There are exciting developments with telehealth reimbursement thanks to the progress in moving towards Patient Centered Care, and a focus on Prevention and Wellness. Early in 2016 we saw the introduction of Senate bill 2484 and with it a proposed path to remove many of the obstacles to providing access to patient centered care and telehealth. Now we are seeing the Comprehensive Primary Care Plus model take shape that further supports telehealth adoption and reimbursements. Imagine a connected care team, in collaboration with patient and family members, the relevant data is available as needed, and an empowered healthcare provider who is able to ‘do the right thing’ with respect to each patient.
Wouldn’t it be great if care was accessible independent of the patient’s or doctor’s location, whether they are rural or urban, whether they are in their home or in a clinic? Well, Senate bill 2484 may do just that. It is looking at removing obstacles to delivering telehealth services and opening the door to the delivery of care where and when it is needed.
Additionally, wouldn’t it be great if the primary care practitioner were free to utilize the right delivery of care at the right time?
To date it has been difficult to find a model that empowers the primary care provider and provides the freedom to do what they know is best for their patients including telehealth as appropriate. This year, a change is kicking off that may go a long way toward enabling the primary care practitioner. It comes in the form of the recent announcement from CMS in an interview with Joyce Freidon from Medpage Today published in article on 4-11-16: “The 5-year initiative, known as the Comprehensive Primary Care Plus model, will give doctors the freedom and flexibility to practice medicine the best way they know how, to return to what matters most to doctors and their patients,” said Patrick Conway, MD, CMS chief medical officer, on a phone call with reporters.
And Dr. Conway states “If telehealth makes sense, they can do that.” As the program kicks off this summer and goes into action January 2017, look for more details to unfold.
The article further quotes Dr. Patrick Conway: “Doctors will be given more freedom to design the type and amount of care that best meets the needs of their patients,” said Conway. “If telehealth makes sense, they can do that … This initiative will also make it easier for doctors to communicate with each other and have all the information they need … to get better support from nurses, specialists, and others on the patient’s care team.”
Guest post by Michael Leonard, director of product management, healthcare, Commvault.
Once a year, the healthcare community gathers to discuss the hottest healthcare trends. This year, the event took place in Sin City, and the turnout was staggering. Topics of choice at the show ranged from EHR best practices to the rising need for telehealth services.
Now that I’ve had a chance to step back and digest, there are a few key moments that jumped out from the event. Here are my top two:
The HIMSS survey showed healthcare organizations are ready for telehealth.
During the show, HIMSS released a survey that had some exciting results around connected technology in the healthcare field. The results showed that 52 percent of hospitals are currently using three or more connected health technologies. Technologies being used by that group that stood out to me include mobile optimized patient portals (58 percent), remote patient monitoring (37 percent) and patient generated health data (32 percent). It’s fascinating to see these results, and important for healthcare and health IT professionals to know that the telehealth wave is here to stay.
The U.S. Department of Health and Human Services’ (HHS) made a key interoperability announcement.
At the show, the HHS Secretary Sylvia M. Burwell made a major announcement around interoperability that was backed by the majority of the top electronic health record (EHR) vendors and is supported by many of the leading providers. This news will enhance healthcare services and allow doctors and patients to make better informed decisions. It certainly has the potential to catapult the industry forward, allowing healthcare partners to increase accessibility by improving their clinical data management solutions.
As always, the conversation at HIMSS was engaging and educational and I left with some great takeaways and predictions for the future of health IT including:
Guest post by Charlotte Hovet, MD, MMM, and Joseph Kim, MD, MPH.
Remember a few years ago, when online shopping was first getting started, and everyone used words like “e-tailer” to refer to companies that sold stuff on line? When was the last time you heard that used? It has become an anachronism, because almost every company is now an e-tailer. And “online shopping” has become merely shopping, because no one thinks twice about buying via the Internet.
The phrase mobile health will soon be headed for extinction in the same way as “e-tailer” because it is becoming a routine way to consult your medical practitioner. Over the next couple of years, it will become a major force in healthcare, and in five years no one will think twice about using remote communications to get medical help. We predict there will soon come a time when young people will wrinkle their noses and ask “Really? You had to drive to the doctor’s office, and sit in a waiting room and infect a bunch of other people just to get some Tamiflu? That’s insane!”
Both public and private health plans are rapidly adding coverage for e-visits. Not only are they cheaper, they are also more effective for some types of care and consumers greatly appreciate this trend. While the baby boom generation may still have some holdouts who don’t like mobile communications, the majority of people across all age groups have not only adopted mobile technology, they’ve melded with it.
