telehealth : using technology in the delivery of healthcare...•potential to increase accessibility...

Telehealth:Usingtechnologyinthedeliveryofhealthcare

UsingTelemedicinetoTreatChronicDiseaseinRuralCommunities

"RuralAmericansfaceauniquecombinationoffactorsthatcreatedisparitiesinhealthcarenotfoundinurbanareas.Economicfactors,culturalandsocialdifferences,educationalshortcomings,lackofrecognitionbylegislators,andthesheerisolationoflivinginremoteruralareasallconspiretoimpederuralAmericansintheirstruggletoleadanormal,healthylife.”+• In2010,theU.S.Censusestimatedthat59.5millionpeople– 19.3%ofthepopulation– livedinruralareas.+

• 10percentofphysicianspracticeinruralAmerica*• 401specialistsper100,000peopleinruralUS,comparedto910inurbanareas*

+Altarum InstituteMarch22,2016*NationalRuralHealthAssociation

TelemedicineTelemedicine

TELEHEALTH

VirtualVisitandDigitalHealth

eConsult/ECHO

http://uhealthplan.utah.edu/virtualvisits/

FactorsdrivingVirtualCare

Virtual Care

Volume to value

Expanding coverage

Physician shortages Triple aim

Population health

Consumerism

MostCommonUSObjectivesforVirtualCare

42.2% 42.2%

15.6%

95.6%

84.4%

66.7%

46.7%

8.9%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Availability of grant(s)

Consumer engagement

Financial incentives

Improve access

Improved patient

outcomes

Physician shortage

Streamlined workflow

Other

HIMSS2015Presentation:EYAdoptionModel

Why?Decantnon-acuteGoupstreamfortimelydx/txAnd?IncreaseinBurnreferralsbecauseitbecameaneasybutton

Why?Decantnon-acuteGoupstreamfortimelydx/txAnd?IncreaseinStroke

Manyothers…

20050.26% ofallclinicvisitsviatelemedicine

12

458

050100150200250300350400450500

2005 2014

TeleBurnVisitGrowth

TeleBurnVisits

201414% ofallclinicvisitsviatelemedicine

Launchedin2005onagrantedfundedprojectTodayisfully-selfsustaining

MustHavesforSuccessfulLaunchandLongevity• ClinicalChampion• OperationalWorkflow

• Onbothends• Technologystrategy

• Developedtomeetclinicalneeds(notinreverse)• Supportprograminplace

• Needtoseethepeople/location• Peopleneedtoknowandtrusttheotherside

• ClearfocusonOutcomes• Whatarewetryingtoaccomplish?• Howwillwemeasuresuccess?

WhatdoesanECHOlooklike?

ProjectECHOPartners


• Perpetuatedbytheinabilitytofindandaffordcare,ruralpopulationsfacehigherincidencesofchronicdisease.• Obesity,diabetes,heartdisease,andalcoholandsubstanceabuseareallchronicconditionsthatdisproportionatelyaffectruralpopulations.• 86%ofallhealthcarespendingin2010wasforpeoplewithoneormorechronicmedicalconditions.• Medicalcostslinkedtoobesity~$147billionin2008.

• Annualmedicalcostsforpeoplewhoareobesewere$1,429higherthanthoseforpeopleofnormalweightin2006.

• Totalestimatedcostofdiagnoseddiabetesin2012• $245billion($176billionindirectcosts&$69billionindecreasedproductivity)

Altarum InstituteMarch22,2016

2010U.S.Census:StateswiththeHighestRuralPopulationsComparedtoStateswiththeHighestRatesofAdultObesity

andDiagnosedDiabetes



• Telemedicineasasolutiontoruralhealthcaredelivery:• helpseliminatedistancebarrierstomedicalservicesthatwouldoftennotbeconsistentlyavailableindistantruralcommunities• potentialtoincreaseaccessibilitytoprovidersandspecialistswhocanremotelymonitorandtreatchronicdisease• withoutthehassleorcostsassociatedwithtraveling• usedmosteffectivelytomonitorandmanagechronicconditionsandpreventivehealthcarecosts



• Challengesoftelemedicineinhealthcaredelivery:• Inmanystatestelemedicineservicesarenotcoveredbyinsurancetothesameextentasin-personservices.

• Planadministratorsandprovidersneedtoworktogethertodiscusstelemedicinebenefitsanddeterminecoverageoptionsandreimbursementpolicies.• MimictheMississippiStateLegislaturepassingabillrequiringprivateinsurancetopayfortelemedicineservicesatthesamerateasitdoesforin-personcare.

• Medicarereimbursesfortelehealth serviceswithrelativelystringentrequirements.• MedicarepaysfortelemedicineservicesonlywhenpatientsliveinHealthProfessionalShortageAreas(HPSAs)andthosewhoengagein"face-to-face"interactivevideoconsultationservices

• Telemedicineisnotareplacementforanannual,in-personphysical.• rulesgoverningthepracticeofmedicinedonotneedtobethesamerulesthatgovernthepracticeoftelemedicine

• Issuesoflicensureareproblematicwhenservicescrossstatelines• Consentisavitalcomponentofhealthcareandismorecomplicatedwithatelemedicineplatform.


TopFederalPriorities

• Reimbursementassistance• MedicareParitywouldbeidealbutprogressinpositivedirectionisslow• AdoptionoftelehealthandavoidingSSArestrictionsinMedicare

• FosteringInnovation• Allowinghealthcaresystemstoimplementvalue-drivendigitalsolutions• ExpandingAccessforHealthOutcomes(ECHO)ActcreatedbySenatorsHatch(RUtah)andSchatz(DHawaii)requiresProjectECHOtypeplatformstobeevaluated

• Clearing/Avoidingartificialnon-medicalrestrictions• i.e.”onlyrural”,“placeofservice”,etc.• Focusonmedicalprofessionaldiscretion

Visionofthefuture• Creationofahigh-functioningnetworkcapableofconnectingcarebetweenprovidersandpatients:

BestOutcomes

Right

Time

Place

ProviderDelivery

Cost

telehealth : using technology in the delivery of healthcare...•potential to increase accessibility...

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