Under s andi ng he Oppor uni i es&chal l eng es oft el eheal h
Inroducion Telehealh is experiencing explosive growh. Indusry analyss esimae ha 37 percen more healhcare providers will offer elemedicine by he end of 2015 1 and ha he global elemedicine marke will surpass $34 billion by 2020 2. Telehealh virual consulaions also known as elehealh video consulaions, evisis and econsulaions are leading he boom, and are expeced o double in he nex five years in he U.S. For decision-makers a hospials, healh sysems and independen pracices, he promise of elehealh is mulifold. Healhcare organizaions are looking o elehealh o suppor growing paien populaions, o provide paien care in rural areas, o preven and reduce ER visis, o improve care, and, ulimaely, o reduce coss. Telehealh providers and EHR companies are also looking for ways o gain a compeiive advanage in he markeplace, paricularly as legislaive changes provide openings for insurance and Medicare/Medicaid coverage. Bu can elehealh live up o is promises? As his whiepaper will demonsrae, he answer is yes, no, and i s oo early o ell. While new sudies suppor some of he benefis of elehealh, oher sources highligh serious concerns. Addiionally, significan barriers o growh exis, making i difficul for all sakeholders, including paiens, o accuraely gauge is worh. Sill, by all esimaes, elehealh is only going o coninue expanding and evolving in spie of myriad challenges. As well, here are many opporuniies during his nascen sage for healhcare organizaions, elehealh providers and oher healhcare IT companies o inegrae lessons learned hus far in order o prepare for wha appears o an ineviable ransiion in he delivery of healhcare services. 1 Gallegos, Alicia. (2015). Telehealh boom raises quesions abou proper pracices. hp://www.pm360online.com/elehealh-boom-raises-quesions-abou-proper-pracices/ 2 Congdon, Ken. (2015). The Telemedicine Tipping Poin. hp://www.healhioucomes.com/doc/he-elemedicine-ipping-poin-0001?secioncode=aricles&emplaecode=single&user=2983867&source=nl:43881 2 HDS WHITEPAPER: UNDERSTANDING THE OPPORTUNITIES & CHALLENGES OF TELEHEALTH
The Telehealh Landscape & Marke A he beginning of 2015, elehealh was pegged as one of he op five healhcare rends o wach. Bu he ruh is, elehealh has been emerging for decades, saring wih he Balanced Budge Ac in 1997, which auhorized parial Medicare reimbursemen for elehealh services in rural areas, followed by he Benefis Improvemen and Proec Ac of 2000, which expanded elehealh reimbursemens and coverage areas, and he HITECH Ac of 2009, which laid he foundaion for a healhcare IT infrasrucure ha would suppor elemedicine. 3 Today, much of elehealh s growh hinges on legislaive changes ha are expeced o open he floodgaes. During he 113h Congress, 57 elehealh bills were inroduced ino Congress, and wo new elehealh bills S. 1549 and H.R. 2725 were recenly inroduced o he 114h Congress. S.1549, or he Care Planning Ac of 2015, aims o require Medicare coverage for round-he-clock emergency suppor for elemedicine and elephone visis when a beneficiary s medical record and care plan are available. H.R. 2725, also known as he 21s Cenury Care for Miliary and Veerans Ac, aims o modify curren legislaion o expand he use of elemedicine in he TRICARE veerans program. Facors Driving Expansion Drivers of he elehealh boom vary. One analysis posis he convenience and low cos of elehealh paricularly virual healh visis as a considerable draw for paiens. This assumpion has araced he aenion of invesors, who have funneled ens of millions of dollars ino elehealh sarups MDLive, Docor On Demand and Teladoc. Anoher analysis aribues he elehealh boom o he larger rend of reliance upon and love of elecronic communicaion mehods, as well as a general dissaisfacion wih he healhcare sysem. Telehealh, from his poin of view, offers a quick, convenien and inexpensive way for paiens o ge he healh care hey need. In urn, hese benefis of elehealh will lead o greaer paien saisfacion. Geographic Physician shorages coninue o play a role in he rise of elehealh. Healh Professional Shorage Areas (HPSAs), defined by he Healh and Human Services Adminisraion (HRSA) as geographic regions wih an inadequae number of Primary Care Physicians, have long received legislaive suppor and paymen coverage. By uilizing elehealh echnologies, Physicians can beer manage growing paien populaions in hese underserved areas. Serving he needs of he growing aging populaion, which is expeced o exceed 70 million by 2030, is anoher major driver of elehealh adopion. In-person docor s visis are paricularly difficul for elderly paiens who may have mobiliy problems or who live in rural areas. Ye, a he same ime, he elderly populaion is also one of he mos in need of regular healhcare for chronic and life-hreaening condiions such as arhriis, hear disease, oseoporosis, diabees, influenza, pneumonia and cancer. Technological enablers, including beer video conferencing echnologies, broadband adopion and increased peneraion of conneced medical devices are also major elehealh drivers. 