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HIMSS 2018 | Confidential HIMSS 2018 Roy Schoenberg, MD, MPH CEO, American Well Telehealth on the Hill: How Policy Is Ushering Change March 8, 2018 Roy Schoenberg, President & CEO
HIMSS 2018 | Confidential
HIMSS 2018Roy Schoenberg, MD, MPH
CEO, American WellTelehealth on the Hill: How Policy Is Ushering Change
March 8, 2018
Roy Schoenberg, President & CEO
1HIMSS 2018 |
Today’s Agenda
• The State of the Union
• Establishing Clarity
• Instruments of change
2
At first glance
EVERYTHING IS
WONDERFUL!
3HIMSS 2018 |
Forward Momentum on ALL Fronts
AWARDED $17M IN
TELEHEALTH GRANTS IN 2017
REMOVED
STATE LINES
LICENSURE
COMPACT
GUIDELINES FOR ETHICAL
PRACTICE OF TELEMEDICINE
CHANGED REIMBURSEMENT
ADDED CPT CODES
REMOVED RESTRICTIONS IN
NEXT GEN ACOS
4HIMSS 2018 |
Why it’s Wonderful (Federal Perspective)
BILLS IN THE 114TH CONGRESSRELATED TO TELEHEALTH
50 BILLS
BILLS IN THE 115TH CONGRESSRELATED TO TELEHEALTH
SIGNED INTO LAW
CHRONIC CARE ACT
HOUSE & SENATE PASSED:
VETS ACT
PENDING IN THE SENATE:
15 HEALTHCARE BILLS
PENDING IN THE HOUSE:
28 HEALTHCARE BILLS
5HIMSS 2018 |
Why it’s Wonderful (State Perspective)
393 BILLS
MNNY CAIL
32BILLS PENDING
43BILLS PENDING
19BILLS PENDING
22BILLS PENDING
6HIMSS 2018 |
Positive Momentum
2013
2015
2017
AK
WA
OR
CA
NV
ID
MT
CO
TX
NMAZ
UT
WY
ND
SD
NE
OK
KS
MN
WI
IA
MO
AR
LA
IL
MS AL
TN
KY
IN
MI
OH
WV
FL
GA
SC
NC
VA
MD
NY
PA
VTNH
ME
DE
NJ
CTRI
MA
DC
HI
CONSIDERATIONS:
- LEGALITY
- REIMBURSEMENT
- PORTABILITY
2018
7HIMSS 2018 |
Anticipated Telehealth Eclipse
Here’s What Your Future Doctor Visits
Could Look Like
“ Tomorrow’s office visit
will increasingly take
place everywhere but
the office.”
MAGAZINE
Source: Fortune, Ray Dorsey/Eric Topol - http://fortune.com/2017/05/02/brainstorm-health-2017/
2024- Dr. Eric Topol
May 2nd 2017
1B 990M 980M960M
930M900M
870M
820M
760M
40M 50M 60M80M
120M160M
230M
330M
500M
740M
1.15B
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
PROJECTED NUMBER OF OFFICE VISITS: 2015 - 2025
PHYSICAL VISITS
VIRTUAL VISITS
8HIMSS 2018 |
Sooner Than You Think…
20142x Increase
20154x Increase
2016As many visits as in
entire previous decade
2017Double that…
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
VIRTUAL VISITS
9HIMSS 2018 |
Not Just Urgent Care
follow-up
Telehealth
320% 600%Chronic care management
visits
140+Telehealth Program
Types
10HIMSS 2018 |
DermatologyOncology Workplace Service
Pediatrics
More Initiatives
Urgent Care Specialist Follow-up Psychiatry Retail
School Health
Visiting Nurse Chronic Care Psychology Nutrition
Neurology
SNFs
2016 2017
3x
6x
2x
11
But
…
12HIMSS 2018 |
Best Intentions May Still Produce Standstill
13HIMSS 2018 |
Addressing Service Delivery Across State Lines
FSMB &
AMA
VA & DODFSMB DOJ and AMA aligning on licensure
compact
Meanwhile, the VA passed a bill to remove
state lines within the VA
Licensure
14HIMSS 2018 |
Addressing Payment for Telehealth Services
HHS/CMS States/Payer
sCMMI and CMS are introducing new
Medicare/Medicaid price lists/fee schedules for
telehealth services one by one
Meanwhile, states have passed parity laws that require
commercial insurers to pay for telehealth at the same
rate as in person visits
Reimbursement
15HIMSS 2018 |
Addressing the Change to Medical Practice Guidelines
EXAM EQUIVALENCE
LA
LEGISLATUR
E
LA Medical
BOARDLouisiana state legislature passed favorable
telemedicine laws allowing patients to be treated over
video.