So the question for physicians and hospitals is not whether to adopt e-visits and mobile technology, but how to use them most effectively.
We co-hosted a webinar on the topic recently, in which we looked at mobile technology from the perspective of patients and caregivers. Both sets of stakeholders have a shared need: simplicity and ease of use. Merely making an application or function mobile isn’t enough. How mobility is integrated and used makes a big difference in the value derived.
During the webinar, we polled attendees on which mobility trends will have the biggest impact in the coming year:
47 percent think a greater use of digital communication between patients and healthcare providers will have the biggest impact.
5 percent voted for Telehealth replacing more in-person visits with healthcare providers
While 14.7 percent see increased use of medical-grade disease management mobile apps and growing adoption of health/fitness wearable devices and apps by consumers.
We will never return to the days of house calls and family doctors who knew you from birth. However, thanks to advances in mobile and digital technology we are well on our way to a new golden age in medicine, one that will offer near instant access to electronically delivered healthcare from humans, anywhere, any time. The groundwork has already been set – there have been more than one billion tablets produced by the tech industry (one for every seven humans), so we certainly have enough screens to get a caregiver’s face in front of every patient.
So, what’s the next step? An understanding and commitment to using this technology to give everyone access to care, whether they are an aging boomer, someone living in a rural area without enough specialists, or a very sick kid who can’t travel because of their treatment regime.
This isn’t science fiction – robotic technology and tablets are already being combined in schools, in homes and in hospitals to better patient experiences. For example, a public elementary school in Round Rock, Texas recently accommodated a student receiving chemo in Philadelphia by using a telepresence robot to put her back “in” the classroom. The technology allowed her to look around the room, interact with fellow students and ask questions as if she were there in person – all for under $1,000.
The ROI of this type of set-up for schools is impossible to calculate nationwide, but the benefits are massive. Not only does the child benefit, so do their classmates who learn about inclusion, the school which evolves its technology, and the community because it gains one more educated human being. More than 40,000 children undergo treatment for cancer each year in the US – imagine giving each of them this opportunity.
Guest post by Torben Nielsen, senior vice president product and strategy, HealthSparq.
The past few years have seen record investments in digital health. More than $12 billion have been poured into digital health companies in 2014 and 2015 alone, according to Rock Health, and there’s no indication of any slowing in 2016. Here are my predictions for what’s in store for health care in the New Year:
#1: Fragmented and disparate data sets turning into relevant and comprehensive information sets
Healthcare data sources have been siloed and fragmented for years. Data in electronic health records (EHRs) have worked within the hospital setting (to some degree), but not across systems, or for the consumer. Patient portals have attempted to bring data together, but with limited adoption due to sporadic data, old interfaces and no clear use model. With new data standards, APIs, and open source developments, data will become more fluid and accessible. We will finally start to see data portability and data integration in ways not witnessed before. This will be to the benefit of the consumer, who will be able to share and embed data from different sources into their preferred view. This will ultimately create a more relevant and engaged experience for the healthcare consumer.
#2 Continuous and team-based care on the rise
Along with a deeper and more portable experience of one’s own healthcare information (both from the healthcare system and via patient-driven data) comes a more continuous and streamlined patient-doctor experience. Interaction between the patient and the system will happen via Wi-Fi enabled technology and smart devices allowing for a continuous stream of data and information. This will benefit the doctor, who will be able to interact and react much faster. It will also do away with the “information black-outs” that often occurs between the time a patient visits their physician, all the way until their next scheduled visit. The patient will also be able to better track their condition. Furthermore, much of this information can be shared with the patient’s broader care team such as significant others, children, specialists, etc. This will ultimately benefit the care provider, the patient and the overall system.
#3 Millennials will be the catalysts for the healthcare consumer revolution
One of the most over-used buzzwords in the healthcare industry today is “consumer/patient engagement.” Everyone seems to have a solution for driving up engagement for the masses. However, it’s a fallacy to believe that anyone or everyone will engage in a particular system, process or technology. As is the case with most products, an early-adopter segment needs to be identified to successfully scale and ramp up sales. For healthcare, millennials will be a great catalyst for change and the movement towards consumerism. This generation has grown up with Uber, Amazon, Instagram and Facetime. They will demand a much more efficient and technology driven healthcare experience. They will push for a seamless and personalized experience, and their voice will become stronger and stronger over the years as they start consuming healthcare to a greater extent.
