Mercy Health System Tele-Medicine 2012

IMPROVING DELIVERY MISSOURI STATS: >1.5 million people served 1,071 integrated physicians 413 primary care physicians 9 acute care hospitals 134 clinic locations HOSPITALS 25 acute care hospitals 6 managed hospitals 3 heart hospitals 2 children's hospitals 1 rehab hospital 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)

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 Medical Director Operations Director Care Model Delivery Population Management Tele – Medicine Virtual Care Center for Innovation Centralized HUB Model Store and Forward Chronic Care Management Scheduling Call Center Research Epic Informaticist Resources have a central feel and central supervision Resources may be either central or distributed encounter is asynchronous and my involve images and or consultation Scheduling & referral management Care Coordination Care Delivery Innovation Grants Nurse on Call Center Post Acute Care Decentralized Consult Collaboration E-Visits 24/7 Asynchronous Care Analytics Resources are distributed although Scheduling and supervision are central Resources are distributed and are outside of Mercy encounter is asynchronous and my involve images and or consultation Home Health Support EHR support

Tele-Medicine Division Connector Tele – Medicine Virtual Care Medical Director Of Critical Care Services & special projects Asynchronous Store and Forward Decentralized Consult Centralized HUB Model Radiology Pathology Dermatology Specialist/patient Specialist/physician 24-7 e-visit support Store + Forward patient visits e-ICU e-LTAC Tele-Sepsis 15 Specialties Video Remote Interpretation Selected as spine destination Tele-Stroke network Imaging from Critical Access Facilities Pediatric Cardiac Echo’s and EEG’s e-Hospital e-after care home monitoring Telemedicine core infrastructure Distributed Scheduling Credentialing/Licensing HR Finance Reimbursement management Analytics (CIC?) Epic expertise Account Management Customer relations/Call center

IMPROVING DELIVERY Mercy’s ACO Readiness: Inpatient hospital utilization management 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 into primary care “teams” 24 hour on-call access for patients Mercy’s ACO Readiness: Components of Milliman’s study on accountable care organization (ACO) models Impact on Medicare – 8.25% Commercial – 9.61%

Virtual Care Services Video Remote Interpretation Tele - Sepsis ACO contracts Medicare Advantage – 30,000 lives CMS – ACO – 250,000 lives Traditional FFS contracts < 10% Shared Savings/Risk Contracts >50% Analytics Medical Home e-ICU School Clinics Work site clinics After Care Models e-Hospitals Tele-specialty e-Hospitals Community clinics e-SNF VRI e-LTACH EHR Optimization Tele - Sepsis Video Remote Interpretation Access Care Coordination Tele-med Primary Care Family Support Community Kiosks Remote Rounding E-ICU & Tele-stroke Navigator Services Tele Surgical f/u Volume Market share PHR e-NICU EHR support 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 Tele-Medicine 2012