Keys to Health Center Success June Conference. Stewart Levy President - Health Promotion Solutions

Transcription

1 1 Keys to Health Center Success June Conference Stewart Levy President - Health Promotion Solutions

2 2 Agenda Introduction Definitions - Telehealth, Telemedicine, Telepresence Benefits to Healthcare System Telehealth funding and initiatives in Government FQHC Case Studies State Regulatory and Reimbursement Opportunities for FQHC Examples of various Telehealth Systems Questions and Answers

3 3 Health Promotion Solutions - Introduction Description - Consulting and service provider focused on evidence based health and disease management solutions Clients - Government agencies, non-profit groups, employers, retailers, academic organizations, Insurance companies, and clinics Disclosure Statement

4 Telehealth Technology is Here Today

5 5 According to American Telemedicine Association : Term Telehealth is used interchangeable with Telemedicine however telehealth does not need to involve clinical services : - General Patient education - Mobile health apps - Non Clinical staff Telephonic Health coaching - Includes Phone, Fax, / Messaging, PACS, EHR Video, Medical device telemetry, Web conferencing, SMS Text

6 Telemedicine Delivery of Clinical Healthcare Services with Practitioner

7 7 Telepresence Telepresence refers to various technologies which allow a person to feel as if they were present, or to have an effect at a place other than their true location.

8 8 Telepresence

9 9 Clinical Uses of Telehealth Technologies 1) *Transmission of medical images for diagnosis (Store and forward ) 2) *Individuals exchanging health services or education live via videoconference (Teleservice or Video / Phone telehealth) 3) *Transmission of medical data for diagnosis or disease management (Referred to as Telehome or home monitoring) 4) Prevention of disease and health promotion ( Health coaching ) 5) Health advice by telephone (Referred to as teletriage) * Telemedicine Services

10 10 Benefits of Telehealth Reduce Travel Time to clinic visits Staffing efficiencies Reduce delays in treatment Reduction in medical costs Direct - staff, clinic Indirect unnecessary ER visits Access rural and urban locations Access to multiple specialties Consumer education Improvement in quality of care

11 Emergency room use nationally Total cost of unnecessary urgent care and ER visits is $31 billion per year 65% of ER visits occur after business hours* 45% of ER visits were not classified as immediate, emergent or urgent at triage* 23% of ER visits for those under age 15 were:* Upper Respiratory Fever with no other complications Sore throat Ear ache National Hospital Ambulatory Care Survey published by the CDC 11

12 12 Americans support the US of Telehealth Online survey of 1,000 consumers was commissioned by the Health Research Institute unit of Price Waterhouse Coopers in Sep % of consumers believe that universal health insurance coverage will not ensure equal access to care Nearly 75% of U.S. consumers say they would use telemedicine, defined as remote monitoring to track their condition and vital signs 50% of consumers would be willing to seek care through computer technology as a substitute for face-to-face, non-emergency visits.

13 13 Telehealth Technology Acceptance in Rural Populations Sample of 199 patients in a Federally Qualified Health Center (FQHC) in the rural South Purpose -investigate access to technologies, comfort with technologies, and willingness to participate in clinical interventions among rural populations. Access to technologies among this underserved group was remarkably high (near or above 50%) for all technologies. Conclusion -access to and comfort with technologies is strong among highly underserved patients. lhealth and Technology Volume 1, Issue 2-4, pp

14 US Growth of Telemedicine According to Information Week research PPACA catalyst for accelerated growth billion billion Telehome market ( growing from 30% - 35%) growing faster than teleservice market (70%- 65% )

15 15 Government Use and Funding Grants - Available through 8 federal programs. 33% is from research contracts with the U.S Department of Defense. Direct Services VHA is largest provider of remote medical services, projected to deliver over 350,000 patients Department of Defense, Indian Health Service and Bureau of Prisons in the Department of Justice. Military Use Triage and field mobile health clinics Medicare Reimbursement for telehealth and remote care Center of Medicare and Medicaid Innovation - projects

16 Government Projects Center for Medicare and Medicaid Innovation 1) Care for intensive care remotely from specialists 2) Patient based home telehealth monitoring 3) Indian Health Services stroke and behavioral health 4) Use of non medical and non specialized providers 5) Gov t promoting hospital initiatives Accountable care organizations

17 Medicare - Approved Originating Sites ( Where eligible patients are located) Offices of Practitioners Hospitals Critical Access Hospitals Rural Health Clinics Federally Qualified Health Centers Hospital based or CAH based Renal Dialysis Skilled Nursing Facilities Community Mental Health Centers

18 18 Medicare Approved Distant Site locations (Where practitioner is located) Physicians; Nurse practitioners (NP) Physician assistants (PA) Nurse midwives; Clinical nurse specialists (CNS) Clinical psychologists (CP) and clinical social Registered dietitians or nutrition professionals

19 Results from VA Northwest Health Network $742,000 cost savings by utilizing telemedicine to provide 23,580 remote consultations Utilized store forward and videoconferencing with trans-disciplinary network Reduction in travel costs in rural areas Improved the quality care due to issues surrounding PTSD stigma

