Here to Stay: Virtual Urgent Care Prepared for Northwest Telehealth - - PowerPoint PPT Presentation

Here to Stay: Virtual Urgent Care

Prepared for Northwest Telehealth Resource Center 2015 Annual Conference Matt Levi, MHA, MPH Ben Green, MD Director of Virtual Health Services Director of Clinical Innovation CHI Franciscan Health Carena

April 1, 2015

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Agenda

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CHI Franciscan Health

• Franciscan Virtual Urgent Care overview
• Results
• Implications and health system next steps

Carena

• Evolution of virtual care
• Market forces
• Clinical experience delivering virtual urgent care

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Franciscan Virtual Urgent Care

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• 24/7 care options through web portal or

toll free #

• Integrated with Franciscan’s:

– Primary care clinics – Main website – Patient access team

• Help patient choose the appropriate

Franciscan care

• Assistance to schedule follow-up care

and/or find PCP

Service Overview

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Franciscan Virtual Urgent Care

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2013 2014 2010-2011 2015 2012

 Launch of after-hours option for existing patients  Answer PCP clinic phones after-hours for patient care, referring patients back to PCPs for follow-up  Development and launch of web portal and regional marketing campaign  Expansion to 24/7 virtual

• ffering, and additional

patient access components  Expansion to growth markets  Transition to employed providers  Insurance coverage  Additional access points  Launch of direct to consumer subscription service  Franciscan Anytime service for FHS, FMG and local CHI employees and dependents

Development timeline

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Why 24/7 Virtual Urgent Care

Strategic rationale

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• Enhance patient experience
• Drive new patient acquisition & retention
• Strengthen primary care practice
• Innovate for population health

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• Appropriate care, setting, and cost
• CHI Franciscan access points:
• Emergency Room
• Avoid as primary care option
• Prompt Care/Urgent Care
• Used for urgent needs
• In-clinic Primary Care
• Virtual Urgent Care
• Episodic consultative care and

referral to PCP for follow-up

CHI Franciscan Health

Primary care options

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Franciscan Virtual Urgent Care

Web Portal Activity

• 5,000

10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 Q3 2014 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Website Visits New Visitors

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Franciscan Virtual Urgent Care

Volume of completed care requests

200 400 600 800 1000 1200 1400 1600 1800 Q3 2014 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014

Engaged Visitors

Engaged Visitors

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Franciscan Virtual Urgent Care

Volume of virtual visits (stacked line graph)

• 100

200 300 400 500 600 700 800 900 1,000 Q3 2014 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Franciscan Anytime patients Afterhours PCP patients Virtual Urgent Care patients

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Franciscan Virtual Urgent Care

% of patients unaffiliated with a PCP

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Q3 2014Q4 2013Q1 2014Q2 2014Q3 2014Q4 2014

No System PCP

No System PCP

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Franciscan Virtual Urgent Care

Patient demographics

Self Pay 17% Commercially Insured 51% Government Insured 11% Unknown 21%

Engaged Visitor Insurance Type

5 10 15 20 25 30 35 40

Engaged Visitor Age Male 34% Female 64% Unknown 2%

Engaged Visitor Demographics

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Franciscan Virtual Urgent Care

Volume of patients requesting help finding a new PCP

50 100 150 200 250 300 350 400 450 500 Q3 2014 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014

Patients requesting a new PCP

Patients requesting a new PCP

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Franciscan Virtual Urgent Care

Delivery on value equation, through September 2014

• Enhance patient experience

– Patients saved an estimated 4,200 hours in travel and waiting room time – Patients saved an estimated $600,000 health care costs

• Drive new patient acquisition & retention

– New patients receiving a virtual visit resulted in 75 hospital visits and an estimated contribution margin of $160,000 – New patients not receiving virtual visits resulted in 118 hospital visits and an estimated contribution margin of $338,000

• Strengthen primary care practice

– 1,472 referrals for new PCP – 50% reduction in pages to our on-call PCPs

• Innovate for population health

– Clinical acceptance, internal champions, and a growing market for virtual care

New patients are those patients who have not had a clinical encounter within the 24 months prior to their earliest FVUC engagement. Contribution Margin reflects revenue less direct costs and is calculated as gross charges multiplied by a conversion factor for any hospital based encounters.

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• Transition virtual visit care to

CHI Franciscan clinicians

• Insurance coverage
• Kiosk access points

CHI Franciscan Health

Next steps for Franciscan Virtual Urgent Care

Ab o ut Ca re na

T e a m o f me dic a l, te c hno lo g y, a nd c o nsume r se rvic e pro fe ssio na ls c o mmitte d to c re a ting the b e st he a lthc a re e xpe rie nc e po ssib le . We pro vide the so ftwa re , 24/ 7 sta ffing , a nd

• pe ra tio ns e xpe rtise fo r he a lth syste ms to de plo y

te le me dic ine – Vir

tual Clinic .

T

• da y o ur Se a ttle -b a se d me dic a l Virtua list a nd

Pa tie nt Co nc ie rg e te a ms o pe ra te c lie nt-b ra nde d Virtua l Clinic s tha t se rve o ve r 8M pa tie nts.

