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to your specific practice and issues.

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About Us

Our passion is to provide solutions for our healthcare provider partners which help them improve patient care, enhance the patient experience and maintain a financially healthy practice.

Since 2003 we have specialized in NextGen Healthcare services including:

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• And productivity tools such as ChartGuard® and RefundManager®

Upcoming Webinars

Breaking Down MACRA

November 16, 2016

12 PM CT, 1 PM ET

Don’t forget to come see us at MGMA next week as we present on Telemedicine as the Future of Healthcare

Delivery!

The Future of Healthcare Delivery:

Telemedicine

Introductions

Cindi Kincade

Vice President, Consulting Solutions

Lindsey Lanning

Healthcare Compliance Consultant

The Future of Healthcare Delivery:

Telemedicine

Today’s Webinar

This session will cover:

Industry Outlook

Telemedicine Basics

The Benefits and Challenges to Telemedicine

Telemedicine Today

Telemedicine Tomorrow

Keys to the Successful Integration of Telehealth

Common Questions

What are the benefits and challenges to telemedicine?

Can physicians practice telemedicine across state lines?

Does Medicare or Medicaid pay for telemedicine services?

What is mHealth?

What is the future of telemedicine and who is using it now?

Industry Outlook

The future of healthcare delivery and payment is value-based care and quality outcomes supported by:

• Triple Aim

• MACRA

• AMA

• HRSA

What is Telemedicine?

• Telemedicine is the delivery of clinical healthcare services from one site to another via electronic communications to improve a patient’s clinical health status.

• Telemedicine includes a growing variety of applications and services using two-way video, smart phones, wireless tools and other forms of telecommunications technology.

Elements of Telemedicine

• The purpose of telemedicine is to provide clinical support by overcoming geographical barriers, connecting users who are not in the same physical location

• Telemedicine uses various types of communication technology

• The overall goal of telemedicine is to improve health outcomes

Modalities of Telemedicine

1. Live video

2. Store-and-forwarding

3. Remote patient monitoring

4. Mobile health

Benefits

• Improved access for patients and expanded physician reach

• Cost efficiencies by reducing/containing the cost of healthcare

• Improved quality of care for patients

• Patient demand created by the desire for reduced travel and stress

Challenges

There are multiple barriers to the widespread use of telemedicine; these include:

• Inconsistent policies by state

• Barriers imposed by states

• Lack of standards

• Licensure portability for out-of-state usage

• Commercial and Medicare/Medicaid coverage

State Telemedicine Gaps Analysis

Conducted by the American Telemedicine Association (ATA) in 2016

Telemedicine by State

• The two reports were titled:

Physician Practice Standards & Licensure

Coverage & Reimbursement

• Both of these reports aim to answer the following questions:

How does my state’s telemedicine policies compare to others?

Which states offer the best coverage for telemedicine provided services?

Which states impose barriers to telemedicine access for patients and providers?

Composite Grade by State

Licensure and Practice Standards

• A few state medical boards are adopting practice standards with higher specifications for telemedicine than in-person care. Such as requiring:

An initial examination be conducted in-person

A telepresenter

An in-person follow up exam

An additional patient informed consent

• Licensure portability, the ability for health care providers to practice out‐of-state using one

license, is another large issue for healthcare providers

In-Person Requirements

Licensure and Out-of-State Practice

Coverage• Payment and coverage for services delivered via

telemedicine are some of the biggest challenges for telemedicine adoption

• Patients and healthcare providers may encounter a patchwork of arbitrary insurance requirements and different payment streams that do not allow them to fully take advantage of telemedicine

• Lack of understanding about how each of the three major payer types reimburse for telemedicine visits

• Telehealth coverage laws exist, however coverage can vary by state and type of insurance (private v. public)

Commercial Coverage

• 30 states and the District of Columbia require that private insurers cover telehealth the same as they cover in-person services