Guest post by Anand Natampalli, MBA, vice president, global business development, HGS, and Daniel A. Schulte, MBA, CHFP, senior vice president, provider healthcare, for HGS.
If there is one constant in healthcare and health IT it’s change. Technological advances, growing workforce needs, regulatory reforms, and the continued shift to value-based care will all continue to have a profound impact on the industry in the coming year. Here is what we think will be the major changes affecting payers and providers:
Data Grows More Critical in a Value-Based World
Payers used to leverage analytics to look for ways to reduce operational costs. In 2016 and beyond, the focus will be on creating highly targeted products, channels and service offerings that keep patients healthier. For example, payers will use highly personalized behavioral data to make wellness recommendations for members. This targeted approach of wellness is possible with analytics resulting in higher adoption rates compared to a traditional outreach.
Greater Focus on the Customer Experience
Members purchasing health insurance on the exchanges will be faced with a choice each year, and those choices will be right in front of them for them to compare. A poor customer experience this year will increase the likelihood of finding a new payer next year. Based on 2014-2015 data, 38 percent of members changed their health plans in state exchanges with in one year. With price points remaining comparable customers will continue to look to service and experience as key differentiators when choosing a health plan.
Engagement and Activation
Technologies that enhance and improve patient engagement and activation will be critical to healthcare moving forward. Through population health management we are learning more about how to create wellness strategies and to stratify patient populations based on their conditions and adjust for nuances in age, race, diagnostic groups, and the like.
This article is part of the “Think Further” series sponsored by Fred Alger Management. For more “Think Further” content, please visit www.thinkfurtheralger.com.
There is almost nothing I’m certain of except that life is an uncertain thing and that it seems to change a lot. Even in the most predictable of settings, even the minutest changes in detail can have a lasting and overwhelming effect on nearly everything in its atmosphere. In healthcare, a space seemingly immune to the status quo, things seem to get a whole lot more complicated. The same can be said of life and death, health and well-being. On their own, they are not so difficult to understand and often, in most cases, predictable and redundant; until the final days, of course, then things begin to get a little more complicated. When we’re fine, we’re fine. Life is good and most of our concerns seem trivial.
Then health gets involved and the minutest change in detail can send our lives in a spiral so much so that we barely recognize our place in it let alone who we are and where we belong. When such an occurrence arises, we begin to rely on beeps and buttons, software and technology in ways never before imagined for the intersection of our lives.
Clearly, the health IT landscape will be completely different five years from now. From where we stand today to where we’re headed, we’ll likely look back on this moment and wonder how we survived such archaic times. Just a couple years removed from the age of the electronic health records, technology that already seems dated and antiquated, is no longer monolithic and domineering to the space as it likely seemed in 2010.
Our future selves might stand on the threshold of 2020 and say that we were being single minded. The technology — EHRs were supposed to save healthcare and are now nothing but foundational. The technology was supposed to simply aggregate information collection, provide for the ability to quickly share information system wide and around the world; and give us the capability accessing all of a patient’s information at the tips of the proverbial finger.
When the promise of those solutions faded (yes, their stars have faded) and as our attention forced us into new technologies (primarily because of consumers’ desire) we are now seeing developments in technology creating touch points that impact patients “where they live” and has become the new force behind healthcare technology.
Consumers will drive healthcare’s future. Probably not a secret at this point, but a point that is hard for the old guard. They’ve had enough of being left out of the ownership process regarding their own health. They’re tired of being locked out of their own records, and kept access to their own information. Such data would not exist without those helping produce it. New consumer technologies have and will further level the field. Consumer tech will continue to spur innovation, at light speeds. Data will flow between healthcare parties and its consumers; HIPAA protections will be waived and open access for the social good will become the norm. Standard and traditional approaches when dealing with patients, in a generation or so, will be completely different and far less segmented, as they are now.
Although life in rural communities offers many advantages, the rural healthcare system in America faces challenges not seen in urban areas, for obvious reason: population loss, poverty and access to healthcare have been problematic in recent years.
Taking a look at Pennsylvania, which is the sixth most populous and ninth most densely populated state in the US, based on information from the United States Census Bureau from 2010 and 2013, as a state it hosts a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of its 67 counties classified as rural, and all but two counties have rural areas. More than one quarter of Pennsylvanians live in rural counties.
Thus, it’s as good a place as any to examine some of the unique issues facing rural communities, who even though they may be within driving distance to some of the best medical care in the world, they are unable to access it each day without some sort of life altering obstacle.
