Health Care Without Boundaries - Mandy Bell
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Health Care Without Boundaries
Mandy Bell
Reimagining What’s Possible
Healthcare Needs Healthcare Gaps
Answering the Call
Avera’s roots stretch back to the frontier
of medicine of the Benedictine and
Presentation Sisters; who were called to
provide health care in Dakota Territory in
1897. This tradition of caring continues today:
“Avera is a health ministry rooted in the
Gospel. Our mission is to make a positive
impact in the lives and health of persons and
communities by providing quality services
guided by Christian Values.”
Copyright Avera eCARE 2019
Avera Health
33
HOSPITALS
80%
CRITICAL ACCESS
HOSPITALS
Copyright Avera eCARE 2019
Avera eCARE
Over 440 sites
in 29 states
2+ million
lives impacted
Serves 13 percent
of all Critical Access Hospitals
in the nation
Copyright Avera eCARE 2019
WORKFORCE INTERNATIONAL AND LOCAL NATIONAL IMPACT eCARE Hubs • San Antonio, TX eCARE averages • Fort Wayne, IN 100 external • Troy, MI • Israel 250+ guests per • India eCARE month • Kenya Employees
Avera eCARE Service Lines
Offering the most diversified telemedicine service in the U.S.
Consult Pharmacy Senior School Hospitalist Behavioral
Care Health Health
1993 2004 2008 2009 2012 2012 2015 2015 2017 2017 2017
Emergency Correctional Specialty
ICU Care AveraNOW
Health Clinic
Acute & Post Acute Services
Ambulatory Services
Current Partners
HOSPITALS & CORRECTIONAL
HEALTH SYSTEMS SCHOOLS FACILITIES
Acute Care – Children Inmates
All Ages
NURSING HOMES &
CLINICS
ASSISTED LIVINGS
Specialty Care –
Seniors
All Ages
Copyright Avera eCARE 2019
Guiding Principles
Improve
Improve Access Workforce
to Care Sustainability
Improve Care & Lower Costs
Outcomes
Copyright Avera eCARE 2019Access: 24/7 Emergency Specialty Care Crisis
Assessment
Experience
ER Nurse
Debriefing
Services
Board
Certified Stroke
Emergency Neurologist
Physician
And more
SANE
Exam
Support
Burn
Surgeon
Copyright Avera eCARE 2019Improving Care: Gestational Diabetes
19% Overall Reduction in C-Sections
Vaginal Deliveries without Complications
Increased by 26.8% at 38 Weeks
24% Decrease in Stays of >2 days at 39 Weeks
$500-$1,000
estimated savings to Patients Saved a Total of 58,186 Miles of Driving
payers per patient
TO DATE
125 mother’s served 25% increase in delivery contribution marginSupporting the Rural Workforce
“Tele-ED helps us to keep those young physicians
here, where they still get to have a family life, time
away, and not be tied to their phones.”
81.5% of clinicians believe that eCARE Emergency has helped with recruitment and retention
2x Increase in
Daily Census
25% Reduction
in ER Staffing
Costs
Copyright Avera eCARE 2019SNF/LTC Outcomes
Proven Results
Lower Costs
$342
Estimated Medicare
Cost Savings PBPM
Copyright Avera eCARE 2019Healthcare Without Boundaries
Behavioral Health, Anywhere
Emergency Group
Room Homes
Employee Mobile
Assistance Crisis
Outpatient
Clinic
Triage Inpatient
School Long Term
Health Care
Copyright Avera eCARE 2019Senior Living
Our program connects
individuals and staff to
RNs & providers at the
eCARE for 24/7 support
& urgent care.
