Healthcare’s future Is happening now

Margaret is 82 years old and has just been discharged following a 10-day hospitalization for congestive heart failure, pneumonia, diabetes, and other serious conditions.

She lives in a small town nearly two hours away from the hospital, and her access to appropriate follow-up care is problematic, at best. The likelihood of a high-risk patient like Margaret suffering a serious setback and being readmitted is very high.

But Margaret has already had a home visit from her new health coach and an assessment by a multidisciplinary team that has crafted an individualized care plan based on a thorough assessment of her environmental, physical, psychosocial and nutritional situation. They explain to Margaret and her caregiver how to use a newly designed "personal health tablet" enabling teleconferencing with a virtual care team. They've also shown them how to use in-home equipment for measuring and recording weight, blood pressure, oxygen saturation, and heart rate. All these vital signs, as well as other indicators of Margaret's condition, are transmitted to a remote team that will be caring for her - from 100 miles away.

"Margaret" is not an idealized fantasy, but a composite of more than 600 actual home-based patients with complex, chronic conditions currently enrolled in the Banner iCare™ program, the latest Banner Telehealth initiative. For patients and providers, this is a new "high tech/high touch" approach in which the most advanced technology is joined with skilled care providers to achieve the Triple Aim – high-quality care and satisfaction, improved health and reduced costs.

Phoenix-based Banner Health is one of the nation's largest nonprofit health systems and one of the earliest and largest pioneers of telehealth. Their initial telemedicine efforts began in the intensive care units. Remote teams of Intensivists, ICU nurses and nurse practitioners use graphical dashboards to analyze, process and visualize complex data in real time to monitor hundreds of critically ill patients in multiple states, and then intervene via audio-video link with the onsite bedside team or with the patient directly. The TeleICU implementation has been so successful that it now covers all licensed ICU beds within Banner, and has provided care for more than 185,000 patients over the past 10 years.

This centralized, proactive care model has numerous benefits. Remote physicians and nurses receive important trending data before onsite staff would typically be aware of potential problems. The telehealth platform provides immediate access to virtual care providers who may not be available or on-site. In addition, the TeleICU also offers an opportunity for veteran ICU nurses to extend their careers. Most importantly, TeleICU is yielding remarkable results. Using APACHE score predictions, Banner estimated that in 2014 they saved 1,890 lives and reduced the predicted length of stay in the hospital by 45,861 days and in the ICU by 46,435 days. Annual length-of-stay savings was calculated to be in excess of $109 million.

These results motivated Banner to leverage years of telehealth expertise, as well as rapidly-advancing technology, on a broader scale into the medical-surgical setting. In three facilities, called TeleAcute hospitals, every acute care bed (not just ICU) is equipped with two-way audio-video equipment, and all vital signs are interfaced into Philips software, which has been updated to include functionality appropriate for general ward patients. Five years post-implementation, there is confidence that having the same ability for a remote team to identify adverse trends and intervene with the bedside team can make a difference in this patient population; reducing transfers from the floor to ICU, reducing length of stay and improving patient outcomes. This expansion of Telehealth efforts has been enabled in large part by advances in health care software, reduction in the cost of Telehealth equipment, and the rapidly developing wearable monitoring device market.

Back to "Margaret"... Extending the models of TeleICU and TeleAcute, Banner iCare is a home-based program aimed at what some call "super-users," the five percent of patients whose medical conditions are so complicated or severe that they account for a disproportionately high percent of total health care costs. More than 800 individuals have been enrolled in Banner iCare since 2013, all of whom have at least five chronic medical conditions (diabetes, congestive heart failure, etc.) and who range in age from 48 to 102. The dedicated Banner iCare staff is one of the most diverse telehealth teams, made up of physicians, nurses, social workers, pharmacists, health coaches, and a "quarterback" who coordinates all the aspects of the remote and on-site efforts.

The early outcomes have been very exciting. Compared to the 12-month period prior to enrolling in Banner iCare, member hospitalizations have been reduced by 45 percent, acute and long-term care costs by 32 percent, and overall costs by about 27 percent.

There are many telehealth opportunities on the horizon. Banner has started implementation of a TeleBehavioral health team employing psychiatrists, psychiatric nurse practitioners and crisis interventionists; a TeleNeurology service aimed at that particular patient population; a TelePharmacist service and a program which provides individuals with the opportunity for virtual urgent care visits.

Banner defines innovation as "The rapid identification and deployment of strategies
leveraging Banner's operating model and the science of care delivery to ensure an extraordinary patient experience, which is safe, efficient and effective". Use and expansion of telehealth is a fundamental component of this innovation strategy and an essential factor in the care delivery model of the future.

Julie Reisetter has more than 30 years of healthcare experience in a variety of roles throughout the U.S. Her professional journey has included clinical and leadership positions in Iowa, Colorado, California and Arizona. In 2011, Julie was selected as Banner Health's first Chief Nursing Officer for Telehealth Services where she is responsible for the development, implementation and sustainability of innovative Telehealth solutions across the care continuum. Ms. Reisetter' s educational background includes a Bachelor of Science in Nursing from the University of Iowa and a Master's in Science from the University of California-San Francisco.

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