• Many other insurers cover at least some telehealth service--and many more have expressed interest in expanding their telehealth coverage

Plans are incentivized due to the high potential for cost savings in the commercial sector—an average of $126 per visit

Medicare/ Medicaid Coverage• Medicaid coverage is controlled at a state level and

Medicare is controlled on a national level

• For traditional fee-for-service beneficiaries living in rural areas, Medicare covers physician services using videoconferencing where the patient is at a clinical site

Medicare Advantage enrollees are currently covered for telemedicine services, regardless of location

• Almost every state Medicaid plan specifically covers at least some telehealth services, however Medicaid differs from Medicare in that its policies vary from state to state; each state has flexibility to determine how it will reimburse for telehealth

Medicare/Medicaid Conditions of Coverage

Originating Site

• Is home permitted?

Eligible Providers

• Are you a qualified healthcare professional?

Technologies Used

• Are RPM, videoconferencing, still images covered?

Services

• Are Ultrasounds and echocardiograms covered?

Distance/Geography Restrictions

• Are there miles or HPSA restrictions?

Medicare Coverage Expanding

• Effective January 1, 2015, telehealth-based

Chronic Care Management (CCM) was

introduced as a new service covered by

Medicare

• Medicare Telehealth Parity Act of 2015

The Act proposes changes to Medicare telehealth

payment methodologies and expands coverage not

only to residents of rural areas, but urban areas as

well. It also includes provisions for Medicare

coverage of remote patient monitoring services

(RPM) for covered chronic care conditions, and

home dialysis for those with ESRD

Medicare Coverage Expanding

• 2017 Proposed Medicare Physician Fee Schedule includes Expanded Medicare Coverage for Telehealth

CMS proposes increasing telehealth coverage by 8 new CPT codes for services beginning January 1, 2017 in addition to the 80 already covered

Additionally, CMS is proposing to introduce a place of service (POS) code specifically designated for telehealth services to clarify confusion concerning whether to report the POS where the distant site provider is located or the POS where the patient is located

Coverage by State

Medicaid Coverage

Private Insurance Coverage

Telemedicine in Action

Telemedicine Today

CVS Partnership 2015

• American Well

• Teladoc

• Doctor on Demand

CVS and Cleveland Clinic

Partnership 2016

• American Well

Who is American Well?

• American Well is a telemedicine technology solution that acts as a direct source of telemedicine services

• American Well also works as a delivery partner with hospitals and provider groups

American Well

American Well

American Well

American Well

One Client’s Story

• Reid Health

Richmond, Indiana

This health system includes a 217-bed hospital on their main campus and numerous satellite locations in the region of Eastern Indiana and Western Ohio

Reid’s service area is home to about 280,000 people and includes six Indiana and two Ohio counties

Reid Health

Since 2014 they have implemented the following telehealth initiatives:

• Telecardiology

• Teleoncology

• Telepsychiatry

• Telepulmonology

• Endocrinology & Orthopedics

• Virtual Visits

App: Reid HealthNOW

Reid HealthNOW

• The website is powered by American Well and has a similar workflow

• Reid Health has also created an app available for download titled Reid HealthNOWto further personalize their delivery

Reid HealthNOW

The patient will find a provider who is on call and then be taken to their provider details where they can choose to wait in a virtual waiting room and then see a doctor that same day

Reid HealthNOW

Reid HealthNOWincorporates mHealthallowing a patient to sign up and sync Apple Health information already on your iPhone to your account

Telemedicine Today

mHealth, also known as Mobile Health, is a form of telemedicine using wireless devices and cell phone technologies

• Wearable technology

Gadgets that companies such as Nike, Fitbit, Jawbone and Apple have recently produced and brought to market

• Mobile Apps

Mobile apps are software programs that run on smartphones and other mobile communication devices

Apple Watch – Patient Perspective

• The Apple watch is both a wearable technology and a mobile app

• It can improve chronic condition management through regular monitoring of vital signs

Apple Watch – Provider Perspective

Telemedicine Tomorrow

• According to a new market research report, the global market for telemedicine is expected to be worth more than $34 billion by the end of 2020.

