1. Mercy Health System
Tele-Medicine
2012

2. 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)

3. 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

4. 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

5. 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

6. 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%

7. 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

8. 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

9. 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.

10. 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

11. Mercy Health System
Tele-Medicine
2012