Transcript tao-healthexpress020515x - Telehealth Alliance of Oregon

Health eXpress Experience
Telehealth in Practice
Telehealth Alliance of Oregon
February 2015
Michelle Wernert
Agenda
• Why Telehealth – What’s the big deal?
• Disruptive Innovation and Telehealth
• Health eXpress Overview
• Health eXpress - 2014 in Review
• Community Partnerships
• Lessons Learned
• Crossing the Chasm
• On the Horizon
House calls circa 1930
Beginnings of Telehealth
The future…?
Pope
Benedict
XVI
Pope
Francis
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Coming full circle
A review of Health eXpress
A web enabled platform that connects consumers to
quality health care providers securely where ever they
are and at convenient hours.
Health care providers can
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Discuss symptoms
Diagnose conditions
Prescribe medications
Manage care more efficiently
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Health eXpress Program Alignment
Improve Population Health
• Improve timely access to care
• Prevent escalation of symptoms
• Decrease avoidable high acuity visits
Care Experience
• Improve convenience for patients
• Increase access to care
• Connected care (EMR, follow-up)
Cost Containment and Affordability
• Increase appropriate use of healthcare services
• Support utilization of preventative care services
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Why online care matters to employers
Improves
employee
satisfaction
• Convenience - patients can access their provider from
home and on their schedule
• High satisfaction scores- 81% rate online care better
than in-person care
• Differentiation in benefit package- offering employees
options and innovative solutions
Increases
productivity and
capacity
• Allows employees flexibility
• Lower absenteeism: average time savings 2 hours per
visit within the work day
• Increase capacity – Same day, flexible appointments
Reduces cost of
care
• Direct savings of 45% to 50% per visit average
• Better utilization of care - higher cost visits avoided (i.e.
late night ED visits because nothing else is available)
• Support employees that are at risk or high needs
patients (diabetes management)
How Health eXpress works
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Patients access care logging in or walking into Kiosk
Electronic medical record is charted in Epic
Providers refer when appropriate
Patients and primary care providers (if agreed to by patient)
receive after visit summary to ensure connected care
Patients receive follow-up phone call and care through
Health eXpress when appropriate
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Health eXpress Clinical Scope
Cough, cold & allergy
Flu
Rash
Oral lesions
Diarrhea
Bladder infection
Smoking cessation
Pinkeye
Ear pain
Acne
Joint pain
Low back pain
Headache
Burns
Sunburns
Wellness services
Children’s services
Rx scripts
28% of IC
and ED
visits
National Institute of Health 2010
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Health eXpress Service Models
• Kiosk Service
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On site location in a private space
Walk in appointments
Clear high-definition video
Telepresenter Option
Current Hours
Mon to Fri: 8am to 8pm
Weekends: 9am to 5pm
• Web/Mobile Service
• On Demand
• Available to anyone with a internet connection, web cam and microphone
• Available on Android and iOS
Web
Mobile
Kiosk
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Health eXpress Kiosk
8 Workstation Kiosks across Oregon
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Meet the Provider Team
Our licensed, board-certified Providence Family Nurse Practitioners
can provide diagnosis and treatment recommendations, which may
include prescriptions or labs.
Thanh Nguyen
Larlene Dunsmuir
Kim Tull
Kimberly Rodda
Kristen Harris
Melissa Sanchez
Rated at 4.8 Stars by Health
eXpress Patients
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Launched in 2014
• Web/Mobile for…
• Employer Group Subscriptions
• Selfpay (Direct to Consumer)
• Insurance Billing
• Providence Health Plan – Launched 1/2/2015
• Kiosks at…
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PEBB & PGE expansion
Promotores Mobile Clinic
Safeway
Medford Hospital
• In partnership with CCOs
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Health eXpress – Web Visit
www.healthexpress.com
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This option means
that the user will
have to go to
MyAccounts, Edit
Profile to enter
their information
later. It acts the
same as selecting
‘no’.