Mission

Re de fine he a lthc a re b y c ha ng ing ho w c o nsume rs a c c e ss c a re a nd ho w pro vide rs de live r it.

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Care na, Inc ., Co nfid e ntia l |

Ca re na ’ s E vo lutio n into Virtua l Ca re

F

• unde d b y Prima ry Ca re MD se e king to

c re a te g re a t pa tie nt e xpe rie nc e s. Pa tie nt-frie ndly a lte rna tive tha t re duc e d c o sts a sso c ia te d with po o r a c c e ss.

2000 House Ca lls

T e c hno lo g y-e na b le d ho use c a ll de live ry. E xpa nde d re a c h a nd inc re a se d va lue witho ut c o mpro mising pa tie nt e xpe rie nc e .

2009 Virtua l House Ca ll

E mpo we ring syste ms to o ffe r b ra nde d c o nsume r-frie ndly virtua l se rvic e s.

2013 He a lth Syste m Solutions

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T he n…

1925: Sc ie nc e and I

nve ntio n ma g a zine

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…a nd no w

Apr il 2014: “Mo de l Po lic y o n the Appro pria te Use o f T

e le me dic ine T e c hno lo g ie s in the Pra c tic e o f Me dic ine ”

June 2014:

“Co ve ra g e o f a nd Pa yme nt fo r T e le me dic ine ”

“The number of doctor-patient video consultations will nearly triple from this year to the next, from 5.7 million in 2014 to over 16 million in 2015, and will exceed 130 million in 2018."

• Harry Wang, Director, Parks Associates*

*So urc e : http:/ / www.pa rksa sso c ia te s.c o m/ b lo g / a rtic le / c hs-2014-pr10

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T a c kling the I ssue s o f the He a lthc a re Co nsume r

• QUAL

IT Y de fine d b y c linic a l sa fe ty & e xc e lle nc e

• ACCE

SS de fine d b y c o nve nie nc e & a va ila b ility

• T

RUST de fine d b y a re spe c te d b ra nd the y a lre a dy

kno w & c o nfide nc e tha t the ir c o nditio n c a n b e ma na g e d

• CL

ARIT Y de fine d b y simplic ity & tra nspa re nc y

• CONNE

CT IVIT Y a s de fine d b y the inte g ra tio n o f the ir

• nline e xpe rie nc e with the ir b ric k & mo rta r

e xpe rie nc e

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E stablishing QUAL IT Y: T

he Virtua list

Car e na Vir tualist T e am

• E

mplo ye d te a m o f b o a rd-c e rtifie d F a mily Me dic ine MDs a nd ARNPs

• De vo te d to a n e xc lusive te le me dic ine pra c tic e
• De ve lo p a nd a dhe re to Virtua l Pra c tic e Guide line s

(VPGs) a t the po int o f c a re

• All pro vide rs lic e nse d in e a c h sta te in whic h c a re is

de live re d

• Co lla b o ra tive c linic a l c ulture
• Co mpe nsa tio n b a se d, in pa rt, o n pa tie nt sa tisfa c tio n a nd

a dhe re nc e to VPGs

• Virtua l Ca re tho ug ht le a de r
• E

mpo we ring the He alth Syste m Pro vide r to de live r Virtual Care

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E stablishing QUAL IT Y: Virtua l Pra c tic e Guide line s

• Dia g no sis-spe c ific virtua l c a re c rite ria a nd

tre a tme nt g uide line s fo r urg e nt a nd prima ry c a re

• Ba se d o n a n a na lysis o f 35,000 Ca re na ho use c a ll

e nc o unte rs & na tio na l sta nda rds o f pra c tic e

• E

mpha size s pa tie nt sa fe ty, b e st pra c tic e s, a nd c linic a l q ua lity

• E

mb e dde d into pro prie ta ry po int-o f-c a re c linic a l so ftwa re pla tfo rm

• Ba sis fo r c linic a l a nd a c tua ria l re vie w a nd study

E stablishing QUAL IT Y: QAI

P

INT E GRAT E D QAIP PROGRAM*

• Clinic a l Appro pria te ne ss o f Virtua l Visit
• Adhe re nc e to Virtua l Pra c tic e Guide line s
• Ong o ing mo nito ring o f pre sc rib ing pra c tic e s a nd a ntib io tic ste wa rdship

pro c e sse s

PROCE SS

• 5 me mb e r Ca re na c linic ia n c o mmitte e
• Qua rte rly Re po rts
• Blinde d re vie ws o f ra ndo m a nd ta rg e te d dia g no se s

*Appr

• ve d by WA State De pt. o f He alth as a Ce r

tifie d Quality Impr

• ve me nt Pr
• gr

am

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E stablishing QUAL IT Y: 5 Da y F

• llo w-up Ca ll Outc o me s

Be tte r 48% Re solve d 46% No Change 4% Wor se 2%

Clinic a l Sta tus

None 82% PCP 12% UC 3% E R 0% Othe r 3%

Subse que nt Ca re Re quire d

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E stablishing ACCE SS: Utiliza tio n

12:00 AM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM

Visit Distribution by time

(we e kda y)

