New York Health Plan Association Challenges and Opportunities of Telemedicine

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1 New York Health Plan Association Challenges and Opportunities of Telemedicine Key Federal and State Telehealth Dynamics: Policy, Politics and Best Practices Victoria L. Shapiro Senior Director Health Care Services September 16, UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.

2 This presentation is for informational purposes only and is not intended nor should be construed to constitute legal advice. Please consult your attorneys regarding any fact specific situation under federal, state, and local laws that may impose obligations on you and your company UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 2

3 Key Federal and State Telehealth Dynamics: Policy, Politics and Best Practices I. Telehealth Challenges and Opportunities: Policy and Politics Federal Dynamics Broad State Landscape Forecast for 2016 II. Best Practices and Lessons Learned Nationwide Programs in the Commercial Market Inside New York Other States to Note 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 3

4 I. Telehealth Challenges and Opportunities: Policy and Politics 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 4

5 Key 2015 Federal Telehealth Political Dynamics Highlights of Recent Noteworthy Actions by U.S. Congress in 2015 H.R. 3081/S.1778 TELE-MED Act: Action: Matching bills introduced in the House and the Senate on July 15, Would lift medical licensure restrictions to facilitate the delivery of telemedicine services across state lines and ease limits on the types of technologies Medicare pays for in the delivery of telemedicine. H.R st Century Cures Act: Action: Passed the U.S. House of Representatives on July 10, Would require CMS and the Medicare Payment Advisory Commission to provide Congress with more information to contemplate whether and how to expand Medicare s telehealth policy. H.R. 2 Medicare Access and CHIP Reauthorization Act: Action: Passed both the House and the Senate in the Spring 2015 and signed into law on April 16, Requires the Comptroller General to submit a report to Congress on the results of studies on telehealth and Remote Patient Monitoring, with legislative and regulatory recommendations. DRAFT Senate Telehealth Bill by Senators Thune, Schatz, Wicker, and Cochran: Action: a draft version of the bill was circulated last month to key stakeholders for input. Would lift current Medicare restrictions on where a patient may receive telehealth services, as well as Medicare limits on the types of technologies that may be used to provide telehealth, among other things. Would establish payment for remote patient monitoring as a stand-alone billable service under Medicare UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 5

6 2015 State Telehealth Politics and Policy At-A-Glance Key Facts Over 200 bills were introduced in the 2015 legislative session. States are broadening access to telehealth services in the Commercial and Medicaid markets using several key policy levers: Easing or removing population, geography or site restrictions (NV, CO) Recognizing store-and-forward technologies (ID, DE, TN) Medical boards are increasing focus and activity on shaping telehealth policy: Texas Alabama Arkansas Colorado 11+ states have now adopted the Federation of State Medical Boards Medical Licensure Compact and many more have introduced it as legislation. 47 states and D.C. offer some form of Medicaid reimbursement via telehealth. 24 states and D.C. do not specify a patient setting or location requirement. Nearly 30 states require coverage parity with inperson services UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 6

7 2016 Telehealth Landscape of Policy and Politics Key Issues and Stakeholders Policymakers Will Likely Be Thinking About Behavioral Health State Agencies Nurses Congressional Budget Office Rural Health State Legislatures Clinical Specialty Societies State Issues Where should a patient receive telehealth services? What services should Medicaid and Commercial health plans pay for and at what rate? Should prescribing be allowed? Where should a provider be licensed and what kind of license should they need? What types of providers should be able to offer telehealth services? Medical Boards Federal Trade Commission Federal Issues Where should a patient receive telehealth services? What services should Medicare pay for and what rate? Does telehealth reduce health care spending? What types of providers should be able to offer telehealth services? U.S. Centers for Medicare & Medicaid Services U.S. Congress Hospital Systems Employer Coalitions Health Plan Associations Technology Associations Doctors 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 7

