2. St. Mary’s Telehealth Program for the Medically Complex Population Elvira F. Roveto, FNP B-C Home Care Administrator, DPS Donna Mapp-Reid, RNC, CCM Telehealth Supervisor

3. St. Mary’s Telehealth Program In July 2014, St. Mary’s was awarded $928,668 from the NYS Balancing Incentive Program Innovation Fund (BIP) Grant allows St. Mary’s to enhance its home care services through the use of an Interactive Voice Response System (IVR) Original BIP contract period August 1, 2014 to September 30, 2015. DOH extension through 2016 Background

4. St. Mary’s Telehealth Program 1.Decrease the risk of re-hospitalizations 2.Increase medication adherence 3.Increase patient/family satisfaction Goals

5. Telehealth Targets The program targets children with medical complexity, with diagnoses including but not limited to:  Seizure Disorder  Asthma  Respiratory (non-asthma)  Dehydration St. Mary’s Telehealth Program

6. How IVR works Patients / Caregivers sign consent to participate in the program Patients / Caregivers agree to accept calls and they specify day/time/frequency that is most convenient for them Automated calls are scheduled and monitored Alerts are triggered based upon responses Action is taken based on the type of alert St. Mary’s Telehealth Program

7. Actions Taken When Alerts are Received Each family that has triggered an alert receives a call by a Registered Nurse with extensive pediatric experience to determine appropriate interventions. Common interventions resulting from the follow-up calls include: Educating about the disease process, complications, and when to contact healthcare provider or seek emergency treatment Providing education regarding medications and treatments Identifying the need for an unscheduled home visit from their primary care Nurse. Contacting the physician, pharmacy or vendor

8. General Interactive Call Demonstration St. Mary’s Telehealth Program Interactive Voice Response (IVR) allows patients to have St. Mary’s “eyes & ears” in the home in addition to regular scheduled in-person visits.

9. Sample Template (Asthma) Asthma Program: Is the patient having any of the following:  Coughing at night?  Fast breathing?  Noisy breathing or wheezing?  Less physical activity?  Using the rescue inhaler more than usual?  Signs of a cold or flu? If yes for any above, alert triggered: ­ Yes: Alert Level: High »We will let the nurse know ­ No: Alert Level: None St. Mary’s Telehealth Program

11. Medication Adherence St. Mary’s recognize the correlation between medication adherence and positive patient outcomes including reduced costs & increased satisfaction associated with fewer hospitalizations and ED usage. Medication teaching and monitoring is a key component of patient care. This program is an opportunity to influence medication adherence more consistently. All patients in the Telehealth program are asked questions about medication.

12. Medication Adherence: Outcomes We monitor adherence with 100% of our Telehealth patients. Medication questions are incorporated in all IVR templates. Regardless of the primary diagnosis or reason they are on the Telehealth Program, patients are asked questions about medications on every call. First Year Alerts: 1844 528 or 29% were medication related More than 90% of these were for new or changed medications Each followed up with a phone call to the home 528 instances of communication with the home

13. St. Mary’s Telehealth Program

14. Program Achievements  500 patients enrolled  Successful DOH onsite survey - March 30, 2015  Patient and staff satisfaction has improved  Decrease in avoidable hospitalizations & medication issues

15. Medication Success Story B.C. is a 14-year-old medically complex female with diagnoses of Cerebral Palsy, Asthma and Epilepsy. She is developmentally delayed, non-verbal and non-ambulatory. In the 12 months before her enrollment in the Telehealth Program, she had 6- 8 E.R. visits. During the past year she only had one visit to the ER which resulted in hospitalization. An alert was generated and from the follow up call the TH RN learned that the mom used the long acting corticosteroid during an acute asthma attack and the child went to the ER. The TH RN reviewed med changes and side effects with mom and information was to the clinical team. The TH RN educated the mother about the difference in asthma meds, about the use of long-acting corticosteroid versus the rescue inhaler. The TH RN also informed the CHHA nurse who visited the patient and reviewed the use of the medications, reinforcing education provided by Telehealth Nurse. The interventions resulting from the IVR alerts led to the child’s respiratory status remaining stable.

16. Another Success Story N.E. is a 7-year-old medically complex female with diagnoses of Anoxic Brain Damage and Epilepsy. She is developmentally delayed, non-verbal and non-ambulatory. In the 12 months before her enrollment in the Telehealth Program, she had 4 Hospitalizations. In the 12 months she has been on the program, she has had two hospitalizations. Follow-up to a Telehealth alert indicated that she was having increased seizure activity and had been evaluated by the Neurologist and anti-seizure medication doses were increased. TH RN reviewed med changes and side effects with the father and information was transmitted via email to the clinical team. Home care RN made an added nursing visit and med reconciliation was performed.

17. Testimonials “The Telehealth program has helped so much, I am able to explain problems to the Nurse and the interventions on the phone help and prevent me from going to the ER. Having the Nurse come out to visit after the phone call is also very helpful. I love the fact that someone always calls back and I am not alone.” “The program helps me, once I took him to Urgicenter but he was still not better. The call came and it was helpful to speak to the Nurse on the phone and then have another nurse visit. This stopped me from having to take him back to the ER. My child is not normal so the additional expert advice benefits him.” “ The program makes me feel safe.” “I have come to rely on the program, knowing I am not alone and have help even when life gets so busy.” St. Mary’s Telehealth Program

18. The Future Use the data from this grant to help develop a care management model that will allow us to provide those services under managed care in the future for our children. Currently grant funded- Our ultimate goal is to work with Managed Medicaid and insurers to recognize the importance of the program in reducing hospitalizations and costs - and make this a reimbursable service. Our goal is to continue to innovate and find cost effective ways to better serve our medically complex children. St. Mary’s Telehealth Program

19. A costly ER visit or hospitalization can be avoided by the push of a button. St. Mary’s at your fingertips is the solution…. St. Mary’s Telehealth Program

20. St. Mary’s Healthcare System for Children Elvira Fardella-Roveto, FNP B-C 718-281-8723 eroveto@stmaryskids.org Donna Mapp-Reid, RNC, CCM 718-281-8935 dmapp-reid@stmaryskids.org www.stmaryskids.org BIP Transformation Grant utilizes “Federal funding” per section G, page 20 of 26 of the Master Contract for Grants.