Increase confidence of resident and
Support RNs and staff, reducing Decrease barriers to accessing care, improving
family, improving occupancy and
burnout and overtime resident experience
length of stay
Copyright Avera eCARE 2019Services: Growth:
• Nurse Extender Services Video Encounters and # of Schools
• Primary School Nurse Services 28
Benefits: 17 2182
9 1497
• Help managing chronic conditions 7
497 367
(diabetes, asthma)
• Help with acute sickness or injury 2015-16 2016-17 2017-18 2018-19
• Case management for parent contacts
regarding prescription refills, mental 91% of students who had an eCARE School
health needs and available resources Health nurse video visit were able to stay in
school instead of going home
Copyright Avera eCARE 2019Urgent Care Women’s Health
▪ Online
▪ Mobile App
▪ Kiosks available in grocery stores ▪ Gestational Diabetes
▪ Health Plan Benefit ▪ Lactation Consulting
Campus Urgent Care Business Health
▪ Colleges – Parent Pre-Pay ▪ Employee Assistance
▪ High Schools Program (EAP)
▪ Physician LIGHT™ Program
Health & Wellness Cancer Care
▪ Health coaching ▪ Cancer Navigation
▪ Coordinated care
▪ Specialty Pharmacy
▪ Respiratory Therapy (COPD)
Copyright Avera eCARE 2019Health Care’s Digital Disruption
Health Systems are Analog in a DIGITAL World
Millennials demanding Digital Health Systems using Analog
• 71% want to use mobile app • Only 17% have e-visits visits
to book appointments widely available
• Only 14% have video visits
• 74% prefer to see doctor widely available
virtually • Only 20% have implemented
• 75% look at online reviews online self scheduling
before selecting physician • Only 47% have implemented
messaging between patient
• 42% have used synchronous and providers
video telemedicine
Copyright Avera eCARE 2019Rapid Change in Technology & Environment
15 Years Ago
10 Years Ago
Today
Copyright Avera eCARE 2019Change
Change in the in the
Last Decade last decade
• How we interact
• How we shop
• How we watch TV
• How we read
• How we vacation
• How we work at home
• How we get around
Copyright Avera eCARE 2019Expectations are Changing
Copyright Avera eCARE 2019We are moving from a Hospital-Dominant
Ecosystem to a Healthcare-Dominant Ecosystem
Large-scale Combination of
New Healthcare Platform,
Non-Acute Care and
Products, and Experience
InsuranceHealth Care Innovations
Wearable technology combined with
smartphone, tablet, or computer apps allow
patients to monitor health data and transmit
them in real time to health professionals.
Copyright Avera eCARE 2019Health Care Innovations
Smart homes outfitted with sensors to monitor sleep quality, medication use, falls,
use of stove, toilet, and shower.
Copyright Avera eCARE 2019AI in Healthcare – It’s Here
• Identifying DNA mutations in
tumors
• Classifying Echocardiograms
• Predicting Heart Attack & Stroke
• Diagnosing Skin Cancer
• Adjusting ICU Treatment
• Detecting Breast Cancer Risk
• Predicting Suicide Risk
• Identifying End of Life for Referral
to Palliative Care
https://medicalfuturist.com/top-ai-algorithms-healthcare
Copyright Avera eCARE 2019Copyright Avera eCARE 2019
65 Enacted Telehealth Bills by 39 States in 2018 https://www.cchpca.org/sites/default/files/2018-12/2018%20Legislative%20Roundup%20FINAL.pdf?utm_source=Telehealth+Enthusiasts&utm_campaign=a85ee891fc- EMAIL_CAMPAIGN_2018_12_10_06_57&utm_medium=email&utm_term=0_ae00b0e89a-a85ee891fc-353229733 Copyright Avera eCARE 2019
Change is Hard
Overcoming Barriers
Inefficiencies and duplications
Technology costs and challenges
Reimbursement hurdles
Regulatory and security hurdles
Licensure and credentialing
Workflow and culture changes
Copyright Avera eCARE 2019It’s been a long road…but maybe we’re at lift off?
Medicare Claims for Telehealth
$28.7M
35.0 2016 Medicare reimbursements under its
2001: CBO Annual Part B telehealth benefit
$28.7
30.0
Estimate = $30 M 500,000
25.0 Billed services to Medicare alone in 2016
20.0
33% Increase
15.0 In Services billed over 2015
10.0 0.25%
Of all Traditional Medicare Beneficiaries
5.0 $2.5
0.0
https://www.healthcarelawtoday.com/2017/08/28/medicar
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 e-payments-for-telehealth-increased-28-in-2016-what-you-
should-know/
Copyright Avera eCARE 2019BUSINESS MODEL
Developing the Structure of Avera eCARE
Funding
IT infrastructure
Build vision for investors
to show value and Build technology
develop strong grant infrastructure to take
writers virtualize care deliver
Relationships Workforce Leadership Support
Create collegiality Develop team of Investment in technology and
culture among hub and experienced providers innovation, demonstrate
site providers – become and support specialists & national value and impact,
‘part of the team’ and recruitment and diversify revenues, be
make job easier retention passionate about impact of
access to affordable quality
Copyright Avera eCARE 2019 careBringing the Services to Life
Project Management
Data
Collection
Sales & Contracting Communicatio Pricing / Funding
ns
Staffing & Training Process
Regulatory Compliance Plan
Improveme
nt
Clinical Workflows Change Management Technology Metrics & ReportingAccelerating Change
Build the Evidence Base
Ward M, Merchant AS, Carter KD, Zhu X, Ullrich F, Wittrock A, Bell A. “Use of Telemedicine For ED Physician Coverage In Critical
Access Hospitals Increased After CMS Policy Clarification.” Health Affairs (Millwood). 2018, 12, 37. doi:
10.1377/hlthaff.2018.05103 https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05103
Mohr, N. M., Young, T., Harland, K. K., Skow, B., Wittrock, A., Bell, A., & Ward, M. M. (2018). Emergency Department
Telemedicine Shortens Rural Time-to-Provider and Emergency Department Transfer Times. Telemed J E Health. doi:
10.1089/tmj.2017.0262 https://www.ncbi.nlm.nih.gov/pubmed/29293413
Natafgi N, Shane D, Ullrich F, MacKinney C, Bell A, Ward M. (2017). Using Tele-Emergency to Avoid Patient Transfers in Rural
Emergency Departments: An Assessment of Costs and Benefits. Journal of Telemedicine and Telecare. March 7, 2017.