4 Marke Predicions Analys predicions for he elehealh marke are nohing shor of asounding: Mordor Inelligence esimaes ha he global marke for elemedicine will be worh more han $34 billion by he end of 2020. IHS Inc. predics ha elehealh video consulaions will see annual growh of nearly 25 percen a year for he nex five years, reaching 5.4 million video 3 Jacobson, Sarah. (2015). How laws and policies are shaping elemedicine. hps://rockhealh.com/how-laws-policies-shaping-elemedicine-marke/ 4 Pennic, Jasmine. (2015). Repor: Telehealh Video Visis o Reach 158M by 2020. hp://hiconsulan.ne/2015/06/25/repor-elehealh-video-visis-o-reach-158m-by-2020/ 3 HDS WHITEPAPER: UNDERSTANDING THE OPPORTUNITIES & CHALLENGES OF TELEHEALTH
consulaions beween Primary Care Physicians and paiens by 2020. Globally, Tracica predics ha elehealh video consulaions will surpass 158 million per year by 2020. Specialy healhcare, including virual visis wih menal healh praciioners, dermaologiss and oher specialiss, is also expeced o jump o 21.5 million. Norh America is expeced o accoun for more han 40 percen of he elehealh video consulaion global marke size 5. Does Telehealh Reduce Healhcare Coss? A Towers Wason analysis esimaes ha elehealh docor visis could save U.S. healhcare organizaions up o $6 billion a year. In 2011, a Sandard Universiy evaluaion found ha is Healh Buddy elehealh program saved beween 7.7 13.3 percen per person per quarer. The U.S. Deparmen of Defense has saved as much as $750,000 a year by using pediaric elehealh in remoe areas. In 2014, a sudy by Red Quill Consuling on behalf of Alliance for Conneced Care found ha elehealh visis save commercial healhcare organizaions $126 per visi and Medicare $45 per visi. And in 2015, a sudy by public healh researchers found ha elehealh video consulaions can reduce he number of paiens being ransferred beween hospials by 31 percen 6 a significan savings in spie of he financial invesmen required o implemen a elemedicine program. To be sure, he cos-saving poenial of elehealh has hospials convinced, given ha more han of half of U.S. hospials used elehealh in 2013 and 10 percen were in he implemenaion process. 7 For hospials, he expansion of elehealh services can be aribued direcly o he goal of lowering healhcare coss by 5 Monegain, Bernie. (2015). Telemedicine marke o soar pas $30B. hp://www.healhcareinews.com/news/elemedicine-poised-grow-bigime 6 Tomiyoshi, Tricia. (2015). Telemedicine Saves Money for Rural ERs. hp://www.fuuriy.org/elemedicine-emergency-medicine-931192/ 7 Ason, Geri. (2015). Telehealh Promises o Reshape Healhcare. hp://www.hhnmag.com/magazine/2015/mar/cov-elehealh-paiens-connec minimizing ER visis, of which 71 percen have been found o be unnecessary and avoidable. 8 Addiionally, elehealh services are expeced o improve paien reenion, opimize Physician ime, increase visi compliance and save overhead coss all of which make a srong case for elehealh. Paien accepance of elehealh is necessary for is success and cos-cuing effeciveness, and here, here is good news: According o a recen Harris Poll of over 2,000 aduls, 64 percen said hey are willing o see a docor via video, and 7 percen said hey would swich o a docor who offers elemedicine. 9 The American Hospial Associaion found paien accepance of elehealh o be even higher a 74 percen. 