Visit Distribution by da y

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E stablishing T RUST

: A Re spe c te d Bra nd

5 Da y F

• llow- Up Ca ll

“Would you use the se r vic e again? ”

YE S 97.2 %

Patie nt Surve y Re sponse s, 2013 – pre se nt, all c lie nt pro g rams

K e ntuc kyOne

• 68 % did no t ha ve a syste m PCP prio r to Visit
• 72 % a vo ide d a n urg e nt c a re visit
• 7% a vo ide d a n E

R visit

F ra nc isc a n

• 1,300 ne w pa tie nt le a ds ide ntifie d
• $600,000 in he a lthc a re sa ving s
• 4,200 pa tie nt ho urs sa ve d

YE AR ONE

E stablishing T RUST

: E ffe c tive Glo b a l T re a tme nt Ra te s

T re a te d Virtua lly 70% Re fe rre d to Urg e nt Ca re 11% Re fe rre d to PCP 9% Re fe rre d to E D 9% Othe r Re fe rra l 1% Othe r 30%

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0% 2% 4% 6% 8% 10% 12% 14%

F r e que nc y of Diagnosis

Co mple te d Virtua l Visit Re fe rre d fo r in-pe rso n Visit

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E stablishing T RUST

: Bro a d Clinic a l Utility

T

• p 15 re pre se nt 79% o f a ll visits

E stablishing T RUST : Judic io us Pre sc rib ing

33% 21%

Any Rx Antib io tic Rx: All Visits

All Visits

Rx Ra te s F SMB Conte xt: “Pre sc rib ing me d ic a tio ns, in-pe rso n o r via te le me d ic ine , is…in ac c o r danc e with c ur r e nt standar ds o f pr ac tic e and c o nse que ntly c ar r y the same pr

• fe ssio nal ac c o untability as pr

e sc r iptio ns de live r e d dur ing an e nc o unte r in pe r so n”

Ca re na pro vide rs DO NOT

pre sc rib e c o ntro lle d sub sta nc e s o r ro utine re fills

38% 69% 73% 48%

Ca re na Co mple te d Virtua l Visits Gro ve r 2012 L e e 2014 Grija lva 2009

Acute Respiratory Tract Infection (ARTI) Antibiotic Prescribing Rates

1. Gro ve r ML , Mo o ka da m M, Rutko wski RH, e t a l. Ac ute re spira to ry tra c t infe c tio n: A pra c tic e e xa mine s its a ntib io tic pre sc rib ing ha b its. Jo urna l o f F a m Pra c tic e . 2012;61(6);330-35. 2. Grija lva CG, Nuo rti JP, Griffin MR. Antib io tic Pre sc riptio n Ra te s in Ac ute Re spira to ry T ra c t Infe c tio ns in US Amb ula to ry Se tting s. JAMA. 2009;302(7):758-766. 3. L e e GC, Re ve le s KR, Attridg e RT , e t a l. Outpa tie nt a ntib io tic pre sc rib ing in the Unite d Sta te s: 2000-2010. BMC Me dic ine . 2014;

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E stablishing CL ARIT Y: Simple Pro c e ss a nd T

ra nspa re nt Pric ing

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E stablishing CONNE CT IVIT Y: Se a mle ss I

nte g ra tio n

CUST OME R

DIRE CT E D T O IN- PE RSON CARE T RE AT E D VIRT UAL L Y RE F E RRE D T O IN- PE RSON CARE ?

• Me dic a l re c o rd to PCP
• Ca re pla n to pa tie nt o ps
• Visit summa ry to pa tie nt
• Pre sc riptio n to pha rma c y
• Sa tisfa c tio n surve y

Data Inte gr ation

• Nurture c a mpa ig n da ta

c a pture

• Se rvic e e nc o unte r da ta

c a pture

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E nc our aging Re tur ns: Pa tie nt Sa tisfa c tio n

Patie nt Sur ve y Re sponse s

2013 – pre se nt, a ll prog ra ms “I a m sa tisfie d with the pro vide r's a sse ssme nt a nd unde rsta nding o f my me dic a l c o nc e rn” “I fo und this to b e a va lua b le se rvic e ”

90%

Ag re e / Stro ng ly Ag re e

Patie nt Comme nts

5 da y F

• llo w-up Ca ll

“Wo uld Yo u use the Se rvic e Ag a in? ”

97.2%

Sa id “YE S”

92%

Ag re e / Stro ng ly Ag re e

T he q uic k re spo nse b le w me a wa y. T he pro vide r wa s tho ro ug h, tre a tme nt wa s suc c e ssful a nd I didn't spe nd a ll mo rning a t the urg e nt tre a tme nt c e nte r. Ve ry sa tisfie d a nd wo uld de finite ly use the se rvic e a g a in.

“

T he e ntire e xpe rie nc e wa s b e yo nd a we so me a nd so e a sy. I wa s a b le to g e t tre a tme nt b e fo re I le ft fo r wo rk this mo rning , so no lo st time …T his e xpe rie nc e fa r e xc e e de d my e xpe c ta tio ns!

“

Sur ve y R e sponse R a te s (R a ng e pe r he a lth syste m): 17- 26%

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