https://doi.org/10.1177/1357633X17696585
Mohr N, Vakkalanka JP, Harland K, Bell A, Skow B, Shane D, Ward M. (2017). Telemedicine use decreases rural emergency
department length-of-stay for transferred North Dakota trauma patients [in press]. Telemed Journal of e-Health.
https://doi.org/10.1089/tmj.2017.0083
VanOeveren L, Donner J, Antegrossi A, Mohr NM, Brown CA. (2017). Telemedicine-Assisted Intubation in Rural Emergency
Departments: A National Emergency Airway Registry (NEAR) Study. Telemed Journal of e-Health 2017 Apr;23(4):290-7.
https://doi.org/10.1089/tmj.2016.0140
Mohr NM, Harland KK, Chrischilles EA, Bell A, Shane DM, Ward MM. (2016) Emergency Department Telemedicine is Used for More
Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study. Academy of Emergency Medicine, 2016.
http://onlinelibrary.wiley.com/doi/10.1111/acem.13120/abstract
Mohr NM, Harland KK, Chrischilles E, Donner J, Bell A, Shane DM, Ward MM. (2016). Telemedicine penetration and consultation
among rural trauma patients in critical access hospital emergency departments in North Dakota. RTRC Research & Policy Brief,
2016 (1):1-4. http://ruraltelehealth.org/briefs/RTRC-NDTelemedTrauma-Brief-2016-sept.pdf
Potter AJ, Ward MM, Natafgi N, Ullrich F, MacKinney AC, Bell AL, Mueller, KJ. (2016). Perceptions of Benefits of Telemedicine in
Rural Communities. Perspectives in Health Information Management. Summer 2016.
http://perspectives.ahima.org/perceptions-of-the-benefits-of-telemedicine-in-rural-communities/
Ward MM, Ullrich F, MacKinney AC, Bell AL, Shipp S, Mueller KJ. (2016). Tele-emergency utilization: In what clinical situations is
tele-emergency activated? Journal of Telemedicine and Telecare. 2016 Jan;22(1):25-31.
https://www.ncbi.nlm.nih.gov/pubmed/26026189
Copyright Avera eCARE 2019Set the New Standard
SOURCES: Brown, C. A., Bair, A. E., Pallin, D. J., Walls, R. M., & NEAR, I. I. (2015). Techniques, success, and adverse events of emergency department adult intubations. Annals of Emergency Medicine, 65(4), 363-
370.e1. doi: http://dx.doi.org/10.1016/j.annemergmed.2014.10.036
Mohr, N. M., Young, T., Harland, K. K., Skow, B., Wittrock, A., Bell, A., & Ward, // M. M. (2018). Emergency Department Telemedicine Shortens Rural Time-to-Provider and Emergency Department
Transfer Times. Telemed J E Health. doi: 10.1089/tmj.2017.0262 https://www.ncbi.nlm.nih.gov/pubmed/29293413
Copyright Avera eCARE 2019Prepare the Next Generation
Copyright Avera eCARE 2019A Word of Caution
Copyright Avera eCARE 2019After all, Technology Solves Little Alone
Copyright Avera eCARE 2019Technology by itself is not the disrupter, not being
Customer-Centric is the biggest threat to any business
Netflix didn’t kill Blockbuster.
Ridiculous late fees did.
Uber didn’t kill the taxi business.
Limited access and fare control did.
Apple didn’t kill the music industry.
Being forced to buy full-length albums did.
Amazon didn’t kill other retailers.
Poor customer service and experience did.
Who’s your customer?
Where can you disrupt?Digital Disruption Has Already Happened
Change
Change in the in the
Last Decade last decade
How we interact
How we shop
How we watch TV
How we read
How we vacation
How we work at home
How we get around
Copyright Avera eCARE 2019Mandy Bell | mandy.bell@avera.org
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