10 However, paien accepance of elehealh is limied, which could have an impac on cos-savings. When i comes o ER visis, only 21 percen of respondens in he Harris poll said hey would prefer a video consulaion. In conras, 44 percen said hey preferred an in-person visi. In a naionwide sudy by TechnologyAdviceResearch, a whopping 75 percen of paiens said hey would no rus a diagnosis made during a elehealh video consulaion. These facors could defea he poin of elemedicine from boh a care and cos perspecive, so hospials, healh sysems and healhcare IT sakeholders should ake hese early polls ino consideraion. If paiens sill prefer in-person ER visis, hen hospials are less likely o see cos reducions in one of he mos expensive areas of care. And if paiens don rus virual diagnoses, hen hey are more likely o ignore he advice given, fail o ake prevenaive seps and fall ou of visi compliance. Telehealh also runs he risk of being an add-on o healhcare visis raher han a replacemen, causing 8 Rodak, Sabrina. (2015). Sudy: 71% of ED Visis Unnecessary, Avoidable. hp://www.beckershospialreview.com/capaciy-managemen/ sudy-71-of-ed-visis-unnecessary-avoidable.hml 9 Wicklund, Eric. (2015). Paiens: elehealh ops he docor s office. hp://www.mhealhnews.com/news/paiens-elehealh-ops-docors-office 10 Glover, Lacie. (2015). How elehealh can save you money and rouble. hp://www.foxnews.com/healh/2015/09/30/how-elehealhcan-save-money-and-rouble/ 4 HDS WHITEPAPER: UNDERSTANDING THE OPPORTUNITIES & CHALLENGES OF TELEHEALTH
a cycle of more ess and more visis which overall don necessarily lead o he savings ha healhcare organizaions expec. Legislaive Complexiies Coverage The complex legislaive landscape governing elemedicine and coverage is he bigges deerren of elehealh expansion in he U.S. The American Telemedicine Associaion describes he landscape as 50 saes wih 50 differen elemedicine policies. 11 Currenly, 47 saes and Washingon D.C. s Medicaid programs offer some coverage for elemedicine, 29 saes have elemedicine pariy laws for privae insurance, and 24 saes have some coverage for elehealh services under sae employee plans. Some of he legislaive challenges are relaed o how each sae defines elehealh. The differences in definiion hen lead o variaions beween saes regarding he ypes of services covered and wha requiremens providers mus mee o ge reimbursed. 12 For example, some saes have limied reimbursemens for elehealh services relaed o menal healh and disabiliies; ohers will reimburse for a wide range specialy services delivered via elehealh. The locaion of paiens and how coverage applies is anoher legislaive conenion among sae policymakers, and can deermine how broad or resricive elehealh coverage is in any sae. In a gaps analysis repor by he American Telemedicine Associaion (ATA), i was discovered ha some saes have designaed qualified paien locaions ha resric elemedicine coverage o cerain originaing sies such as Hospials, Independen 11 American Telemedicine Associaion. Sae Telemedicine Gaps Analysis: Coverage & Reimbursemen. hp://www.americanelemed. org/docs/defaul-source/policy/50-sae-elemedicine-gaps-analysis---coverage-and-reimbursemen.pdf 12 Lopez, Julian. (2015). Barriers o leveraging mhealh, elemedicine effecively. hp://www.healhcarebusinessech.com/barriers-elemedicine/ Physician Pracices, Criical Access Hospials, Rural Healh Ceners, Skilled Nursing Faciliies and he paien s home. On he oher hand, he sudy also found ha 24 saes do no specify a paien seing or paien locaion a all. Legislaion has creaed significan openings in wo areas: mileage resricions and live video. Currenly, he ATA repors ha 82 percen of saes have no saewide disance resricions or geographic designaions, which has helped elemedicine o flourish in areas ouside of rural seings. Live video consulaions, according o a repor by he Cener for Conneced Healh Policy, are he mos predominanly covered elehealh service naionwide, wih 47 saes providing some level of coverage. Medical Licensure Dispariies in elemedicine licensure add anoher layer of legislaive complexiy ha impedes elehealh expansion. According o he Cener for Conneced Healh Policy, eigh saes Alabama, Louisiana, New Mexico, Ohio, Oklahoma, Oregon, Tennessee and Texas require providers o obain a special license o pracice elemedicine. Such licenses do have benefi, as hey allow ou-of-sae clinicians o provide elehealh services o paiens in oher saes. Eleven saes Alabama, Idaho, Illinois, Iowa, Minnesoa, Monana, Nevada, Souh Dakoa, Uah, Wes Virginia and Wyoming have adoped he Federaion of Sae Medical Board s Inersae Medical Licensure Compac, which allows Physicians o apply for elemedicine licenses in oher saes hrough an expedied process governed by an Inersae Commission. In Alabama, Louisiana, Minnesoa, Nevada, New Mexico, Ohio, Oregon, Tennessee and Texas, ou-of-sae Physicians may obain a condiional elemedicine license. 5 HDS WHITEPAPER: UNDERSTANDING THE OPPORTUNITIES & CHALLENGES OF TELEHEALTH