Meanwhile, the state medical board is requiring that
patients have peripherals.
16HIMSS 2018 |
Addressing Jurisdiction over Medical Practice Limits
Texas state legislature passed a law allowing providers to
care for patients without having an in-person visit first
TX Medical
Board
Tx District
CourtUntil September 2017, Texas medical Board continued to
enforce rules that required providers to establish a
relationship with patients through in-person visits
OVERALL Permissibility
17HIMSS 2018 |
Different Perspectives
Different
Technologies
Different Patients Different
Providers
Different
Schedules
Different
Workflows
Different
Motivations
Different
Payment
Different
Risk
Different
Cost
Different
ROI’s
Web vs SIP Consumers vs Patients Organic or Cover On-Demand or Scheduled Full or Partial Parity
Acute vs FollowUp Care Volume, Access, Brand By Service Who’s Risk
18HIMSS 2018 |
Different Motivations, Different Legislative “Asks”
Prevent ER
Overutilization
Way to acquire
new patients
Way to prevent
patient leakage and
external referrals
A way to deal with
after hour services
Way to prevent
unnecessary patient
transfers
A way to humanize the
pain of care delivery
Safety of medical
practice
Protect local
physicians livelihood
Payers Hospitals ACO Private Practice
SNFs Hospices State Boards State Associations
19HIMSS 2018 |
The Tower of Babylon
The Term “Telehealth” Does not exist.
For “Telehealth” seeTelemedicine or e-Health
Pieter Bruegel, 1563
20HIMSS 2018 |
Why is Ambiguity Such an Issue
Bills ScoringMotivations Funding
21HIMSS 2018 |
An Analogy…
How would CBO Score Email ?
22HIMSS 2018 |
CBO’s Job to Score The Budgetary Impact of Telehealth….
23HIMSS 2018 |
Challenge #1 : Complex Formula
Anytime, Anywhere
Vs
Care Fragmentation
Access
Timely Access to Best Clinicians
Vs
Loss of Physical Exam
Quality
Avoid ER Visits
Vs
Over-Utilization
Cost
24HIMSS 2018 |
Challenge #2 : Technology is a Moving Target
By the time the CBO does it’s calculation, it’s obsolete.
Phones
Dedicated
Stations
Browsers with
web camsMobile Devices
inside other
Applications
Inside Medical
Devices
25HIMSS 2018 |
Challenge #3 : Jurisdiction Over The Practice of Medicine
State Federal
• States vs. Federal Policy
- FSMB - Cross-State Licensure
- Medical Boards - jurisdiction on quality
- Medical Associations – protecting the guild
- Medicaid State Exemptions - payment
vs
26HIMSS 2018 |
Challenge #4 : What’s Included in Telehealth ?
Tele-stroke
Urgent Care On Your Phone Follow-up with Your Cancer Patient
Apple Heart Study
27HIMSS 2018 |
Challenge #5 : Mixed Roles
Employers
Health Plans
Delivery Systems
Pharmacy and Retailers
WHO WHAT
Purchased Coverage
Managed Healthcare Coverage and Risk
Care for Patients
Dispense Rx and Supplies
The Old Days Now
Payer
Employers
Delivery System
Pharmacy
28HIMSS 2018 |
“altogether now” is not always a good thing…
29HIMSS 2018 |
Today’s Agenda
• The State of the Union
• Establishing Clarity
• Instruments of Change
30HIMSS 2018 |
3 Types of Telehealth
Acute Care Telehealth
Typically On-demand care
Success : Online Experience
Value to Consumers : Access, Convenience
Value to Payers : ER substitution
Follow-Up Telehealth
Typically Scheduled visits with own Patients
Success : Workflow Integration
Value to Patients : Care Continuity, Quality
Value to Providers : Readmission, Reduced Risk
Provider-to-Provider
Typically Inpatient Consults
Success : Load Balancing
Value to Patients : Timely Right Care
Value to Health Systems: staffing Cost Efficiency
31HIMSS 2018 |
Telehealth : Care Delivery Over Technology
Acute Care Telehealth
Urgent Care
Behavioral Health
Dermatology
….
Follow-Up Telehealth
Post Surgical Follow Up
Cancer Care
Chronic Patient Care
….
