Populationbased Health and Care Management Strategies

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Population-based Health and Care Management
Strategies
Linda Dunbar PhD RN Vice President, Care
Management

• JOHNS HOPKINS

• H E A L T H C A R E

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• JOHNS HOPKINS

• H E A L T H C A R E

Johns Hopkins University (JHU)
Johns Hopkins Health System (JHHS)
Johns Hopkins HealthCare (JHHC)
Organizational Support Services
Care Management
Operations
Network Management
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JHHC Disease Management
End Stage Renal Disease
Behavioral Health
Physical Rehabilitation
End of Life Care
Guided Care
Complex Medical
Cardiovascular/Diabetes TeleWatch
Partners with Mom
Children with Special Needs
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The challenge of traditional Disease Management

• Very labor intensive
• To achieve benefits, frequent contact with
  patients is essential
• Prospectively identifying the patients most in
  need on a daily basis is impossible
• Increase the efficiency of DM program
• Automate routine processes
• Weight, BP, basic query of symptoms
• Efficiently detect early clinical deteriorations
• Focus resources on patients in need

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• Development of a telemedicine system was a joint
  project between
• JHU- School of Medicine, Division of Cardiology
• JHU- Applied Physics Laboratory
• Goals of the telemedicine system
• Easy to use
• Inexpensive
• Employ widely available technology

TeleWatch
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TeleWatch Telemedicine System

• Automated, telephone-based telemonitoring system
• Patients self-report physiologic parameters
  (using durable medical equipment) and answer
  pre-recorded, disease-specific questions
• Algorithms designed to detect worrisome trends or
  responses which automatically alert the nurse
• Validation algorithms ensure data integrity

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Automating Disease Management TeleWatch Version
1.0
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TeleWatch deployment for JHHC
Delaware
West Virginia
TeleWatch server at Glen Burnie, MD
Washington D.C.
Virginia
Coverage of TeleWatch Nurse Case Managers at
Johns Hopkins HealthCare
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Summary of TeleWatch utilization

• 70 of patients call into the system at least 3
  times/week
• High level of patient acceptance
• 4 calls/week/patient
• Similar to other studies
• But significantly larger number of patients
• Broader sampling of population
• More efficient

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Developing models predictive of physiologic
instability
Hospital admission
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Developing models predictive of physiologic
instability
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Heart FailureMedication Management
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Heart FailureFinancial Outcomes
Zhang et al 1996 data in J Am Geriatrics Soc
2003. Healthcare inflation from BLS Medical Care
item. Sept. 2003
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Conclusions from JHHC experience

• TeleWatch decreases total expenditures mainly
  through
• Decreased hospitalizations
• Admissions PMPM decreased 52 compared with
  baseline year
• Decreased length of stay
• Length of stay per admission decreased 71
• 3.5 ALOS in baseline year compared to 1.0 ALOS
  post-program enrollment

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Patient perception of TeleWatch

• Easy connectivity (7.9)
• Adequate sound quality (7.5)
• Questions easy to understand (7.8)
• Easy to input data (7.4)
• Too complicated to use (1.6)
• Dont like putting data into computer (1.8)

8strongly agree 1strongly disagree
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What patients value from using TeleWatch

• 39 Nurse/Physician reviewing daily data
• 37 Helps patients to monitor their own health
• 11 Ability to get answers to clinical questions
• 4 Aids in taking medicines properly

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Current Challenges

• Increase physician interaction
• Align reimbursement with outpatient monitoring
• Dedicated time for physicians to monitor and
  respond to patients
• Incentivize physicians
• Increase patient utilization of monitoring
• More automated integration of monitors
• Incentivize patients
• Reduce telecommunication costs
• Use of internet as communication medium

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TeleWatch Projected Enhancements
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Other uses of TeleWatch

• Disease Management
• Asthma/COPD
• High risk pregnancy
• Other chronic illnesses
• Infectious Disease
• Bioterrorism/Disease Outbreak monitoring of
  symptom progression
• Large-scale medical management

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Summary

• Understand quality improvement and care
  management strategies of Johns Hopkins HealthCare
• Specific population management strategies
• Understand the use of data in all quality and
  care management activities
• Importance of data-driven decisions and programs