Telemedicine at Alabama Department of Public Health County Health Departments

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1 Telemedicine at Alabama Department of Public Health County Health Departments Goals Define and demonstrate telemedicine Discuss why Alabama can benefit from having telemedicine services Describe role ADPH can provide September 2015 Telehealth Use of digital technologies to connect multiple users in separate locations to provide: Medical Care, Health Education, etc Broad definition of technology enabled health care services Includes video conference and telemedicine Telemedicine Use of digital technologies to exchange medical information from one site to another: To improve a patient s clinical health status Not a medical specialty but a delivery system Encrypted and HIPAA compliant Real time 2-way video and audio Store and forward Clinical Application Full spectrum of medical services Early patient assessment Diagnosis Consultation Many peripheral exam tools 1

2 Bluetooth Stethoscope Handheld Exam Camera Ultrasound General purpose abdominal Vascular Endocavity Why Telemedicine is Important Triple Aim (Institute for Healthcare Improvement) 1. Improve patient outcomes 2. Improve access to care 3. Reduce health care costs Health Care Delivery Problems Barriers of time and distance Professional shortages Disparities in access to care Quality of care Hospital readmits, ER overuse Costs of delivery Convenience and patient choice 2

3 Alabama Health Problems #46 Diabetes #41 Smoking #47 Obesity #49 Infant Mortality #45 Overall Alabama Rural Health Outcomes Heart Disease - mortality rate for rural residents is 37% higher than urban residents Cancer - mortality rate for rural residents is 16% higher than that for urban residents Obesity 45% of the adult population in 10 rural counties are obese AL Hospitals Closed Since Woodland Medical Center 2011 Randolph Medical Center Southwest AL Medical Center 10! 2012 Infirmary West Greil Memorial Psychiatric Hartselle 2013 Elba General Florala Memorial Telemedicine is Important to Governor Bentley... proposals to make Alabama healthier HEALTH CARE IMPROVEMENT TASK FORCE Jan 3, 2015 Sub-committee: Access to care / Telemedicine Telemedicine is Important to Alabama Medicaid To provide for the delivery of medical services to Medicaid beneficiaries on a managed care basis through Regional Care Organizations Obtain independent evaluation: - Cost savings; Patient outcomes; Quality of care Telemedicine is Important to Alabama Medicaid Adopted Incentive Measures to be linked to financial incentives Diabetes care, medication management, cervical cancer screening, prenatal/postpartum care, LBW, FU post hospitalization, well-child visits 3

4 Alabama Medicaid Telemedicine Utilization FY 2014 $34,800 FY 2013 $18,300 FY 2012 $ 5,900 FY 2011 $ 4,300 FY 2010 $ 3,800 Telemedicine Should Be Important to Insurers Reduce ER visits Reduce hospitalizations Reduce LBW babies Lower infant mortality Healthier population Save money $ $ $ $ $ $ $ $ A Sustainable Business US Telemedicine Legislation 30 states have enacted legislation: - Parity for private coverage = 30 states - Medicaid coverage = 14 states ATA as of 7/7/15 States with Parity Laws for Private Insurance Coverage of Telemedicine (2015) Telemedicine in Alabama Parity Insurance Medicaid State Employee Health Plan F C F (LA, MS and TN have private insurance parity laws and Florida proposed legislation in 2014) 50 State Telemedicine Gaps Analysis ATA September

5 Alabama Changes Telehealth Rules (August 2015) Alabama Medical Board suspended rule requiring first time visits between a patient and physician be in person AL, AR and TX have strictest requirements for delivering telemedicine services compared to inperson health care (ATA) Alabama Department of Public Health: Infrastructure Innovation Partnerships ADPH Infrastructure County Health Departments Distance Learning (Satellite conferences, Webcasts, Video conferencing) Technical Expertise (IT) Bandwidth Administrative and Program Support Clinic Exam Cart Camera Codec Computer Stethoscope Exam camera ADPH Innovation ADPH Partnerships Strength in Partnerships ADPH: Bricks and mortar Staff Medical Providers Multi-county catchment area Telemedicine at ADPH County Health Departments Health Departments in all 67 counties 44 of 67 counties have bandwidth capacity for telemedicine 5

6 ADPH and Telemedicine Strengths: ADPH infrastructure and experience Price point of telemedicine cart Widespread support and interest ADPH (CO, AO, CHDs) Providers Telehealth Telemedicine ADPH and Telemedicine Challenge: Sustainable business model Reimbursement ADPH and Telemedicine Teamwork and Homework: Grant opportunities Education and outreach AL Partnership for Telehealth Annual Conference (11/17/15) Partnerships To Discuss Opportunities Michael Smith, MSPH, MEd michael.smith@adph.state.al.us Jeannie Gaines jeannie.summerlin@adph.state.al.us (click on Telemedicine link) 6