Provider-to-Provider
Tele-Stroke, Tele-ICU
Tele-Psych
SNFs, Schools
.…
Care Delivery over Technology
32HIMSS 2018 |
What’s Not Telehealth
Self Help
Self assessment
Triggered Content
Home Biometrics
Wellness Trackers
Data Services
Monitoring
Pop. Analytics
AI
Alerts and FeedbackAcute Care Telehealth
Urgent Care
Behavioral Health
Dermatology
….
Follow-Up Telehealth
Post Surgical Follow Up
Cancer Care
Chronic Patient Care
….
Provider-to-Provider
Tele-Stroke, Tele-ICU
Tele-Psych
SNFs, Schools
.…
Care Delivery over Technology
33HIMSS 2018 |
It’s Traditional Medical Practice
WHAT CARE WHEN DELIVERED WHY DELIVERED BETWEEN WHOM HOW DELIVERED
Care Delivery over Technology
34HIMSS 2018 |
The Leap
From ProductQuick way to see a doctor
To CompetencyDigital Distribution of Healthcare
35HIMSS 2018 |
Why is the leap so important?
Data as product Data as
competency
36HIMSS 2018 |
Why is the leap so important?
booksA Website Selling A Product
Inventory and Distribution Competency
Focus on Books(a product)
Focus on
Distribution(A competency)
38HIMSS 2018 |
Where could telehealth go? (if allowed to run free)
Where Could We Goif We embraced Telehealth as a
Competency
39HIMSS 2018 |
National Load-Balancing
40HIMSS 2018 |
Replenish the Clinician Pool
• Practice from Home
• As much as you like
• Whenever you like
41HIMSS 2018 |
Remove Quality Variations
Care Coordination Centers helping local PCPs
deliver best-practice care of complex
conditions
42HIMSS 2018 |
Complex Cancer ?
Sloan Kettering
Connecting to Provider
offices across U.S.
43HIMSS 2018 |
Health Insurance Starts Here !
EMO
Treatment Options
Treat urgent care
via Telehealth
Send Rx via mail order
Warm Transfer to
another provider
Schedule a face to face with
a primary care provider
Schedule a face to face
visit with a specialist
ER Substitution
PBM
Network Management
Gatekeeping
Referral Management
44HIMSS 2018 |
National NIITB Programs
Enrollment Detection Intervention
45HIMSS 2018 |
Graceful Aging at Home
Stress/Depression
Therapist
Eating Disorders/
Substance Abuse
Nutrition/Social W
Coping/Compliance
Others
46HIMSS 2018 |
Reimagine Patient “Support”
47HIMSS 2018 |
Reimagine Patient “Support”
48HIMSS 2018 |
Healthcare as an Export
• We will be in a position
to export healthcare
• Mayo and Cleveland Clinic are already
opening campuses all
over the world, leveraging their brand
names
49HIMSS 2018 |
Not Without Challenges…
Quality Trust Fulfillment
Shipment TrackingPCI Credit Card RulesNo Question Returns
50HIMSS 2018 |
Today’s Agenda
• The State of the Union
• The Future State of the Union
• Instruments of Change
51
Alignment is Key
52HIMSS 2018 |
#1 : Clear, Timeless Definition
Telehealthis the delivery of
care over technology
53HIMSS 2018 |
#2 : Make the Leap
TelehealthIs a logistical infrastructure for
distribution of healthcare
54HIMSS 2018 |
#3 : From Codes to Modifiers
TelehealthIs a method of delivering
Traditional care
Use Modifiers if needed, but not CPT codes
55HIMSS 2018 |
#4 : There are no “Places of Service”
Remove “Originating Sites”
Remove “Geographies”
Repeal 1834M
Its where the Internet Is
56HIMSS 2018 |
Digital Distribution effects access, cost and
quality.
Add Telehealth to Meaningful Use.
#5 : Like the embrace of EMRs, Incentives work !
57HIMSS 2018 |
Proliferate the understanding of safe use of telehealth in
medical practice
Introduce telehealth to Medical training
curriculum and USMLE
#6 : Education is Fundamental to Success
58HIMSS 2018 |
18% of the electorate is unable to access
telehealth
Make healthcare less painful
Bonus Slide : Telehealth is a Political Goldmine
59HIMSS 2018 |
Final thought
Are wethere yet?
60HIMSS 2018 |
The Domino Effect
HIMSS 2018 | Confidential
HIMSS 2018Roy Schoenberg, MD, MPH
CEO, American Well
Telehealth & WashingtonThe Tower of Babylon
March 8, 2018
Roy Schoenberg, President & CEO