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Community Partnerships
Health eXpress Mobile Clinic
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Partnership with the Parish Health Promoter
Program – “Promotores”
Provide a Nurse Practitioner consult as
appropriate via Telehealth
Provide health screenings to underinsured
population
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Blood Pressure
Cholesterol
Lipids
Glucose
Includes referrals to PCP care as well as
financial assistance programs
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Community Partnerships Promotores
2014
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Patient Satisfaction
12 clinics offered
• 100% would recommend service
Patients Screened = 220
• 100% patients understood next
Patients Health eXpress Visit = 79
steps in care or treatment
Patients Referred to additional services = 38
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Promotores Health eXpress
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Community Partnerships
Health eXpress Medford
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Partnership with the Oregon CCOs
Staffed kiosk located at the Medford
Hospital
50,000 CCO Members
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~400 to 500 per month seek care at ED for
low acuity conditions that can be treated by
Health eXpress
• CCO Members = $0
Selfpay = $49
Providence Health Plan = depends on plan
Launched November 2014
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Community Partnerships
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2014 in Review
Lessons Learned
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Health eXpress Visits Trends
Volume increased 3X Year over Year
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Utilization vs. Satisfaction
1591
2014
98%
96%
515
2013
98%
81%
210
2012
96%
81%
# of Patients seen
% Patient satisfaction rate
% Patients believe service is same or better than a traditional visit
Where Would Patients Have Gone
n = 483
Location
PCP
Urgent
Immediate Care
ER
Average Cost
$
159
$
193
$
193
$
1,557
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2014 Top Medical Conditions
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Top 10 Medications Prescribed
Total Prescriptions: 1,070
% of Visits that Resulted in a Prescription: 67.3%
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Addressing Patients’ Concerns
Percent of patients whose medical concern was addressed: 98.7%
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Health eXpress Demographics
Age & Gender
• Overall Male: 29.1%
• Overall Female: 70.9%
% of Visits
• Average Age: 41.5
• Oldest Patient: 83
• Youngest Patient: 1 month
Our Providers can treat children to as
young as they feel comfortable,
recommended age is > 4 months old
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Web vs. Mobile Utilization
% of Visits
• Female mobile users are the
largest demographic
• Mobile is comparatively more
popular with women than men
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Health eXpress Demographics
Location
69% of selfpay visits are
patients in the
Portland/Vancouver Metro area
DTC Patients by County
PDX Metro
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Health eXpress Wait Time
Average Wait Time: 3:40 minutes
Wait Time Target: < 4:00 minutes
Average Wait Times Over the Year
6:00
4:48
3:36
2:24
1:12
0:00
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Health eXpress Duration of
Visit
Conversation Duration
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# of Visits with Duration
Average Visit Length: 10:46
Key Factors in Longer Visits:
• More complicated health issue
• Technical Issues
Providers becoming more efficient
with technology, lowering duration
of visits. Average visit duration fell
by 3 minutes over the year.
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40
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10
0
:00 :02 :04 :06 :08 :10 :12 :14 :16 :18 :20 :22 :24 :26
Minutes
Average Duration of Visits Over Time
0:20
0:17
0:14
0:11
0:08
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Crossing the Chasm
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Finding and engaging clinical telehealth champions
Medical Liability
Provider Compensation Infrastructure
Reimbursement
Navigating Regulations
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Licensure
Medicare & Medicaid
FSMB Guidelines
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State by State adoption
• Integration with EMR
• Adoption
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On the Horizon
• Expansion
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Washington (EPIC) – Q1 2015
Health eXpress Regional Expansion
Additional Employer Groups
Additional Payers
• PHP Medicare Advantage
• Primary Care
• Specialty Care
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Questions?
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Retail Staffed Kiosk Model
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Health eXpress Service Models
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Patient
Technology
Scheduled?
Customers
Notes
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Web
(Unstaffed)
American Well On-Demand
Website
Platform
Oregon: Selfpay,
The web
PEBB, Evergreen,
application can
PHP Insurance, Intel include a Single
Sign On
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Mobile
(Unstaffed)
American Well On-Demand
App (iOS or
Android)
Oregon: Selfpay,
The app does not
PEBB, Evergreen,
include all features
PHP Insurance, Intel of the website
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Employer
Kiosk
(Unstaffed)
Jabber / Cisco
Scheduled
8 Kiosks: PEBB &
PGE
Free to employees
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Retail Kiosk
(Staffed)
Jabber / Cisco
Scheduled
2 Kiosks: Safeway,
Jackson Care
Connect, All Care
Health Plan
Available in
Medford (OR) as
alternative to ER
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Employee
Clinic Kiosk
(Staffed)
Jabber / Cisco
Scheduled
2 Kiosks: PSVMC,
PPMC
An extension of
Employee Health