Currenly, here are 32 ypes of healhcare providers who are designaed by some saes as qualified healh care professionals who may be covered for elemedicine services. In addiion o Physicians, some saes allow Physician Assisans, Nurse Praciioners, Deniss and Pharmaciss o receive elemedicine reimbursemens. Fifeen saes, including Washingon D.C., do no currenly specify or designae cerain ypes of healhcare providers who can receive reimbursemens for elemedicine services. While many saes have elemedicine licensure policies in place, ohers do no. For hospials, healh sysems and oher healhcare faciliies in he saes where such laws exis, i is criical no only o be aware of such policies bu also o have processes and soluions in place o monior he medical licensing of employed and conracual clinicians. The Role of Reail Clinics Dubbed he new fronier of elemedicine, reail medical clinics are making noable srides in elemedicine expansion. CVS Healh deserves menion for parnering wih American Weil, Docor on Demand and Teladoc afer discovering ha onehird of more han 1,700 paiens said hey preferred elehealh visis o in-person visis. This is significan, given ha he convenience, price ransparency, and low-cos benefis of CVS and oher reail clinics have already disruped he primary care marke. I is in he reail medical clinic space where innovaion and adopion of he laes echnologies are expeced. From collaboraing wih elehealh providers o expanding he range of services o using conneced devices and inegraing EHR sysems, he reail medical clinic is emerging as one of he mos accessible and acceped ceners for healhcare. As Pharmacis provider saus gains racion on boh he sae and federal level, reail medical clinics are expeced o become even more prominen in he healhcare landscape. Saes such as Alabama, Massachuses and California prohibi Physicians from prescribing medicaion wihou a physical exam. In oher saes, elehealh prescribing is only limied for cerain classes of drugs paricularly conrolled subsances. And sill oher saes explicily prohibi prescribing based on Inerne quesionnaires while ohers do no. Overall, rural saes end o have he friendlies elehealh prescribing laws. Markeing Telehealh In addiion o paien accepance, clinician accepance of elemedicine is essenial for expansion. As his whiepaper demonsraes, a variey of clinicians from Deniss o Physicians o Nurse Praciioners are eligible o receive reimbursemens for cerain ypes of elemedicine in cerain saes. Physician accepance of and involvemen wih elemedicine is undergoing a sea change. The American College of Physicians recenly repored ha mos of is 140,000 Physician members are involved in some sor of elehealh iniiaive. Sill, many Physicians are resisan o change, while ohers are cauiously enhusiasic. Concerns abou he qualiy of care and he erosion of paien-provider relaionships also weigh heavy on he minds of clinicians. One way o reduce resisance and build suppor for a burgeoning elemedicine program is hrough adequae educaion and raining. Early raining of Physicians, Nurse Praciioners, Physician Assisans and oher clinicians is recommended. Hospials, healh sysems and healhcare IT providers looking o arac clinicians wih elemedicine experience or hose who are ineresed in produc demonsraions or educaion should plan o develop full markeing sraegies ha uilize email markeing, webinars, and on-demand conen all of which Physicians uilize and prefer. Sae drug prescribing laws could pose a significan obsacle o reail medical clinics, as well as hospials, healh sysems and oher healhcare organizaions. 6 HDS WHITEPAPER: UNDERSTANDING THE OPPORTUNITIES & CHALLENGES OF TELEHEALTH
Conclusion The ime is ripe for elehealh o make groundbreaking changes in healhcare on a mass level. As healhcare organizaions feel he pressures o suppor and improve he healh of enire populaions and o reduce coss while doing i, elehealh s efficien and cos-saving value proposiion will be undeniable. As he healhcare indusry awais legislaive changes o make elemedicine ruly viable, hospials, healh sysems, and healhcare IT providers should prepare for he ransiion by considering he paien and provider concerns presened in his whiepaper. By adoping early lessons learned, coupled wih essenial ools and soluions o manage some aspecs of elemedicine, healhcare organizaions can make he ransiion o elemedicine wih more confidence and success. To learn how accurae provider daabases, email markeing services and a Medical License Monior soluion can suppor your elemedicine program, conac Healhcare Daa Soluions a 1-877-472-9066 or visi www.healhcaredaasoluions.com. 7 HDS WHITEPAPER: UNDERSTANDING THE OPPORTUNITIES & CHALLENGES OF TELEHEALTH