Telemedicine Offers Growth for Hospitals, Rural Care Opportunities

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1 Telemedicine Offers Growth for Hospitals, Rural Care Opportunities The internet and digital technology have transformed our lives, changing the way we keep in touch with our family and friends, shop, pay our bills, and even search for information about health issues and disease. More consumers are using smart phones, tablets, and other devices, learning to be comfortable with all of the connectivity, apps, and extensions that the devices offer. As patients have become more digitally-savvy, they ve become more open to actively maintaining and guiding their own health outcomes. They are interested in any new way they can interact and spend time with extremely busy doctors. Telemedicine is opening a whole new world for them by enabling remote engagement. Digital Management of Health Telemedicine involves harnessing digital information and communication technologies, such as PCs, tablets, mobile devices, and video, to manage one s well-being and health outcomes. Telemedicine can include a number of services, ranging from the remote monitoring of vital signs, such as blood pressure, to diagnosing disease symptoms, sharing video or still diagnostic imagery, to online physician-patient visits and engagement. Clinical applications of telemedicine include: Remote (tele-) monitoring and diagnostics; Remote (tele-) nursing services; Remote (tele-) trauma care; Remote (tele-) surgery; Remote (tele-) radiology; Remote video-based patient-physician interaction. Non-clinical applications include: Management and sharing of electronic health records; Professional educational conferences; Intra- and inter-hospital department meetings; Provider training; Patient education; Healthcare system integration; Overall healthcare system management. 1

2 Advantages for Hospitals and Providers Telemedicine offers a number of advantages, thanks in part to faster internet connections and better software. It can optimize the quality of care and patient health outcomes. Many patients are comfortable with using the technology. Essentially, with mobile devices, patients can consult a doctor, a laboratory, a clinic, or a hospital department, such as radiology, from anywhere -- to review a diagnosis or to obtain results from laboratory diagnostic or imaging tests. The idea is that telemedicine, through internet or mobile technology, can reduce the need for outpatient visits, as well as make remote prescription management or drug administration oversight practical. In addition, electronic health records make it easier for doctors to access patient records remotely. The goal is to fill clinical needs, cut costs, and meet patients demands for more convenient care. Motivation There is a shortage of 45,000 primary care physicians in meeting the needs of patients nationwide, according to the American Association of Medical Colleges. The issue is especially challenging for the 25% of the US population that lives in rural areas, where access to health care, particularly subspecialty care, is often lacking. More than 10 million consumers directly benefited from using telemedicine last year, according to the American Telemedicine Association. A recent Harris Poll survey found that 27% of consumers would choose a telehealth visit if the option was available to them. The ability to leverage telehealth technology and enable virtual visits improves access to critical health services. Already, some private insurers, as well as many hospitals, see the benefits. UnitedHealthcare is expanding coverage options for video-based virtual physician visits, giving people enrolled in self-funded employer health plans secure, online access to a physician via mobile phone, tablet or computer 24 hours a day. The cost of a video-based virtual visit is less than $50 and provides significant savings when compared to costs for similar minor medical needs treated at a doctor s office ($80), urgent care facility ($160), or in an emergency room ($650). UnitedHealthcare plan participants pay a portion of the cost for the virtual visit, subject to deductibles, copays and out-of-pocket expenses based on their specific benefit plan. 1 In May 2013, Cigna announced it is working with MDLIVE, a telehealth provider of online and on-demand health care delivery services and software, to offer eligible Cigna health plan customers access to 24/7/365 online video or telephone consultations with board-certified internal medicine, family practice, and pediatric physicians. Eligible Cigna health plan customers can choose a convenient appointment time or request to speak to an available health care professional on demand with an average response time of 11 minutes 1 UnitedHealthcare Covers Virtual Care Physician Visits, Expanding Consumers Access to Affordable Health Care Options. April 30,

