TelehealthDan Schwartzer

Deputy CommissionerWisconsin Office of the Commissioner of Insurance

ACA – Year 2

Transitional Policies

Network Adequacy

Self-Funded

2017 Waiver

State of the Market

2013 NGA/IOM meeting at Wingspread had 40 attendees, including Gov. Walker, over 2.5 days.

Major points of agreement, healthcare system needs:◦ Provider payment reform◦ Better focus on primary care and coordination of care

(including wellness programs)◦ Governor is state official best suited to drive real

change: Influence over state employees, Medicaid Can convene stakeholders and drive agenda better than

any other official

Wingspread Conference: Better Health at Lower Cost

Group offered competing opinions on how to make provider payment reform and increased focus on primary care happen.

Developed five tasks:1. Statewide review of healthcare manpower requirements;2. Dept. of Health Services (DHS) to develop package of Medicaid

reforms for near and long-term program savings;3. OCI and DHS to develop package of changes to state laws and

regulations to facilitate and enhance the use of telemedicine in rural WI.

4. State agencies and stakeholders to identify best practices for health benefits and services for small businesses.

5. Wisconsin’s health care data groups will develop opportunities to provide consumers transparency in health care quality and costs.

Wingspread: Task Development

OCI and DHS tasked with developing package of changes to state laws and regulations necessary to facilitate and enhance the use of Telemedicine in rural WI.

Gov. Walker gave permission to expand task to all of Wisconsin, as issue is far more than rural.

OCI uses term “Telehealth” to capture all remote health care clinical services using telecommunications technology.

Telehealth Task

Although still in early stages, many insurers are adopting Telehealth solutions◦ Insurers recognize that Telehealth can support integrated

health care◦ Can be more economical than in-person care in appropriate

settings

Models include:◦ Video conference (Skype) only◦ Integrated video conference and kiosk unit◦ Video conference in conjunction with PA or LPN

May be adaptable for mobile clinics and more economical than near-site facilities

Industry Adoption

Practice of medicine◦ Telehealth provider must operate within scope of license◦ Generally, is considered to be practicing medicine in the state

in which doctor resides◦ Must be licensed by the patient’s state of residence

Medicaid definition◦ Medicaid defines which services should be covered by

telehealth

Private Insurance ◦ Widely covered by private insurance◦ Limited Regulation

No real definition

No impact on network adequacy

Current Regulatory Environment

No statutory limits allow providers and insurers to innovate and adapt new technology as it becomes available

But complete lack of statutory definition makes limits of playing field uncertain – What is permissible?

Inhibits speed to market as insurers do not know whether regulator will approve

Importance of Statutory Definition

Broad statutory definition would define limits of playing field without stifling innovation◦ “Telehealth” means health care delivery,

diagnosis, consultation, treatment, transfer of medical data or exchange of medical education information through the use of interactive audio, video or other electronic media, provided that services delivered through audio only telephones, electronic mail messages or facsimile transitions are not included.”

Recommendations

Patient Compensation Fund structure already accommodates Telehealth◦ Practitioners in other states who see a small number of WI

patients via Telehealth may obtain an exemption;◦ Practitioners who see a greater number of WI patients will

pay a varying percentage of the PCF contribution depending on the number of hours they devote to WI patients

Licensure: ◦ Other states have implemented Expedited or Special Purpose

license; Compacts; Universal Licensure Application.◦ DSPS Moving towards Universal Licensure (Already being

proposed by FSMB)

Recommendations

For State Government:◦ ETF’s GIB recently approved full use in state

employee plan; further state employee use may be desirable

◦ Department of Corrections uses Telehealth for behavioral health patients, but continuity of care is hampered by absence of electronic medical record

◦ Current statute limits Telehealth use in Medicaid; Can it be expanded without expanding state budget?

Recommendations

Basically government needs to stay out of the way

Let medical community determine appropriate use, just as it does today.

Other Considerations