20 Military Study % reduction in bed days and 19% reduction in admissions for military telemedicine

21 Results from Rural FQHC Study - Practice based vs. telemedicine in collaborative care model for depression in rural FQHC patients screened for depression Measure response, remission, change in depression severity 1) Clinic onsite primary care and nurse care manager 2) Telemedicine - Onsite primary care, and offsite team of nurse, pharmacist, psychologist, and psychiatrist

22 FQHC Study Results Contracting with offsite telemedicinebased collaborative care team showed significant improvement. Potential to yield better outcomes than traditional practice based care with clinic staff

23 23 Georgia Partnership for Telehealth FQHC - Case studies The Georgia Partnership for Health (GPT) network includes 201 statewide access points Includes healthcare providers, health plans, schools, rural health centers, nursing homes, group practices, hospitals, community mental health centers, and Prisons

24 Georgia Partnership for Telehealth Year 1 Payers provided reimbursement for telemedicine the same as an office visit 160 physicians in 40 specialties participate most utilized specialty being psychiatry. In 2010, the GPT facilitated 31,000 encounters - 11,000 were store-and-forward consults, with the remainder comprising real-time visits.

25 25 Challenges of Wide-scale Telemedicine Adoption State Regulatory Laws Scalability Bandwidth Data Platforms Security Provider training and certification Interfacing with other multiple applications

26 State Provisions State is responsible for assuring access and covering face-to-face visits/examinations by these recognized practitioners/providers in those parts of the state where telemedicine is not available or limited. The general Medicaid requirements of comparability, statewideness and freedom of choice do not apply with regard to telemedicine services.

27 27 Telemedicine State Regulations 14 states allow for first patient visit physician examinations to take place electronically California New Mexico Hawaii North Carolina Kansas Pennsylvania Louisiana South Dakota Maryland Texas Ohio Vermont Nevada Virginia

28 Current Medicaid Reimbursement for Telemedicine

29 Medicaid Reimbursement Originating Site Facility Fee Practitioner Distant Site 35 states offer some reimbursement States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services

30 Telemedicine State Coverage States have the option/flexibility to determine whether (or not) to cover telemedicine Types of telemedicine to cover; Where in the state it can be covered; How it is provided/covered; Types of telemedicine practitioners/providers may be covered/reimbursed, as long as such practitioners/providers are recognized and qualified How much to reimburse for telemedicine services, as long as payments do not exceed Federal Upper Limits.

31 New legislation Dec 2012 Mike Thompson introduced legislation To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes by eliminating in state licensure requirements and support reimbursement measures

32 Review of Various Telehealth Products and Services Teladoc Health Spot Optimized Care Network Home Monitoring / Personal Body Devices

33 Teleadoc results Employer and Cash pay Telehealth provider 4 million users 97% Member Satisfaction 97% Physician Satisfaction 10min Avg. Consult Duration 0 Malpractice Claims 22min Avg. Response Time 91% Patient Issues Resolved All *Based on Teladoc reporting and member surveys

34 34 Health Spot - The walk-in kiosk has integrated medical devices and is staffed by an attendant. Inside, patients receive care from practitioners over realtime interactive videoconferences.

35 35 The Care4 Station Patient entry

36 36 Medical Assistant - Attendant Always present Facilitates: Check-in / ID validation Sanitization Patient assistance Additional capabilities based on attendant certification

37 37 Patient Check in Process HIPAA/Terms of Service Acceptance Name and contact info Payment / Insurance Symptoms Current medications Existing conditions Allergies

38 38 The Care4 Station patient steps inside Floor View

39 39 Vitals Check Weight Temperature Blood Pressure Summary

40 40 Technology Pulse Oximeter Otoscope Stethoscope Dermascope

41 41 Physician Portal Displays patient summary Device controls in kiosk Image capture Dictation E-prescriptions and EMR integration in development

42 42 Post-appointment and follow-up Printed patient summary EMR record Access records online

43 43 Conditions Treated Colds & Flu Eye Conditions Skin Conditions Sinus Infections Earaches Sore Throats Depression/Anxiety Bronchitis URI Wellness check ups Blood pressure checks Diabetes Monitoring

44 44 Health Spot Utilization and Empowered Patient Care Preference over urgent care or ER: 98% Would use Care4 Station again: 95.5% Patient age range: 24 89

45 45 Clinic? Public Housing?

46 Health Spot Video cakkva4

47 47 Optimized Care Network The OCN is a non profit, health care provider network, consulting, and service organization to support effective telehealth solutions including - HealthSpot Station - Home monitoring - Telepresence Offices - Other.

48 48 OCN Trans-disciplinary Telehealth Providers Primary Care Doctors Pharmacists Behavioral Health Coaches Dieticians Nutritionists Specialists

49 Optimized Care Telepresence

50 Optimized Care Network bkbexve&sns=em

51 Home telehealth monitoring

52 Home Monitoring Telemedicine Devices Blood Pressure EKG Pulse Weight Glucose Prothrombin time Blood Oxygen Spirometry

53 Summary Trends of exponential growth with health care reform Telehealth has been established with proven results Efficiencies, Cost reduction and improved care Already being used by Community Health Centers Flexible types of models Easy to implement Barriers becoming minimal or no longer exist Tie into CHC efforts with patients and community Consumers accept technology and find empowering Funding available

54 Questions