3 -- for non-emergency medical issues, such as a cold and flu, rashes, sinus issues and headaches for children and adults. 2 Trends Whether a patient is seeing his or her physician in person or via telemedicine, the same standards of care must be maintained. The American Medical Association (AMA) believes that the appropriate use of telemedicine to deliver care to patients could greatly improve access and quality of care, while maintaining patient safety. In June 2014, the AMA approved guiding principles to ensure the appropriate coverage of and payment for telemedicine services. The principles aim to foster innovation in the use of telemedicine, protect the patient-physician relationship, and promote improved care coordination and communication with medical homes. The evolution of telemedicine impacts all of the AMA's strategic focus areas: Improving health outcomes; Enhancing physician satisfaction and practice sustainability; Accelerating change in medical education. 3 Variation in state laws has always posed challenges to the adoption and use of telemedicine services by healthcare organizations. These challenges can take the form of anything from provider licensing restrictions to the availability of insurance coverage. In Kentucky, state laws are in place for private and public payers. In 2013, lawmakers in the state expanded coverage of telemedicine services for Medicaid beneficiaries, so long as these are delivered exclusively by way of interactive video-conferencing. The telehealth services covered by the law are extensive, ranging from mental health evaluations and care management to diabetes and physical therapy consultations. 4 Telemedicine is improving the quality of health care coverage at remote medical clinics throughout the US. Technical advances in Bluetooth wireless technology, including a virtual stethoscope, and video teleconferencing, enable doctors anywhere to provide online consultations with these patients. From a public health perspective, healthcare providers are actively pursuing these telemedicine advancements, according to a 2015 survey released by health care law firm Foley & Lardner. The survey asked senior executives of for-profit and non-profit health care providers about the future of telemedicine and how their organizations are navigating regulatory and reimbursement challenges, as well as other barriers to widespread adoption of telemedicine. Key findings in the 2014 Telemedicine Survey Report include: Nine out of 10 report their organizations have already begun developing or implementing a telemedicine program; 2 The Doctor Will See You Now: Cigna Teams with MDLIVE to Offer Health Care Access 24/7/365. May 10, AMA Adopts Telemedicine Policy to Improve Access to Care for Patients. June 11, Laws increase telemedicine coverage in Kentucky, Missouri. July 18,2013. https://ehrintelligence.com/2013/07/18/laws-increasetelemedicine-coverage-in-kentucky-missouri/. 3

4 84% say that offering meaningful telemedicine services will be central to the success of their organizations. The majority of respondents currently offer remote patient monitoring services (64%), and real-time interaction capabilities (52%). 5 Telemedicine also will lead to the establishment of virtual medical centers, which will host an array of clinical specialists who will serve patients in outlying areas. Such centers can accommodate dozens or hundreds of doctors, nurses, specialists, researchers and support staff. Telemedical care will be delivered 24/7 using video, audio, and data connections to nearby or remote locations. The service area could be expanded by establishing partnerships with other health care institutions or even private employers interested in providing medical care for employees. As the use of smartphones and tablets with connectivity continues to grow, the use of such smart devices in health offerings also is expanding. A variety of mobile health offerings is available including community care connectivity products, and biometric and vital sign tracking apps and devices. The number of mobile health products available on the market is impressive. Consider all of the intelligent watches and health trackers already on the market. In a few short years, all consumers, if they want, will have access to mobile medical care at the touch of a button. Simple, acute care diagnostics are part of mobile health, as well as wellness screening, training and weight loss coaching, and chronic disease monitoring and management, with a virtually unlimited amount of data stored in the cloud. However, there also has to exist an analytical component that makes all of this data meaningful for end-users. Federal grants have helped to establish about 200 telemedicine programs linking multiple health centers throughout the US. Almost all these programs are hub-and-spoke models, in which a large central hospital unidirectionally provides services to connected sites. An alternative approach, connecting multiple centers using a true network design, is starting to gain favor. This new model is based on paid memberships, with services delivered from any point on the network to any other point. The Arizona Telemedicine Program is an example of this approach. 6 The US Health Resources and Services Administration offers several Telehealth Grant Programs. Licensure Portability is a competitive grant program that provides support for state professional licensing boards to carry out programs under which licensing boards of various states cooperate to develop and implement state policies that will reduce statutory and regulatory barriers to telemedicine. Telehealth Network is a competitive grant program that funds projects that demonstrate the use of telemedicine networks to improve healthcare services for medically underserved populations in urban, rural, and frontier communities. Telehealth Resource Center is a competitive grant program that provides support for the establishment and Telemedicine Survey Executive Summary. Nov. 11, market trends for telemedicine. January 6,