• Approximately 71% of employers say they will offer telemedicine consults through their health plans by 2017.

• Driving growth in this market, researchers say is an increasing aged population, increasing incidences of chronic diseases and a rapid rise in the software market.

• As insurance companies see documented efficiencies, they too are increasing coverage of these services.

• Telemedicine is changing the way medical care is delivered. Patients are embracing it, the cost savings are increasing, and its efficacy has been proven. However, doctors are still somewhat reluctant.

Keys to a Successful Integration of Telehealth

Key Tactics for Developing a Successful Telehealth Program

• Build an effective team to provide oversight

Specifically, identify an executive champion and physician champion

• Understand and assess the needs and demographics of your community

• Design your telehealth program with provider input and expertise

• Develop an integrated marketing plan

• Identify key metrics to measure outcomes

• Design a multi-phase implementation strategy

• Build on existing brand reputation and quality

• Align your telehealth program with your organization’s values and other ongoing initiatives such as population health

Gaining Patient Buy-In

Gaining patient buy-in can be achieved by highlighting these four points:

• Increased Comfort & Convenience

• Decreased Cost

• Comparable Quality of Care

• Guaranteed Continuity of Care

Gaining Provider Buy-In

To gain provider buy-in across your entire healthcare organization:

• Recognize telehealth buy-in starts from the top, down

• Encourage active participation by providers

Asking for their expertise on guidelines, such as when a visit may need to be in-person or can be completed digitally

• Arrange for education on how to provide quality care through a digital environment

‘Webside’ manner

• Provide reassurance to physicians

Combat and mitigate provider pushback

Providers may be uneasy or feel threatened by the fear of a decreased patient volume

‘Webside’ Manner

Telemedicine's rapid growth means more physicians will need to be trained on how to handle virtual visits and develop a good “webside manner” so their patients receive the same quality of care they would in-person

• Physicians should be aware of their internet connection, camera resolution and audio equipment to make sure their stream won't cut out in midsession

• Lighting and background are key elements of getting websidemanner right

Multi-Phase Implementation

To ensure a successful program launch implementation should happen in phases:

• Foundational research and organization buy-in

• Employee launch

Pilot program acting as a discovery process to gain feedback and make changes or provide additional educational resources

Employees can become word-of-mouth ambassadors for this program

• Public launch

• Ongoing promotion and engagement

Key Components of Implementation

• Awareness

Introducing a new way of healthcare delivery to patients

Examples: emails, newsletters, etc.

• Engagement

Grab consumers attention in their own environment

Examples: screensavers, web banners, social media marketing, etc.

• Utilization

Encourage use and stay relevant

Examples: email, text, promotions

In The End…

• Every practice will have a different telehealth transformation and there is no one-size-fits-all or one right way to accomplish this. Every practice and organization is unique.

• However, the potential of telehealth to extend and enhance the quality of care to your community of patients while supporting the growth of your own healthcare organization is something that cannot be overlooked.

• As with all the other changes that have been thrust on the healthcare industry recently, each organization needs to find its own way, consistent with its values and sustainable with its resources.

What will your next doctors visit look like?

Uncertain Where Your Practice Stands?

Let Itentive help:

• By assessing your current readiness

• Providing recommendations

• Implementation of new processes and procedures

Next Steps

• Visit us Itentive.com

• Sign-up for our informative webinars and blog

• Consider our 3-day, fixed price on-site consultations:

Clinical Workflow

Revenue Cycle and Front Office

Technology and Performance

• Test Drive our Products

Questions

• Lindsey Lanning

Healthcare Informatics Coordinator

llanning@Itentive.com

224-220-5621

• Cindi Kincade

Vice President, Client Solutions

ckincade@Itentive.com

224-220-5575

Thank you