1. Telemedicine: Transforming Health Care in Illinois Lori Williams Illinois Hospital Association March 20, 2014

2. Status of rural health care in Illinois Transformation of Health Care in Rural Illinois Legislative Initiative in Illinois Questions Presentation Outline

3. Illinois Hospital Association 3 Offices in Naperville, Springfield and Washington, D.C., an advocate for 200 hospitals and health systems 88 are considered Small & Rural 51 are Critical Access Hospitals

4. Rural Health Care in Illinois

5. Many Population Health Needs Exist Obesity, Cancer, Asthma, Violent Crime, More Illinois Health Status Compared to U.S. Average Source : The Henry Kaiser Family Foundation IllinoisU.S.  Overweight/ Obese Children 34.9 % 31.6% Overweight/Obes e Adults 63.2%63.8%  Cancer Incidence Rate Per 100,000 484.2462.1  Asthma Among Adults 9.2%8.6%  Violent Crime Rate Per 100,000 435.2403.6 Child Obesity Threatens Illinois Future Child Obesity Threatens Illinois Future  Illinois ranks 42 in overall prevalence of child obesity with 34.9% of children considered either overweight or obese.  The Illinois prevalence of overweight and obese children has risen since 2003.  1 in 8 preschoolers are obese.  Children who are overweight or obese are five times as likely to be overweight or obese as adults. 27.1% of Illinoisans were obese in 2011; Projected to reach 53.7% by 2030.  30.0% of low-income children ages 2-5 are overweight or obese in Illinois.  Illinois ranks 42 in overall prevalence of child obesity with 34.9% of children considered either overweight or obese.  The Illinois prevalence of overweight and obese children has risen since 2003.  1 in 8 preschoolers are obese.  Children who are overweight or obese are five times as likely to be overweight or obese as adults. 27.1% of Illinoisans were obese in 2011; Projected to reach 53.7% by 2030.  30.0% of low-income children ages 2-5 are overweight or obese in Illinois. Illinois Distressing Cancer Rates Overall  Illinois has higher than average incidence of cancer in 19 out of 20 cancers. Breast Cancer  Chicago‘s breast cancer disparities are among the highest in the nation.  African American women in Chicago die from breast cancer at rates 62% higher than White women. Colorectal Cancer  Colorectal cancer is the 3rd most common cancer in the U.S., and is the second leading cause of cancer death in Illinois.  Illinois ranks 43rd for colorectal screening (only 62% screened).  Screening rate is significantly lower for the uninsured. Overall  Illinois has higher than average incidence of cancer in 19 out of 20 cancers. Breast Cancer  Chicago‘s breast cancer disparities are among the highest in the nation.  African American women in Chicago die from breast cancer at rates 62% higher than White women. Colorectal Cancer  Colorectal cancer is the 3rd most common cancer in the U.S., and is the second leading cause of cancer death in Illinois.  Illinois ranks 43rd for colorectal screening (only 62% screened).  Screening rate is significantly lower for the uninsured. Illinois Outpaces the Nation: Obese Children, Cancer, Asthma, and Violent Crime.

6. Many Population Health Needs: Inadequate Mental Health Services Inadequate IP Psychiatric Care Inadequate IP Psychiatric Care Shortage of Psychiatrists  Illinois has 102 counties 50 counties don‘t have a psychiatrist 84 counties don‘t have a child psychiatrist  70% of the 84 medically underserved counties in Illinois did not have a psychiatrist  100% of medically underserved counties in rural Illinois with no psychiatrist Source: Illinois Psychiatric Society  Illinois has 102 counties 50 counties don‘t have a psychiatrist 84 counties don‘t have a child psychiatrist  70% of the 84 medically underserved counties in Illinois did not have a psychiatrist  100% of medically underserved counties in rural Illinois with no psychiatrist Source: Illinois Psychiatric Society  In 2012, Illinois hospital Emergency Departments (EDs) treated more than 1.05M people with a behavioral health condition  Behavioral health as an ED primary diagnosis has increased by 19.1% since 2009  In comparison, all ED visits have increased by 6.4% during the same time period  In 2012, Illinois hospital Emergency Departments (EDs) treated more than 1.05M people with a behavioral health condition  Behavioral health as an ED primary diagnosis has increased by 19.1% since 2009  In comparison, all ED visits have increased by 6.4% during the same time period EDs Have Become the Safety Net for Illinois Mentally ill The rapid decline of adequate mental health services is resulting in steep increases in ED visits—the most expensive type of care—by the mentally ill.

7. ACA: Illinois Impact Expanded Coverage: 2013  1.7 million uninsured Illinoisans By 2015  More than 400,000 will gain coverage in the Health Insurance Marketplace  Nearly 350,000 to be covered under Medicaid

8. Primary Health Care HPSAs in Illinois 8

9. Mental Health HPSAs in Illinois 9

10. Nationwide Provider Shortage 10 It is estimated that rural counties in Illinois will reach a shortage of 600 primary care physicians over the next two years. Illinois is currently short 1,200 nurses statewide right now. Nationally, nurse practitioner graduations have almost doubled between 2001-2011.

11. Provider Trends are Clear 11 Fewer primary care physicians New staffing patterns for providers Strategic use of NPs and APs

12. Transformation in Rural Health Care

13. Obama Signs the Affordable Care Act into Law – March 23, 2010 13

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15. ACA Goals – Trends are Clear 1.Bend the cost curve 2.Improve quality & patient safety 3.Improve population health 15

16. Telemedicine  Improving access to care  Improving Patient Outcomes  Improving Population Health & Wellness 16

17. Televisits – OSCAR Inc. Pictured above: Oscar's co-founders, from left, Mario Schlosser, Kevin Nazemi and Josh Kushner Modern Healthcare, January 6, 2014 17

18. Telemedicine Emerging as Rural ICU Solution HealthLeadersMedia 1.23.14 54 Tele-ICU monitoring centers – 21 rural Beds equipped with Smart Alert software UMASS (year 1) Reduced ICU Patient Mortality by 30% Reduced Hospital Acquired Infections 18

19. Tele-ICU Mercy Health System (Missouri) 480 beds expanding to 24 rural hospitals 30% reduction in ICU mortality 20% drop in LOS Saves $25 million per year John Muir Health (Northern California) 45% reduction in ICU mortality 54% reduction in LOS 19

20. Legislative Initiative

21. HB5313 & SB3319  Requires commercial payers to reimburse for services provided via telemedicine in HPSAs.  IPS, ISMS, IRHA, IHA, Commercial Payers  Sponsor working on final language  16 states have passed similar legislation & 9 others are considering it. 21

22. Thank You