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Driving Telehealth Adoption Through the Triple Aim

Jonathan Neufeld, PhD, HSPPUpper Midwest Telehealth Resource CenterIRHA Annual Conference - August 13, 2015

telehealthresourcecenters.org

• Links to all TRCs

• National Webinar Series

• Reimbursement, Marketing, and Training Tools

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The Triple AimIn business, three things matter:

Quality, Performance, and Price.

You can pick any two.

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A Realistic Approach

• Services done right will improve Patient Experience (Better Care)

• Providing the right services will improve Population Health

• Better Health will lead to Lower Cost

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Telehealth in a Triple Aim ContextThe right tool changes everything…

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Three Domains of Telehealth

• Hospitals & Specialties• Specialists see and manage patients remotely

• Integrated Primary Care• Mental health and other specialists work in

primary care settings (e.g., PCMH’s, ACO’s)• Transitions & Monitoring• Patients access care (or care follows patients)

where and when it is needed to avoid complications and more costly levels of care

**Value proposition differs among these types**

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Hospital and Specialty Care

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Three Domains of Telehealth

• Hospitals & Specialties• Specialists see and manage patients remotely

• Integrated Primary Care• Mental health and other specialists work in

primary care settings (e.g., PCMH’s, ACO’s)• Transitions & Monitoring• Patients access care (or care follows patients)

where and when it is needed to avoid complications and more costly levels of care

**Value proposition differs among these types**

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Integrated Primary Care

Hub and Spoke Telemedicine

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Peer-to-Peer Telemedicine

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Peer-to-Peer Telemedicine

– Peer-to-Peer Model• Clinicians anywhere• Patients anywhere• Patient site bills,

receives payment• Clinician gets paid by

patient site (as an employee or contractor)

• Clinicians anywhere• Patients anywhere• Patient site bills,

receives payment• Clinician gets paid by

patient site (as an employee/contractor)

• “Telecommuting” (IN & IL)

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Three Domains of Telehealth

• Hospitals & Specialties• Specialists see and manage patients remotely

• Integrated Primary Care• Mental health and other specialists work in

primary care settings (e.g., PCMH’s, ACO’s)• Transitions & Monitoring• Patients access care (or care follows patients)

where and when it is needed to avoid complications and more costly levels of care

**Value proposition differs among these types**

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Transitions and Monitoring

P2P Network(s)

• 3 CMHC• 1 RHC• 2 FQHC• 1 LTC (plus MD/NP site)• 2 CAH• 1 Admin (Grantee)

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P2P – Putting Rural in Charge

• Rather than connecting with a large health system, rural CHCs can hire/contract directly with the clinicians/services they need– CHC drives the project– CHC chooses clinicians/services/format– CHC bills for services– CHC pays clinician

• CHC maintains ownership/control

Telemedicine Policy & Payment• Regulations: Professionals are regulated at the

state level (doctors, nurses, counselors, etc.)• Medicare: Pays for certain outpatient

professional services (CPT codes) for patients accessing care in rural counties and HPSAs in rural census tracts.

*No regs; only conditions of payment.• Medicaid: Telemedicine is “a cost-effective

alternative to the more traditional face-to-face way of providing medical care…that states can choose to cover.”

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Triple Aim - Volume vs. Value

• Still early in the “Transition to Value”– Only 11% of dollars linked to value today

• Volume still drives most of sustainability• Keeping patients healthy and out of the ED

is a key goal of primary care

Main strategy: Driving utilization…

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Driving Utilization

Drive from high cost to high effectiveness– Away from ED (to Primary Care)– Away from No Care (to Primary Care)– Common element: To Primary Care

Strategies:1. Actively find patients2. Reduce gaps, dropouts, lost to follow up

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ED Mental Health Evaluations

• Minimize impact of adverse utilization• Improving efficiency of ED– Reduced “boarding”– Reduced lost costs for self-pay patients

• Routing the adverse utilizer into more appropriate services

** Improved Integration will be Essential! **

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Other Potential Integrations

• LTC/SNF Integration– Geriatric Primary Care & Monitoring– Geropsychiatry

• Community Paramedicine and Mobile Integrated Health (MIH)– Urgent Care/ED replacement– Providers plan care if patients can’t

Telehealth Connects the Pieces

Innovation at the Bottom:

Innovation at the Top:• New and better treatments

• New and better delivery

Better outcomes for the whole population

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Key Factors That Drive Success

• Clear Vision (with a sustainable model)• Technological Openness Among Staff– “Can we meet by video?”

• Good Information (regs, billing, etc.)• Solid Partners & Partnerships• Efficient Execution, with Frequent and

Scheduled Testing and Rehearsal

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CONTACT

Jonathan Neufeld, PhD, HSPPClinical DirectorUpper Midwest Telehealth Resource Centerjneufeld@umtrc.org(574) 606-5038