1. Business Models and Economic Issues of
telehealth: Experiences of Yorkshire
Rebecca Malin
Head of Business Development and Investment
Airedale NHS Foundation Trust

3. The Local Context
Airedale’s catchment area:
2012-13 = 3 Commissioners
2013-14 = 7 Commissioners

4. The bigger picture …
scale of financial
challenge
growing demand
unmet need
+ traditional
hospital dominated
medical model
=
designed
inappropriate by default
utilisation
stretched capacity

5. … a system
designed by default

6. so less in here
and more
out there…

7. Our focus,
the patient experience

8. But how to change?
Introducing telehealth
• tele care
• tele coaching
• tele monitoring
teleconsultation

9. Airedale Teleconsultation
• Prison health care
7 year programme
Live in 20 prisons
Up to 50% change in patient flow
>2200 consultations past 2 yrs
• Care in the community
• Care at home
• Stroke patients
• Occupational health
• Supporting end of life patients
• Nursing and Residential care homes

10. care in the community

11. nursing and residential care homes

12. Emerging evidence
)

13. Results:24 hr tele consults
to 25 COPD patients at home
Bed Days used
300
-29.5% 250
200
-36.5%
150
100
50
0
Year pre post Year pre post

14. Nursing and Residential
Care Home Results
(Hull University)
47% reduction in ED attendances for homes with Teleconsultation vs. 27%
45% reduction in hospital admissions for homes with Teleconsultation vs. 33%
April – April –
Based on 13 Nursing and Residential September
September Difference
Care Homes 2011* 2012*
ED attendances (mean per home, per month) – care homes with
telemedicine in 2012 (n=13) 2.56 1.37 -47%
ED attendances (mean per home, per month) – care homes without
telemedicine in 2012 (n=67) 1.31 0.95 -27%
Hospital admissions via ED (mean per home, per month) – care
homes with telemedicine in 2012 (n=13) 1.44 0.79 -45%
Hospital admissions via ED (mean per home, per month) – care
homes without telemedicine in 2012 (n=67) 0.71 0.47 -33%
*Figures are rounded to two decimal points; percentage difference is calculated using unrounded figures.

15. Business Models
)

16. Which business
model?
To consider… Models available
•Who is commissioning? 1. Full Telehealth Hub service?
•Where is the pressure coming 2. Call triage only?
from? 3. Use of technical infrastructure
•Provide own clinical service only?
(how)? 4. Training and consultancy
•Own hub (how)? only?
•Technical infrastructure? 5. Hub of Hubs?
•Experience?
•Commissioners on board?
Each model has different benefits
and cost savings

17. Data modelling
overview
Region A Region B
Nursing Homes 53 Nursing Homes 116
Patients Involved 1,105 Patients Involved 1,750
Associated Admissions 2,928 Associated Admissions 2,505
Associated Bed days 29,199 Associated Bed days 27,901
> 25 Admissions per year > 9 Admissions per year

18. Data modelling Region A
20% reduction in short stay admissions (0-5 days) from nursing homes
Net Impact to
Service health
PCT Provider Economy
Income Emergency Admissions 30% rate 156,480 (156,480) 0
Changes 70% left 365,120 365,120
Other Income saved ( OPD & A&E ) 15,458 (15,458) 0
Income impact 537,058 (171,938) 365,120
Costs Investment in telemedicine (225,080) (225,080)
Trust Cost savings 922,162 922,162
Total impact on costs (225,080) 922,162 697,082
Net impact associated with 53 Nursing Homes 311,978 750,224 1,062,202
50% reduction in short stay admissions (0-5 days) from nursing homes
Total impact on costs (292,400) 995,348 702,948
Net impact associated with 53 Nursing Homes 1,050,571 565,177 1,615,748

19. Data modelling Region B
20% reduction in short stay admissions (0-5 days) from nursing homes
PCT Service Net Impact to
Provider Health
Economy
Income Emergency admissions (above threshold) 30% rate 133,382 (133,382) 0
Changes Emergency admissions (below threshold) 70% left 311,224 0 311,224
Other income saved (Outpatients and A&E) 10,986 (10,986) 0
Impact on Income 455,592 (144,368) 311,224
Costs PCT investment in telemedicine (425,360) (425,360)
Service providers cost savings 421,704 421,704
Impact on Costs (425,360) 421,704 (3,656)
Net impact associated with 116 Nursing Homes 30,232 277,336 307,568
50% reduction in short stay admissions (0-5 days) from nursing homes
Total Impact on Costs (472,640) 462,647 (9,993)
Net impact associated with 116 Nursing Homes 666,050 102,019 768,069

20. What are the
challenges?
 tariff
 the importance of scale
 evidence base
 culture change
 scheduling
 collaborative working
(community teams, GPs)
 technical

21. call to action
“…we need to have the courage to make
changes and be less risk averse,
we need to take a longer term view on
investments, and we need to ensure staff are
supported to introduce new ideas and
technologies…”

22. Business Models and Economic Issues of
telehealth: Experiences of Yorkshire
Thank you