In general, residents of rural communities in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.
Between 2000 and 2010, the Pittsburgh Post-Gazette reported that rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only because of the eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.
In some places, the situation is bleak. The newspaper highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18. That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”
In an ideal world, a patient should be able to visit the doctor whenever he has health concerns. However, for many patients, particularly the millions living with lifelong chronic diseases, such as diabetes, heart failure and chronic obstructive pulmonary disease (COPD), meeting this need is a challenge because of several reasons. Key among these are: lack of time and limited access to a nearby health facility. These obstacles, in turn, sometimes create even bigger problems, such as patients’ failure to practice daily routines of disease prevention and management, resulting in worsening of their conditions and triggering the need for emergent care.
Fortunately, a solution is underway. Experts are taking advantage of today’s modern technology—telehealth — and are using it to bring healthcare education and services closer to consumers. Most simply put, telehealthcare provides contact between clinicians and patients who are at some distance from each other, and uses telecommunication-ready tools to “see” each other and undergo clinical examinations even at a distance.
Through telehealth, patients can easily get in touch with their doctors without having to worry about geographical distances. From a residential setting, not only can a simple and known tool like a telephone be used as an audio communications device to connect patients with their clinicians, but an array of monitoring devices, such as blood pressure cuffs, pulse oximetry measurement tools, weight scales, and others, can also be used to transmit current vital sign readings for clinicians’ review. In the same manner, physicians can use today’s information technology to easily access their patients’ electronic health records and monitor their patients’ development outside the walls of their clinics or hospitals.
Truly, telehealthcare and remote monitoring have enabled many healthcare practitioners to help manage the chronic health conditions of their patients, and subsequently, help improve their patients’ quality of life.
Here are some selected FAQs about telehealth service delivery that focus most particularly on the home healthcare arena, which is most probably the health service sector most unaffected by new technology introduction and use until recent decades. Strictly hands-on, or ‘high touch” care service delivery was the order of the day throughout the 20th century. Yet home healthcare is likely to become a very critical component for achieving the much broader and longer term view of patient care delivery after patients’ discharge from hospital. It is then and at home that patients will receive subsequent services through their continuum of care that will keep them well over a long term.
Can I get reimbursed for providing telehealth?
The answer is yes, usually, for providing home telehealth services but not in the usual billing scenarios most home healthcare organizations are used to for submitting bills to Medicare or other insurers. As of now, mid-2015, changes in Medicare and Medicaid fee for services are just coming on-board affecting home telehealth service delivery. There is still a long way to go until Medicare will not very much require face-to-face home healthcare visits during a patient’s admission period—this is the same insurer who absolutely required specific documentation about every portion of nurses’ contact with patients and let the home health agencies (HHAs) know that to CMS, if something was not documented [e.g., a telephone call between nurse and patient about wellness directives] , it didn’t happen [and the bill would therefore not be paid]. Today there are many insurers beyond Medicare that are paying for home telehealthcare (e.g., Aetna, United Healthcare), but it’s very early on—we need to return to this question later this year.
How will I develop a home telehealth service capability? How will I develop a strategic and operating plan for this new delivery channel? Where will I get the technology? What type of training will be required of my people and what will the cost of training be and how many employee hours need to be dedicated to this training?
It’s best to keep in mind that, although the technology is new, you’re not beginning with a blank slate for running a healthcare service delivery business. While all of these questions about telehealth tool acquisition and use are important, the very first question to ask, not mentioned in this list of questions is, hands down, who are my HHA’s most costly patients? An agency-wide chart review would reveal that these are the patients that require the most visits, and additional training in self-management skills and routines.
Once identified, and these are usually patients living with specific chronic diseases and conditions, such as congestive heart failure (CHF) and non-healing wounds, then the subsequent questions can be addressed. In earlier days of home telehealth service delivery (ca. mid-1990s), a full-scale workstation was typically available that could be assigned to any home healthcare patient and came fitted with telecommunications-ready vital sign measuring peripheral devices such as a blood pressure cuff and pulse oximeter, as well as glucometer for measuring diabetic patients’ blood sugar levels even though some patients didn’t have diabetes. These were kind of a one-size-fits-all system, though these proved to be too costly for HHAs and too complicated for patients to use regularly and correctly. More common now is to order and assign only needed and stand-alone telecommunications-ready peripherals devices for patients to perform daily measurements and transmit them to their clinicians.