Rhonda Chetney, MS, RN

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Rhonda Chetney, MS, RN

• Intel Corporation
• Digital Health Group
• Previously with Sentara Home Care Services
• Chesapeake, Virginia

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Sentara Healthcare

• Largest integrated health care provider in
  southeastern Virginia
• Serves 2 million residents with more than 87 care
  giving sites
• 7 acute care hospitals with 1,722 beds
• 2 Outpatient campuses
• 7 Nursing Centers with 3 Assisted Living
  facilities
• 265 Primary Care Specialty Physicians

• Sentara Healthcare offers
• Award-winning Centers of Excellence
• Home health hospice
• Physical therapy rehab
• Nightingale regions only air ambulance service

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Sentara Home Care Services

• Freestanding, not for profit
• Home Care, Hospice, Infusion, HME
• Admissions 14,191 per year
• Patients on Service at any given day 8,000
• Home Care Visits 266,663 annually
• Number of Employees 680

4
Telehealth Programs at Sentara include
Heart failure Asthma Wound care COPD DM
Philadelphia VNA
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Heart Failure Telehealth Study

• Use of telehealth to decrease admissions and ED
  visits.
• Improve hospital capacity
• Save home care visit costs

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Charges/Admission Sentara Hospitals
NYHA Functional Classification 3 and 4
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Partnering with hospital

• Capacity Management teams
• Monthly report cards to physician groups with LOS
  difference from expected, LOS and charges,
  readmissions
• ED to Home Care Program
• Telehealth Pilot program for heart failure

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Inclusion criteria and data collection

• Retrospective. Case Controlled study.
  Symmetrical periods are compared Pre and Post
  intervention of telehealth program.
• Primary Diagnosis of CHF
• Enrolled gt5 months. Avg patient enrolled 8.5
  months.
• Discharged between 11-1-1999 and 7-31-2005
• NYHA 3 or 4
• Exclude patients if no matching Pre comparison or
  if no activity pre and post.
• Comparative Non-study population also limited to
  LVEF 3-4, CHF primary diagnosis.

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Decrease in Hospital Admissions
72 Decrease in Hospital Admissions
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Decrease in Hospital Days
72 Decrease in Hospital Days
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Savings from telehealth program
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Healthcare system buy-in

• Relief on hospital bed capacity enables more
  profitable admissions
• Increased physician satisfaction
• Reduced ER utilization and backup
• Less use of overflow beds in swing units.

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Patient Buy-in

• Promotes self-care and independence
• Age not a factor
• Patient friendly technology
• Improves quality of life
• Gives patient more control over health status
• Less intrusive
• Increases interaction with nurse
• Patients begin to develop self-care attitude
  because of the immediate feedback from the unit.
• Patients become in control of their health status

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Partnering With Health Plans

• Show cost, quality, adherence outcomes
• Be creative with use of resources
• Be willing to take risk
• Show improvement in access
• Demonstrate a competitive edge

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Sentara Health Plans, Inc.

• OptimaHealth
• 350,000 covered-lives
• Provider network 6,000
• Award-winning Disease Management Programs
• Partners in Pregnancy
• Sickle Cell Care
• Diabetes Care
• Asthma 1st U.S. EPA Award

• 700,000 covered-lives in statewide Behavior
  Health EAP programs
• Consistently ranked among nations top integrated
  health care networks
• Ranked among the top 25 Medicaid top 50
  Commercial plans nationally by U.S. News World
  Report in 2006

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Proof of Concept

• Home-based Telemedicine for Uninsured, High-risk
  Diabetic Population
• Inpatient Admissions ? 32
• Emergency Room Encounters ? 34
• Outpatient Visits ? 49
• (Diabetes Technology Therapeutics Journal,
  2002)

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Remote care Management Proof of Concept Project

• Optima Health and Sentara Home Care Services have
  partnered to evaluate whether remote care
  monitoring can improve clinical and cost outcomes
  for members with DM.
• Focus will be on patients who are on multiple
  oral medications who have suboptimal hemoglobin
  A1cs.

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Diabetes management project

• Determine whether patients who are on multiple
  orals can transition to insulin with the support
  of home health remote monitoring.
• Evaluate glycemic control as measured by A1c and
  mean daily glucose.
• Sustainability of results once monitoring is
  discontinued will also be measured.
• IRB approval

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Inclusion criteria

• Age greater than 35
• Type 2 diabetes at least 1 year prior to
  enrollment
• Non-insulin users on multiple oral meds.
• HbA1c gt8.0
• Member of the Health Plan at least one year.
• 50 members will be randomized into the
  intervention group and an equivalent number will
  be randomized into the control group

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Process

• Training for members in intervention group
• Remote monitoring device installed by home health
  nurses
• Insulin testing by members
• Data downloads from the telehealth units
• Home health staff will evaluate the data and
  contact the members and attending physician per
  the clinical protocol for med adjustments.
• Remote monitoring device in home for 6 months
  home care nurses case manage
• Follow-up monthly contacts for the next 6 months
  by health plan case managers.

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Health Economics

• Reduction in diabetes-related medication costs
• Cost savings overall with improved A1cs
• Patient satisfaction will also be measured.
• Satisfaction of home care nurses with the program

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Questions?