Transformation

Panel Presentation

(T2-01) Telemedicine-enabled, Integrated Stroke Care: Building a Bundled Payment Model to Improve Outcomes and Lower Costs

Sunday, April 23
11:30 AM - 12:30 PM
Location: W331 A

Objectives
As the 5th leading cause of death and the leading cause of disability in the United States, stroke costs an estimated $33 billion/year with direct costs projected to triple by 2030. Cost-effective stroke care requires timely intervention for acute onset and long-term strategies post-discharge to decrease morbidity and mortality. Current stroke care is poorly coordinated, including conflicting geographic care locations and changing providers designed to foster confusion. Telemedicine combined with evidence-based, integrated care across the continuum can reduce stroke costs and ensure quality. Bundled payment models that reimburse based on expected costs per episode could enable clinical innovation by aligning financial incentives with high quality care in acute and post-stroke settings.

This panel will:
1. Describe an innovative stroke care model that integrates a comprehensive telehealth system.
2. Describe advantages of integrating telehealth into stroke care.
3. Discuss bundled payment strategies development and methods for cost analyses, including TDABC methodology.

Methods
A demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award (HCIA #1C1CMS331043) tested the impact of an Integrated Stroke Practice Unit (ISPU) in New Orleans, Louisiana. The ISPU combined a comprehensive hub and spoke telestroke system utilizing both “drip and ship” and “drip and keep” methodologies with acute/in-hospital (called Stroke Central) and home-based (called Stroke Mobile) care components to provide treatment, follow-up, risk factor management, and education for 12 months’ post-discharge. A partnership is ongoing with a commercial payer, an academic medical center, and university partners to analyze care costs and develop a comprehensive bundled care model for stroke.

Results
Approximately 4,000 telestroke consults for ischemic, hemorrhagic, and transient ischemic attacks were completed from 2009-2014, resulting in a 275% increase by 2014 in rtPA utilization compared to pre-telestroke rates. Stroke Central followed 3,714 patients hospitalized with suspected stroke symptoms (January 2013-December 2015); In Stroke Mobile, 558 patients discharged with a stroke diagnosis from St. Tammany or Jefferson Parishes were seen at least one time (February 2013-December 2015), and 192 patients/caregivers completed all 12 visits. Preliminary data suggest a 15% decrease in 30-day readmissions and an 8% decrease in cost-per-case compared to retrospective controls.

Conclusion
Innovative stroke care that combines integrated care with telehealth programs can increase care quality and reduce recurrence and readmission, and reimbursement using bundled payment has potential to decrease cost of care. Bundled payments empower providers across care continuum and allow addition of innovative telemedicine and mobile technologies that provide value for patients while integrating acute, rehabilitation, and chronic treatment with education and risk factor control.

Kenneth Gaines

Professor
Vanderbilt University Medical Center

Dr. Gaines is a Board Certified Vascular Neurologist with over 25 years experience in stroke care and clinical trials, including NIH trials for stroke therapy (NINDS tPA stroke trial and WARSS), carotid endarterectomy (ACAS, NASCET), interventional management of stroke (WASID), and multiple trials of antiplatelet and cerebral protective agents. He was Principal Investigator of a Centers for Medicare and Medicaid Services Health Care Innovation Award (#1C1CMS331043; 2012-2015) to foster in-hospital and home-based care coordination. Dr. Gaines developed a 30+hospital telestroke system in Louisiana and has served as Director of the Ochsner Neuroscience Institute and Medical Director for Ochsner’s Telemedicine/Telehealth. Dr. Gaines is currently Professor, Department of Neurology, at Vanderbilt University Medical Center.

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Patricia Commiskey

Research Assistant Professor
Vanderbilt University Medical Center

Dr. Patricia Commiskey is a researcher focused on chronic disease prevention and management, including education, engagement, and behavior change strategies. With almost 20 years of experience working on federal and state-funded initiatives in cancer and chronic disease, her previous research has focused on identifying and eliminating health disparities, building research participation and academic-community partnerships, incorporating technology into healthcare, and reducing risk factors and disease recurrence post-stroke. Most recently, Dr. Commiskey served as the Clinical Research Scientist and Co-Investigator for a three-year Health Care Innovation Award (#1C1CMS331043; PI: KGaines) funded by the Centers for Medicare and Medicaid Services. She is currently a Research Assistant Professor at Vanderbilt University Medical Center, focusing on integrated care system redesign across the continuum (from acute onset to one-year post-stroke) and the impact of innovative, long-term care strategies on patients and caregivers.

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Meredith Alger

Senior Researcher
Harvard Business School, Institute for Strategy & Competitiveness

Meredith Alger leads research, projects and program development for Professor Michael Porter's Health Care team at the Institute for Strategy and Competitiveness (ISC) at the Harvard Business School. The ISC focuses on developing the intellectual framework for realigning the delivery of health care to maximize value for patients. She partners with innovative organizations in the health industry, including providers, payers, suppliers, pharma and government regulators, to design and implement value-based health care delivery and reimbursement models. She leads care redesign efforts with multidisciplinary teams, develops standard tools and processes to enable design and operationalization of Integrated Practice Units (IPUs) and support services and identifies conditions for which formation of an integrated practice unit can advance operational, clinical, and financial outcomes. She has designed and built time-driven activity-based cost frameworks to better understand the actual cost of care by medical condition, developed risk stratification techniques and care delivery strategy for primary care/ population-based models, designed value-based reimbursement models (bundled payments) for acute and chronic diseases and negotiated payer/employer contracts in bundled pricing. She earned a Master of Health Administration from the Medical University of South Carolina and a Master of Science from Georgia State University.

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Steve Davis

Healthcare Consultant
Industry Healthcare Consultant

Steve Davis has over 25 years of healthcare experience with subject matter expertise encompassing a broad service base including EHR, telehealth, e-prescribing, electronic charge capture, revenue cycle management, knowledge-based medicine, disease state management, HITECH ACT/Meaningful Use, interoperability, ICD-10, The Affordable Care Act/ACO's. His experience includes strong working relationships and a professional network with leading health plans, payers, academic medical centers, hospitals, pharma/biotech and integrated delivery networks across the healthcare spectrum. This includes well respected CIO’s such as Dr. John Halamka from Boston and world-renowned epidemiologist and speaker Dr. William Castelli from the Framingham Heart Study. In addition, Steve has a Master’s Degree specializing in clinical exercise physiology/cardiac rehabilitation with certification as a cardio/pulmonary exercise specialist through the American College of Sports Medicine.

Awards and recognition include the Professional Excellence award for Marketing Excellence while at Parke-Davis Pharmaceuticals serving as a Sr. Product Manager in the Women’s Healthcare specialty area. This is addition to President’s Sales Awards and honor recognition in the specialty areas of Cardiology, Neurology, CNS and Women’s Healthcare. Steve has been recognized as a healthcare advisor and subject matter expert representing and speaking at trade shows, conferences, professional associations as well as company sponsored events and media sessions.
Steve is committed to giving by volunteering and supporting both local and national organizations including the Dana Farber Cancer Institute and the Jimmy Fund, the Alzheimer’s Association, Child Hunger Ends Here, local food banks and church and community service initiatives and needs.

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(T2-01) Telemedicine-enabled, Integrated Stroke Care: Building a Bundled Payment Model to Improve Outcomes and Lower Costs



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