Mercy Health System
TeleMedicine
2012
HOSPITALS
25 acute care hospitals
6 managed hospitals
3 heart hospitals
2 children's hospitals
1 rehab hospital
MISSOURI STATS:
>1.5 million people served
1,071 integrated physicians
413 primary care physicians
9 acute care hospitals
134 clinic locations
LEGEND
Hospital
Managed Hospital
Ambulatory Facility
Urgent Care
AMBULATORY SERVICES
233 clinic locations
27 urgent care centers
7 outpatient surgery centers
4 retail clinics
MEDICAL STAFF & CO-WORKERS
37,000 co-workers
1,580 integrated physicians
5,369 active medical staff
(includes integrated and non-integrated physicians: OHH)
619 advanced practitioners
UTILIZATION
3,937 staffed beds
574,666 ED visits (FY11)
6,566,057 outpatient visits (FY11)
160,382 inpatient discharges (FY11)
2
What are we solving for
a new model of care
• Access to Care
– Primary Care
– Specialty Care
• Provider Shortages
– PCP and Specialty
• Cost pressures
– Hospital will be a cost center and not a revenue center
• Patient Centeredness
– High service model
Mercy’s Center for Tele Health and Innovation
Virtual Care Center
Chief Innovation Officer
Medical Director
Operations Director
Clinical Ops VP
Operations Director
Tele – Medicine
Care Model
Delivery
Virtual Care
Population Management
Centralized
HUB Model
Resources have a central feel and
central supervision
Decentralized
Consult
Resources are distributed although
Scheduling and supervision are central
Store and
Forward
Resources may be either
central or distributed
encounter is asynchronous
and my involve images
and or consultation
Collaboration
Resources are distributed
and are outside of Mercy
encounter is
asynchronous and my
involve images
and or consultation
Chronic Care
Management
Scheduling
Call Center
Scheduling &
referral
management
Care
Coordination
Nurse on Call
Center
Post Acute
Care
E-Visits
24/7
Asynchronous
Home Health
Support
Care
EHR support
Medical Director
Operations Director
Center for Innovation
Epic
Informaticist
Research
Care
Delivery
Innovation
Grants
Analytics
Tele-Medicine Division
Connector
Tele – Medicine
Virtual Care
Asynchronous
24-7
e-visit support
Store + Forward patient visits
Medical Director
Of
Critical Care Services
& special projects
Store and
Forward
Decentralized
Consult
Radiology
Pathology
Dermatology
Specialist/patient
Specialist/physician
Imaging from Critical
Access Facilities
Pediatric Cardiac
Echo’s and EEG’s
15 Specialties
Video Remote Interpretation
Selected as spine destination
Tele-Stroke network
Telemedicine core
infrastructure
Distributed Scheduling
Credentialing/Licensing
HR
Finance
Reimbursement management
Analytics (CIC?)
Epic expertise
Account Management
Customer relations/Call center
Centralized
HUB Model
e-ICU
e-LTAC
Tele-Sepsis
e-Hospital
e-after care
home monitoring
Mercy’s ACO Readiness:
 Inpatient hospital utilization management
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

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– Avoiding medically unnecessary admissions
– Avoiding medically unnecessary discharge delays
– Aligned hospitalist programs
Outpatient utilization management
Case and chronic condition (disease) management
Primary care population management
– Primary care e-visits
– Specialist e-consults
– Urgent care centers
– Aligned provider incentive programs
Mature PCP-driven group practice
– Extended office hours
– Incorporation of advanced practice RNs and/or PAs
Components of Milliman’s
study on accountable care
organization (ACO) models
Impact on
Medicare – 8.25%
Commercial – 9.61%
into primary care “teams”
– 24 hour on-call access for patients
6
Virtual Care Services
ACO contracts
Medicare Advantage – 30,000 lives
CMS – ACO – 250,000 lives
Traditional FFS contracts
< 10%
Analytics
Medical
Home
e-ICU
>50%
Shared Savings/Risk Contracts
School
Clinics
Work site
clinics
After Care
Models
e-Hospitals
Telespecialty
e-Hospitals
Community
clinics
e-SNF
VRI
e-LTACH
EHR
Optimization
Tele-med
Primary
Care
Video Remote
Care
Coordination
Interpretation
Tele - Sepsis
Access
Family
Support
Remote
Rounding
Community
Kiosks
Navigator
Services
Tele
Surgical f/u
E-ICU & TeleVolume
stroke
Market share
PHR
EHR
support
e-NICU
Convenient
care
Predictive
Modeling
E-visit 24/7
Store &
Forward
Concierge’s
Service
Nurse on
Call
Tele-Home
Health
Home
Monitoring
Palliative
Care
E-ICU + tele-stroke
• ICU mortality rates 20% below predicted
• 30% reduction in ICU length of stay
• 50% decrease in Central Line Blood Stream
Infections
• >95% compliance with VAP bundle protocols
and corresponding significant decline in VAP
cases
• Tele-stroke – trebled the appropriate use of
tPa in Arkansas ER setting
Sepsis
• Mortality decrease with people in severe
sepsis and septic shock of 50% and 60%
respectively
• Compliance with sepsis bundles increased by
30-40%
• ICU LOS – decreased from 8.16 days to 3.43
days
• Over 9 months of the program – 100 lives
were saved.
Video Remote Interpretation
VRI
• In 2007, over 55
million Americans
spoke a language
other than English
at home
• Represents nearly
20% of the
population
• Increased from 14%
of the US
population in 1990
and 11% in 1980
•Less likely to have a “usual” source
of medical care
•They receive preventive services at
reduced rates
•They have an increased risk of non
adherence to medication
•Children with asthma have an
increased of intubation
•Higher rates of hospitalizations and
medication complications
•Greater resources are used in their
care and they have lower levels of
patient satisfaction
Mercy Health System
TeleMedicine
2012
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Tele-medicine and Mercy