5 development of telemedicine resource centers, which assist health care organizations, health care networks, and health care providers in the implementation of cost-effective telemedicine programs to serve rural and medically underserved areas and populations. Medicare reimbursement for telemedicine services is divided into three areas, according to the American Telemedicine Association: Remote patient face-to-face services seen by live video conferencing; Non face-to-face services that can be conducted either through live video conferencing or Store-and-forward telecommunication services; Home telemedicine services. National and local coverage determinations may alter or expand the services that are eligible for reimbursement. For hospitals under pressure to find cost-effective methods of engagement with their patients, telemedicine offers ways to streamline operations and create multiple touch points with patients, making it one of the most reliable methods for transitioning to a post-affordable Care Act, forward-looking reimbursement model, although the customary fee-for-service environment makes it challenging to be paid for medicine practiced outside the traditional spheres of interaction. 7 The Tech Challenge New York City health tech startups are feverishly pitching area hospitals in the hope of landing a big client. But it s important for technology providers to understand a hospital's strategic goals. Montefiore Medical Center, for instance, has made it widely known that its goal is to manage the health of 1 million people as it takes on an increasing volume of risk contracts. Accomplishing that will put a considerable strain on the health system's care management organization. The technology that Montefiore seeks is in the telehealth space and remote monitoring -- to be able to take care of patients outside of the walls of the hospital. It s currently doing it with care managers, but for them to be able to scale and handle the increased load, the medical center must infuse the right technology. New York City digital health startups haven't had trouble with funding. They received $505 million in 33 deals last year, according to StartUp Health. But reaching a deal with a hospital can be difficult. Integrating an outside company's product can take up to two years. 8 In 2014, Montefiore partnered with Sense Health, a New York City-based healthcare company focused on supporting patients through mobile technology, in a randomized control trial that focused on engaging a high-cost Medicaid population. The study utilized Sense Health's mobile care management platform that creates, delivers, and monitors interactive text message-based support plans to improve patient adherence to medications, doctor appointments and care plans Telemedicine Survey Executive Summary. Nov. 11, Hospitals share tech strategies as startups crave deals. June 5,

6 After a two month test period with 67 patients and 15 care managers involved in Montefiore Medical Center's Medicaid Health Home, Sense Health found a significant improvement in a number of key patient engagement metrics, including: self-reported patient adherence to: appointments (a 40% increase); medications (a 12% increase); and care plan goals (a 7% increase). In addition to focusing on adherence to appointments, medications and care plans, the study also focused on measuring improvements in some of the key health determinants that dictate how effectively someone manages their own health. The clinical trial found patients receiving care management support with Sense Health technology were 21% more motivated, 26% more confident, and 22% more knowledgeable about the lifestyle changes recommended for their health, compared to patients simply receiving care management services without the intervention. 9 Hospital Strategies In 2014, 46% of healthcare providers answering a survey from the Healthcare Information and Management Systems Society (HIMSS) were using several telemedicine technologies in their practice, with the most popular technology being two-way video messaging. HIMSS received 400 responses to its online survey, mostly from directors and managers at hospitals, but also from doctors and nurses in hospitals and private practices. The results paint a picture of the adoption of telemedicine to fill niches in a healthcare system still very much focused on meaningful use. 10 While this is a sign that some form of telemedicine is already harnessed by a number of hospitals and healthcare providers, there remain many institutions and providers who have yet to take advantage of the technology. There are a variety of processes and strategies that these organizations should consider as they plan to include telemedicine as one of the services they provide to patients. These organizations should: Learn their service market and the population s clinical needs: Determine the size of the market; Determine local demographics; Analyze key disease trends in the market; Analyze competitors telemedicine services, if any. Conduct an assessment of the market/community for its remote medicine needs; Analyze the types of telemedicine technologies available that would achieve a hospital s objectives: Video conferencing; Smart phone apps; Wearable diagnostics. 9 Randomized Control Trial Finds Sense Health's Mobile Care Management Platform Can Boost Patient Adherence. July 9, Why hospitals are investing in telemedicine technology. Aug. 14,

7 Align a telemedicine program with the hospital s overall mission: Is its purpose to better manage a disease state or a health population; Determine how it gives value to the hospital s overall objectives. Design the telemedicine program: Establish a governance structure; Assign program responsibilities; Establish standards and policies that govern the telemedicine program; Establish a timeframe for offering the service; Establish a revenue model/plan. Select technology providers and solutions; Establish training for staff in cooperation with technology providers; Measure initial performance and success of the telemedicine service: Conduct performance interviews with staff and patient-users; Continuously monitor performance of service and make adjustments as needed. Filling gaps in patient care is one of the key reasons for adopting telemedicine technologies and strategies. Moreover, telemedicine can enable a provider to significantly expand its geographic footprint, gain market share, and improve patient interaction. While implementing a telemedicine program requires a significant commitment and due diligence, the payoff for both the provider and the patient will be significant. 7

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