8 Summary of Likely 2016 Challenges and Opportunities Top Telehealth Politics and Policy Challenges and Opportunities X Congress is only likely to pass bills to address the debt ceiling, appropriations, and the Highway Trust Fund. It is possible that a telehealth bill could get incorporated into one of those legislative vehicles, but the telehealth bill would need to have non-controversial, bipartisan support from Congressional leadership. X The Congressional Budget Office, which puts price tags on Congressional bills, views telehealth as a cost-driver instead of a cost-saver. There has been a steady escalation year over year of bipartisan telehealth bills by leaders in Congress and stakeholder groups continue to ramp up lobbying efforts to press Congress for telehealth action. X The Centers for Medicare and Medicaid Services are wary of how broadening access to telemedicine services will impact health care costs and unlikely to pursue transformative telemedicine policies until they fall under pressure from the Administration or Capitol Hill. State political and policy activities have grown year-over-year in the last 5 years and 2016 is expected to bring another round of transformation in state telehealth policy. X There continues to be questions about the value of telemedicine and a need for robust, clear and compelling evidence on where and how telemedicine improves patient outcomes, increases quality of care, and lowers health care spending. Investment and innovation by the private sector to deploy telehealth services more broadly is increasing UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 8

9 II. Best Practices and Lessons Learned 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 9

10 Nationwide Programs Approximately 65% of emergency room, urgent care, office and retail health visits could have been handled via telemedicine. Also, about 74% of U.S. patients are open to a virtual doctor visit. Problem: Millions of people are gaining access to health care coverage, but the U.S. will have fewer doctors. With research indicating that there will be 70,000 fewer doctors by 2020 and particularly a lack in primary care providers, patients are going to face challenges getting appointments and longer wait times. 70% of individuals are without a primary care provider or are not utilizing one. Solution: Anticipated patient appointment wait time averages of 2½ weeks to 3 months. Our NowClinic and Virtual Visits offer secure, private, real-time consultations with licensed clinicians through a computer, phone or mobile device. No appointments necessary and wait times are usually 10 minutes or less. Help physicians extend care to a wider range of people and locations. Outcomes: 98%+ users required no followup visit within 30 days 85%+ saved a trip to ER or other acute care settings 95% would definitely use again 93% saved money 88% saved personal time 87% saved time away from work 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 10

11 Outcomes in New York and Arizona: Remote Monitoring Problem: The Centers for Medicare and Medicaid Services has a 30-day hospital readmissions reduction program, which ties readmission rates for Medicare beneficiaries to penalties. Stony Brook University Hospital on Long Island, NY learned that its 30-day readmission rate for heart failure, pneumonia and heart attack was above the national average. Solution: Outcome: Patient populations with Congestive Heart Failure in New York had a baseline readmission rate of 20.6% We conducted 6-month pilot programs offering remote patient monitoring collaborating with Stony Brook. At Stony Brook, the high-tech aspect of the program incorporated remote diagnostic testing and patient monitoring via live webcam with clinicians. This was coupled with a high-touch aspect of the program to ensure coordination and regular communication among patients, caregivers, clinicians and pharmacists, as well as Stony Brook s affiliated skilled nursing facilities and home care agencies. Through programs using remote patient monitoring, we achieved significant reduction in hospital readmissions for those with Congestive Heart Failure the pilot program in NY lowered readmissions to 4.3% from 20.6%. Similar Results in Arizona 6-month pilot with Yuma Regional Medical Center CHF readmissions dropped from 20.6% to 8.3% 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 11

12 Case Study in Georgia: Telepsychiatry A national shortage of 60,000 psychiatrists is expected this year and a shortage of 2,900 geriatric psychiatrists. The lack of access to psychiatry will likely be exacerbated since only 4% of medical graduates are going into psychiatry. Problem: In Griffin, GA, Brightmoor Nursing Facility residents are nearly 80 miles from the nearest available psychiatrist. Brightmoor s more than 300 residents cope with issues such as loss of independence, health conditions, sleeping troubles, social isolation and medications. Most have dementia or other cognitive issues, making the logistics of getting patients to see a psychiatrist very challenging. Solution: Outcomes: We conducted a pilot program with five skilled nursing facilities in Georgia featuring telepsychiatry through onsite video conferencing. Brightmoor residents received private consultations with a licensed psychiatrist located in Cumming, GA, which would have otherwise taken over 4 hours of driving round trip. In the first 6 months of the pilot, use of psychotropic medications among Brightmoor residents declined by 45% and there was no increase in the use of substitute drugs. Many of the residents had increased activity, engagement, involvement and awareness UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 12

13 Questions? Victoria L. Shapiro, J.D. Senior Director Health Care Services UnitedHealth Group, Government Affairs 2015 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 13