Telemedicine: Transforming Health Care in

Illinois

Lori WilliamsIllinois Hospital AssociationMarch 20, 2014

• Status of rural health care in Illinois

• Transformation of Health Care in Rural Illinois

• Legislative Initiative in Illinois

• Questions

Presentation Outline

Illinois Hospital Association

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• Offices in Naperville, Springfield and Washington, D.C., an advocate for 200 hospitals and health systems

• 88 are considered Small & Rural

• 51 are Critical Access Hospitals

Rural Health Care in Illinois

Many Population Health Needs ExistObesity, Cancer, Asthma, Violent Crime, More

Illinois Health Status Compared to U.S.

Average

Illinois Health Status Compared to U.S.

Average

Source: The Henry Kaiser Family Foundation

Source: The Henry Kaiser Family Foundation

Illinois U.S.

Overweight/ Obese Children

34.9%

31.6%

Overweight/Obese Adults

63.2%

63.8%

Cancer Incidence Rate Per 100,000

484.2

462.1

Asthma Among Adults

9.2%

8.6%

Violent Crime Rate Per 100,000

435.2

403.6

Child Obesity Threatens Illinois Future

Child Obesity Threatens Illinois Future

Illinois ranks 42 in overall prevalence of child obesity with

34.9% of children considered either overweight or obese.

The Illinois prevalence of overweight and obese children has risen since 2003.

1 in 8 preschoolers are obese.

Children who are overweight or obese are five times as likely to be overweight or obese as adults.

• 27.1% of Illinoisans were obese in 2011; Projected to reach

53.7% by 2030.

30.0% of low-income children ages 2-5 are overweight or obese in Illinois.

Illinois ranks 42 in overall prevalence of child obesity with

34.9% of children considered either overweight or obese.

The Illinois prevalence of overweight and obese children has risen since 2003.

1 in 8 preschoolers are obese.

Children who are overweight or obese are five times as likely to be overweight or obese as adults.

• 27.1% of Illinoisans were obese in 2011; Projected to reach

53.7% by 2030.

30.0% of low-income children ages 2-5 are overweight or obese in Illinois.

Illinois Distressing Cancer Rates

Illinois Distressing Cancer Rates

Overall

Illinois has higher than average incidence of cancer in 19 out of 20 cancers.

Breast Cancer

Chicago‘s breast cancer disparities are among the highest in the nation.

African American women in Chicago die from breast cancer at rates

62% higher than White women.

Colorectal Cancer

Colorectal cancer is the 3rd most common cancer in the U.S., and is the second leading cause of cancer death in Illinois.

Illinois ranks 43rd for colorectal screening (only 62% screened).

Screening rate is significantly lower for the uninsured.

Overall

Illinois has higher than average incidence of cancer in 19 out of 20 cancers.

Breast Cancer

Chicago‘s breast cancer disparities are among the highest in the nation.

African American women in Chicago die from breast cancer at rates

62% higher than White women.

Colorectal Cancer

Colorectal cancer is the 3rd most common cancer in the U.S., and is the second leading cause of cancer death in Illinois.

Illinois ranks 43rd for colorectal screening (only 62% screened).

Screening rate is significantly lower for the uninsured.

Illinois Outpaces the Nation:

Obese Children, Cancer,

Asthma, and Violent Crime.

Illinois Outpaces the Nation:

Obese Children, Cancer,

Asthma, and Violent Crime.

Many Population Health Needs: Inadequate Mental Health Services

Inadequate IP Psychiatric CareInadequate IP

Psychiatric Care Shortage of PsychiatristsShortage of Psychiatrists

Illinois has 102 counties

50 counties don‘t have a psychiatrist

84 counties don‘t have a child psychiatrist

70% of the 84 medically underserved counties in Illinois did not have a psychiatrist

100% of medically underserved counties in rural Illinois with no psychiatrist

Source: Illinois Psychiatric Society

Illinois has 102 counties

50 counties don‘t have a psychiatrist

84 counties don‘t have a child psychiatrist

70% of the 84 medically underserved counties in Illinois did not have a psychiatrist

100% of medically underserved counties in rural Illinois with no psychiatrist

Source: Illinois Psychiatric Society

In 2012, Illinois hospital Emergency Departments (EDs) treated more than 1.05M people with a behavioral health condition

Behavioral health as an ED primary diagnosis has increased by 19.1% since 2009

In comparison, all ED visits have increased by 6.4% during the same time period

In 2012, Illinois hospital Emergency Departments (EDs) treated more than 1.05M people with a behavioral health condition

Behavioral health as an ED primary diagnosis has increased by 19.1% since 2009

In comparison, all ED visits have increased by 6.4% during the same time period

EDs Have Become the Safety Net for Illinois Mentally ill

EDs Have Become the Safety Net for Illinois Mentally ill

The rapid decline of adequate mental health services is resulting in steep

increases in ED visits—the most expensive type of care—by the mentally ill.

The rapid decline of adequate mental health services is resulting in steep

increases in ED visits—the most expensive type of care—by the mentally ill.

ACA: Illinois Impact

Expanded Coverage:

2013 1.7 million uninsured Illinoisans

By 2015

More than 400,000 will gain coverage in the Health Insurance Marketplace

Nearly 350,000 to be covered under Medicaid

Primary Health Care HPSAs in Illinois

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Mental Health HPSAs in Illinois

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Nationwide Provider Shortage

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• It is estimated that rural counties in Illinois will reach a shortage of 600 primary care physicians over the next two years.

• Illinois is currently short 1,200 nurses statewide right now.

• Nationally, nurse practitioner graduations have almost doubled between 2001-2011.

Provider Trends are Clear

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• Fewer primary care physicians

• New staffing patterns for providers

• Strategic use of NPs and APs

Transformation in Rural Health Care

Obama Signs the Affordable Care Act into Law – March 23,

2010

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ACA Goals – Trends are Clear

1. Bend the cost curve

2. Improve quality & patient safety

3. Improve population health

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Telemedicine

Improving access to care

Improving Patient Outcomes

Improving Population Health & Wellness

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Televisits – OSCAR Inc.

Pictured above: Oscar's co-founders, from left, Mario Schlosser, Kevin Nazemi and Josh Kushner

Modern Healthcare, January 6, 2014

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Telemedicine Emerging as Rural ICU Solution HealthLeadersMedia 1.23.14

54 Tele-ICU monitoring centers – 21 rural

Beds equipped with Smart Alert software

UMASS (year 1)

Reduced ICU Patient Mortality by 30%

Reduced Hospital Acquired Infections

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Tele-ICUMercy Health System (Missouri)

480 beds expanding to 24 rural hospitals

30% reduction in ICU mortality

20% drop in LOS

Saves $25 million per year

John Muir Health (Northern California)

45% reduction in ICU mortality

54% reduction in LOS

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Legislative Initiative

HB5313 & SB3319

Requires commercial payers to reimburse for services provided via telemedicine in HPSAs.

IPS, ISMS, IRHA, IHA, Commercial Payers

Sponsor working on final language

16 states have passed similar legislation & 9 others are considering it.

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Thank You