mHealth Israel conference, UnitedHealth Group, Dr. Pramod Gaur, VP TeleHealth: Trends & Opportunities in US TeleHealthcare

Proprietary and Confidential. Do not distribute. 1Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies

Trends & Opportunities in US TeleHealthcare

Pramod K. Gaur, Ph.D.Vice President – TeleHealth

UnitedHealth Group

Monday, October 7, 2013, Tel Aviv, Israel

http://www.mhealthisrael.com/


Agenda

Introduction – Background

mHealth Definition and Market Segmentation

Why mHealth is Important?

Obamacare

Stakeholders in US Healthcare Ecosystem

mHealth Enabled Total Population Management

Stay Healthy - Diabetes Example

Get Healthy -Telemedicine Example

Living with Illness - RPM Example

Opportunities to Improve Total Population Management Using mHealth



Health Benefits

Employer & IndividualMedicare & Retirement

Community & StateMilitary & Veterans

Health Services

OptumHealthOptumInsight

OptumRx

A Fortune 25 Health and Wellbeing CompanyMission: Help People Live Healthier Life

Role: Help Make Health Care Work Better for Everyone



SIG or Chapter Name: mHealth– Chair(s): Steven Dean

– Vice Chair: Pramod Gaur, PhD

– Past Chair: Sunil Hazaray

– SIG Executive Committee Members: Rob Williams MD, Napoleon Monroe, Bree Holtz, Mohit Kaushal MD, Hon Pak MD

Mission

The mission of the mHealth group is to enhance access to health care through innovative mobile technologies, including phones, tablets, applications (apps), sensors, and supporting infrastructure. The mHealth group represents academia, government, healthcare, and industry. The group’s mission would be to promote dialogue between all stakeholders, to improve the understanding and use of mHealth platforms, and to provide guidance to the ATA Board of Directors regarding mHealth.

American Telemedicine Association:


http://www.americantelemed.org/home


American Telemedicine Association: mHealth SIG

Objectives for 2013-14

Keep a dialogue with the FDA

Conducting a half-day education course at the ATA annual meeting

Facilitate quarterly webinars Continue outreach and partnerships with other professional organizations (e.g., HIMSS)

Develop Practice Guidelines for mHealth

Peer-review of ATA conference abstracts

Increase SIG membership Update mHealth reference paper

Subgroup Activity – Medication Management


http://www.americantelemed.org/home


http://www.worldcongress.com/events/HL13028/


mHealth – Definition

mHealth Applications and Technologies:

1. Remote Patient Monitoring (RPM): Consumer (home) setting to professional – use of telemetry for store and forward data (vital signs, images, surveys, etc.) to a centralized health data management application. Remote professional monitors patient vital/behavior data and intervenes as necessary.

2. Telemedicine: Use of real time video and/or audio technology for medical encounter in a professional to professional or professional to patient setting. This may be used with or without telemetry.

3. mHealth: Telemedicine/RPM with the use of mobile (cellular or Wi-Fi) technology. Applicable with common off the shelf mobile products.

Defined broadly, mHealth is the ability to allow patients and providers to easily and quickly connect and exchange health data via information communication technology from anywhere at anytime to facilitate continuum of care delivery at lower costs, and improve outcomes.



Regulatory Compliant M-Health

Capability

Professionally Entered Patient

Data

Hospital

Record

Self Entered

M-Health Record

Lab Results Record

Doctor’s Office

Record

Pharmacy Record

Why Important?M-Health fills an important gap in a patient’s medical record that exposes health/social aspects in consumer’s life at home, work, or while on the road



OBAMACARE

1. Access to Healthcare2. Quality of Healthcare3. Patient and Provider’s User

Experience

AFFORDABLE CARE ACT



PatientsConsumersCare Givers

Family Members

ProvidersDoctors, NursesTherapists, CareManagers, etc.

PayersFed Govt.

