Telemedicine and the
Patient Experience
Definitions, Models, Implications
Matthew E. Hanis
[email protected]
636.537.5454
© Hanisworks 2016
AGENDA
Presenter Background
Mercy Virtual Overview
Defining Virtual Health
Healthcare Industry circa 2025
Sustainable Opportunities for Consideration
20 Years in the Business of Healthcare
TouchCare
Mobile Health Engagement Platform
Hanisworks
Independent consulting practice
Mercy Virtual
Top 10 virtual health service provider
Advanced Practice Strategies
Measure & Improve Clinical Decision Making
Healthcare Business of Thomson Reuters
Now Truven Health Analytics
APACHE Medical Systems
Critical Care Clinical Analytics now part of Cerner
Telemedicine
Remote
delivery of
medical consult
Virtual Health
Anticipate Worsening
Activate Healthy Behavior
© Hanisworks 2016
October 22, 2015 | Mercy
PANEL 2
Measuring and improving care
Source: Health Leaders 10/2015
6
Virtual Health Maturity Model
Net Economic Impact
+
Dignity
Avera
Carolinas
FACTORS:
 Clinical Breadth
 Digital Footprint
 Patients Served Virtually
o PMPM Lives
o ED Enc, Acute Admits
o PCP, Urgent Care
o Self-serve Transactions
 Contribution Margin
0
Mercy
-
Size = Scale
Teladoc
Fragmented
Care Continuity
home – mobile – clinic – acute – post-acute
Integrated
© Hanisworks 2016
Virtual Care Center
A Hospital without Beds
October 22, 2015 | Mercy
Source: Google Images 6/2016
8
October 22, 2015 | Mercy
Sepsis Program
50%
Pre-Sepsis Program (2005 – 2008)
Deployment
Post-Deployment
40%
Percent Mortality
34%
30%
23%
22%
19%
20%
10%
9%
7%
0%
Severe Sepsis
Septic Shock
Source: Health Leaders 10/2015
9
Virtualizing Healthcare
Retailing & Banking Rationalized,
What Happened to Healthcare?
US Banking Transforms 1990-2005
Banking Locations per 10,000 people, US
• 15% less branches per 10k people
• 55% less employees per branch
• 85% more deposits increase
Retail Supply Chain Productivity 1995-2005
Year
US
WMT
WMT % US
1990
1.8
2.3
3.0
0.03
0.14
0.33
1.7%
6.1%
11.0%
2000
2010
Annual Retail Sales (in $T)
Technology, Regulatory, Business Model
© Hanisworks 2016
Population Health productivity improved 0.5% from
1995-2005. Retail productivity improved 28%.
Assumes admissions per thousand a proxy for improved population
health productivity e.g. triggering healthy behaviors and initiating
clinical interventions sooner
Financial Implications
2015 Anchor Points & Assumptions
2015 US Healthcare Spending: $3.1T
US Healthcare Spending by Payer Type
Source: https://www.cms.gov/research-statistics-data-and-systems/
Source: http://www.chcf.org/publications/2015/12/data-viz-hcc-national
Provider-Side Assumptions
(a) 4 Service Segments = $1.8 T
(b) Consumers want virtual
(c) $306 Billion (17%) impacted
(d) Payer will accumulate value
© Hanisworks 2016
Payer-Side Assumptions
(a) $252 Billion economic value
(b) Really, really complicated
(c) Enormous Barriers
•
•
•
Health data fragmentation
Misaligned Provider incentives
Inflexibility & provincialism
The Virtual Healthcare Consumer
Three personas
(a) Under 30, healthy: convenience, my clinician, low co-pay
(b) 40 – 50 year with complex Illness: make my complex health information
portable & meaningful
(c) Adult child of a severely-ill parent: create convenient access, interact daily,
keep me notified
All Consumers prefer Virtual with their
regular provider
#2 priority varies by age:
Younger consumers rank cost 2nd and
older consumers rank immediacy
From the Advisory Board Virtual Visits Consumer
Choice Survey of nearly 4,900 consumers
Virtualizing Urgent Care
ROI Model: Load Balancing in Urgent Care
Load Balancing + Bricks & Clicks
(a) Urgent Care providers typically have 20% unused capacity
(b) Consumers seek urgent care virtually for convenience
(c) TouchCare matches consumer demand with unused urgent care provider
capacity
(d) Generates 300%+ ROI, new patient acquisition, consumer loyalty
Customer Data
4
40,000
$135
80%
$80.00
4,000
$320,000
Sites
Encounters per Year (Total, all sites)
Avg revenue per Patient
Clinician Utilization %
Virtual Price
Net-new Visits: Virtual
Net New Revenue, Annual
2,000 North Carolina commercial insurance plan members surveyed
62% prefer a virtually provider with local presence
11% would switch primary care provider to get virtual offering
October 22, 2015 | Mercy
In-Home Poly-Chronic
Care Management
Source: Google Images 6/2016
21
ROI Model: Medicare Advantage PMPM
Medical Spend, Current
Patient gets better quality of life
Plan sponsor saves enormous $
Acute Care provider loses cash flow
Emergency Transport
ED Encounters
Acute Admits
Medical Spend, Avoided
Virtual Health Services
Net Savings per Patient
$75,123
-6
-6
-4
$49,581
$12,800
$36,781
Accrues to risk-bearing entity
Small & Rural Hospitals
Ambulance
bypasses due
to capabilities
Small Hospital
Tertiary
Retain Small Site Patients Locally
• CHS transferring sites operate at 49%
capacity
• Transfer 13k per year, 30% avoidable
• Retain avoidable transfers increase to
56% capacity
• Adds $55 M to small hospital revenue
• Load balancing reduces nighttime
physician costs
Barriers & Roadblocks
(a) Reimbursement
• CMS, Medicare, Medicare Advantage
• Commercial Payer Telemedicine Policies
(b) Clinical Workflow & Clinician Adoption
• Kaiser Northern California did 60% of patient encounters virtually
(c) Consumer Readiness
• Missouri Telehealth Network survey of 30,000 telemedicine consumers
found 90% were satisfied with the quality of care
(d) Licensing & Credentialing
• National Licensure Compact
(e) State regulatory barriers
• Texas Medical Board vs. Teladoc
Matthew E. Hanis
636.537.5454
[email protected]
54 Broadview Dr., Clayton MO 63105