Transformation
Panel Presentation
Kenneth Gaines, MD PhD, MBA
Professor
Vanderbilt University Medical Center
Participants should be aware of the following financial/non-financial relationship:
Hospital Alliance Tennessee: Consultant
Ochsner Medical Center: Consultant, Grant/Research Support, Salary
Tennessee Stroke Task Force: Consultant
Vanderbilt University Medical Center: Salary
Patricia Commiskey, DrPH, MA
Research Assistant Professor
Vanderbilt University Medical Center
Participants should be aware of the following financial/non-financial relationship:
Vanderbilt University Medical Center: Salary
Meredith Alger, MHA, MS, RD
Senior Researcher
Harvard Business School, Institute for Strategy & Competitiveness
Participants should be aware of the following financial/non-financial relationship:
Harvard Business School: Salary
Steve Davis, MEd
Healthcare Consultant
Industry Healthcare Consultant
Participants should be aware of the following financial/non-financial relationship:
AT&T: Salary
Rural Healthcare Funding Program: Grant/Research Support, Other Financial or Material Support
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.