State Govt.Employers

Insurance Co.Self Pay

RegulatorsHealthcare PolicyFDA – 510(K)HIPAA

Transition from Pilot to Scalable and Sustainable Program

Key Stakeholders for US Healthcare System



Source: Helpfulness of Caregiving Technologies, e‑Connected Family Caregiver: Bringing Caregiving into the 21st Century

Technologies/Services Sought by Caregivers

PATIENTS/CAREGIVERS



PROVIDERS

1. Provider Institutions – Move Towards Integrated Health Delivery Networks (IDN)‾ Primary Care

‾ Specialty Care

‾ Out Patient Clinics

‾ Transitional Care

‾ Home Care

2. Provider Professionals – Move Towards Group Practices‾ Primary Care Physicians

‾ Specialty Care Physicians

‾ NP and PA Support

‾ Nurse Line (24/7 support line)

‾ Nutritionist Coaches

‾ Wellness and DM Coaches



REGULATORS

1. Healthcare Legislation – Federal/State and Local

2. Medical Board – Each State has its own Medical Board

3. FDA‾ Medical Device Act and Fees

‾ Mobile Health Guidance

‾ Mobile Healthcare Device

‾ Mobile App

‾ Mobile Health App

4. HIPAA

5. ICD-10


http://www.fda.gov/default.htm


PAYERS

1. Federal Government – Medicare• Traditional Medicare

• Managed Medicare

2. State Governments – Medicaid• Traditional Medicaid

• Managed Medicare

• Medicaid - Medicare Dual Eligible

3. Large Employers – Self Insured• ASO Contracts with Insurance Companies

4. Insurance Companies• Risk Based Policies for Individuals and Small Businesses

5. Self Pay – Consumers



PAYMENT MODELS

1. Traditional Fee for Service

2. Capitated/Negotiated Rates• ACO• PCMH• Bundle Payment• Episode of Care

3. Employer Wellness/Prevention Incentives

4. Pre-Tax Spending Accounts• Health Savings Account• Flexible Savings Account

5. Over the Counter - Self Pay



Wellness and Prevention Care

Chronic Disease End Of Life Care

Acute andSub-Acute Care

Goal Impro

ve Overal

l Health

and Wellbeing

Mobile Health

TelemedicineRemote Patient Monitoring

Goal is to Improve Overall Health and Wellbeing of Populations and Individuals by Providing Comprehensive and Integrated Care Across the Care Continuum

M-Health Innovation: Total Population Management



M-Health Enabled Stay Healthy:

Helping people live healthier livesPAYERS ARE PAYING FOR THIS SEGMENT WITH DEMONSTRATED OUTCOMES



• A technology for bringing healthcare services online

• Live interaction between patients and available network physicians

• Extends traditional healthcare into people’s homes

• Upholds care continuity

“The doctor will see you now”It’s time that technology allowed just that.

M-Health for Get Healthy:

9725551212

Consumer to Physicians Via Two-Way Video, Secure Chat Or Phone CONSUMERS AND SOME PAYERS ARE PAYING FOR THIS SEGMENT WITH DEMONSTRATED OUTCOMES



M-Health for Living with Illness:

Heart Failure Program

PAYERS ARE PAYING FOR THIS SEGMENT WITH DEMONSTRATED OUTCOMES



Prescriptions aren’t filled Medication isn’t taken Overlap/confusion of medication Allergic reactions are not identified

No follow-up visit with PCP No transportation Can’t get appointment PCP is not notified of admission or discharge

Patient health deteriorates Lack of care giver support Home not conducive to post acute environment

Medication Related

Logistics/Transport Related

Support/Management Related

Opportunities for mHealth Solutions



THANK YOU

Pramod K Gaur, PhDVice President TeleHealthOptum, a UnitedHealth Group CompanyRye Brook, NY 10573Tel: [email protected]

mailto:[email protected]

mailto:[email protected]


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mHealth Israel conference, UnitedHealth Group, Dr. Pramod Gaur, VP TeleHealth: Trends & Opportunities in US TeleHealthcare