTION AND EDUCATION

HIGH RISK, MULTIPLE DISEASES

EPISODIC CARE MGMT, CLINICAL

GUIDELINES, HIGH RISK DM

HIGH RISK, MULTIPLE DISEASES

EPISODIC CARE MGMT, CLINICAL

GUIDELINES, HIGH RISK DM

COMPLEX & INTENSIVE

CARE

TOTAL CARE INTEGRATION

COMPLEX & INTENSIVE

CARE

TOTAL CARE INTEGRATION

Population 50% 20% 25% 4%

1%

Population 50% 20% 25% 4%

1%

MEDICAL COSTSMEDICAL COSTS

10%10% 10%10% 25%25% 30%30% 25%25%

High need patients with avoidable institutional services pre-65 =.3% to .8%, post-65 = 3 to 5%

The OpportunityThe OpportunityHigh Cost Members Current Status

Top 5% users:

50% of care services

65% of services are institutional (Hospital and ER)

High Cost Members w/ LifeView Care Clinic The New Reality

Home Intensivist Practice

Chronic Care SpecialistPatient Needs MetSuperior Financial

Impact

60% drop in institutional costs

Greater access Superior Satisfaction50% Net ROI Year

One

The OutcomeThe Outcome

People We Help?People We Help?Multiple Intersecting DiseasesMultiple Intersecting Diseases

Target ProfileMultiple chronic diseases & conditionsPsycho-Social issuesMental & Behavioral issuesPoly-PharmacyKnowledge DeficitHeavy users of ER and Hospital

Co-Morbid ConditionsHeart FailureBrittle DiabetesChronic Obstructive Pulmonary DiseaseObesityHypertensionChronic Kidney DiseaseBehavioral illness

We’ve been working with the medical We’ve been working with the medical community for 15+ years to refine and our community for 15+ years to refine and our solution … solution …

US Department of Veterans Affairs

• 100 patients produced savings of $1.8M in 18 months• ROI of 94%

• Before ATI: 310 patients averaged 5 admits/yr for 2 years (1,500 admits)

• After ATI: 3 admits for entire patient group

• Net yield 1% readmission

• 150 patients/3+ years: Inpatient costs down 95%

• ER costs cut by 100%, net 73% cost reduction

• Readmit rate at 5% for all telehealth monitored patients.

• 781 patients produced $26M in 1st year savings

• 9:1 ROI

Practice of Medicine vs. Disease Practice of Medicine vs. Disease ManagementManagement

Why DM produces small impactWhy DM produces small impact

Disease Management

Scope of PracticePractice of

Medicine Scope of Practice

The Difference with a Home The Difference with a Home Intensivist PracticeIntensivist Practice

MEDICINE PRACTICED EVERYDAY: LIFEVIEW MEDICINE PRACTICED EVERYDAY: LIFEVIEW CARECARE

Day 1

Day 2

Every

Day

Medical Practice : individual care plans adjusted daily

&&

Hom

e In

ten

siv

ist P

ractic

e

Life

Vie

w C

are

Team

DM Nurse

Primary Care

Hospital/Facility Services

Physicians

Homecare

Basic

N

etw

ork

Telecare Clinician

Pharmacist

Chronic Care Specialist

Specialists

Nutritionist

FAMILY

PARTICIPANT

Connects Expert Care Where and When Needed

• Expert physician-led interdisciplinary team• Expert applied-knowledge networks• Mass customization of physician level care

algorithms with integrated medical devices • Real time patient assessment & intervention as

needed

•Clinical work flow redesign•Continuous access to proactive care•Daily self care/patient empowerment•Bidirectional data/knowledge exchange•Ordinary telephone line or broadband

Stitches

RX and OTC Confirmation

Injections

Tools to Keep Patients Stable at Home

Clinician Dashboard

What Changes?What Changes?Clinical

◦Proactive replaces reactive◦Continuous 24/365 connected

care replaces fragmented◦Empowerment ◦Activation◦Practice at top of license◦100-300% increases in

efficiency, effectiveness and impact

Operational/financial◦Aligned incentives◦Expert operations support◦Leverage of national and

regional infrastructure◦Rapid CQI & R&D◦Product expansion

Dramatic Improvement

Much lower utilization

Lost a lot of weight

Controlled diabetes

Off insulinOff Lasix

Cholesterol lower by 110

12 fewer prescriptions

Active and engaged

After ACM

0 Admits 1 ER165 lbs. HBA1C4.2 Insulin 0 unitsdiscontinued

Lasix discontinuedTotal Cholesterol 134 Medications 35Notes: Shopping by herself; Used debit card first time, Daily exercise at gym

Female, 57 yrs. Disabled Nurse

PCP & system expert in complex chronic care (Mayo Clinic)

Repeating cycle of ER and Hospital use…deterioration

Patient X

ACM Improves Lives

Participant Feedback “The monitor has given us peace of mind.”

“The monitor was very helpful in understanding my condition and made me more aware of what I must

do to help myself.”

“I found out so many ideas to help me cope with my health issues.”

“I liked it. Didn’t want to return it. It helped me a lot.”

“I wish I could have it always. Makes me feel more secure.”

Connect Expert Care Where & When Needed

Provider Station

LifeView™ Video Patient Station

ROI = 20% + Better Patient Outcomes ROI = 20% + Better Patient Outcomes with no Change in Existing with no Change in Existing

Benefits/ProviderBenefits/Provider

TargetedEnrollees

ACM Program Overview

Expect .5% of plan enrollees◦ 5 participants:1000 enrollees

Highest health care users ◦ more than $15,000 institutional costs

IDENTIFICATION - Complex cases (higher acuity & at higher risk for utilization)◦ More than 9 medications◦ Many health problems with one or

more uncontrolled◦ Often accompanying psycho-social

issues

Proactive physician led clinical team skilled in the “Telecare” of complex patients

ACM Program Expense◦ $1000 /patient/month◦ $500 / install & training◦ $250 / recovery

Targeted ROI : 20% QTR Progress Reporting

Insurance Cos, ACOs, & Employers

Lower , predictable health care costs; more control over financial exposure

Cost reductions drop to bottom line No disruption to current benefit

structure or network providers Reduced calls to Benefits

administrators from chronically ill employees

People, Members, Employees, &Dependents

Improved health and quality of life while breaking the cycle of deterioration

Health is stabilized and patient is more confident about self care

Care addresses holistic view of patient, not merely medical

The End Result: Everybody The End Result: Everybody BenefitsBenefits