Time for Telehealth: Critical Connection &

Foundational Cornerstone

Tamara Y. Demko, JD, MPH, ABDDirector, Florida TaxWatch Center for Health & Aging

Florida TeleHealth SummitWinter Park, FloridaDecember 5, 2014

The Promise of Telehealth

• Successfully used worldwide to deliver a full spectrum of health care services From pediatric endocrinology to emergency

management “Anything ending in –ology”

• Access to safe, appropriate health care when needed and before more costly interventions are neededReduction in emergency department

utilizationRural and non-ambulatory accessSpecialist consult as needed

The Progress of Telehealth

• World Health Organization – 25% responding countries have national telehealth policy/strategyMany more have telehealth programs (Mongolia,

Norway)Or use for specific topics (28+ countries use for

cardiology)

• United States21 states + Washington, D.C. legislatively mandate

private coverage 12 states + Washington, D.C. legislatively mandate

Medicaid coverage 43 states + Washington D.C. provide some level of

Medicaid reimbursement

Case-by-Case Building of ROIConvincing, But Fragmented

State System Telehealth Delivery

Patient

Condition(s) Metric 1

ROI Impact on

Metric 1 Metric 2

ROI Impact on

Metric 2

CO

Centura Health at

Home (CHAH)

integrated home telehealth

services with remote

monitoring and a clinical

call center

Congestive heart

failure, chronic

obstructive

pulmonary disease,

and diabetes Cost savings

$1000 and $1,500

per patient

Thirty-day

readmission rates

Reduced by 62

%

FL

Baptist Health South

Florida

eICU LifeGuard remote 24/7

physician monitoring Varied

Total Savings in 1

Year Snapshot

$15 million

($1,800/day)

Length-of-Stay (7 year

period)

Reduced 29%

ICU stay;

reduced 33%

hospital stay

FL

University of

Florida/UF Health

Florida Initiative in

Telehealth and Education

(FITE), videoconferercing

rural areas to UF specialists Diabetes (pediatric)

Total program

savings per year

(excluding

transportation

savings) $27,860

Hospitalizations of

children with diabetes

per year

Decreased

from 13 to 3.5

MA

Partners HealthCare

along with the

Center for

Connected Health

(CCH)

Connected Cardiac Care

Program (CCCP)

telemonitoring Heart failure Net savings $8,155 per patient

Heart failure hospital

readmissions

Reduced by 50

%

TX

CHRISTUS Health

System

Videoconferencing, home

monitoring (Remote Patient

Monitoring Solution (RPMS)

Pilot) Heart failure Cost of care

Decreased from

$12,937 to $1,231 Average admissions

Decreased

from 1.43 to

0.20

Florida Needs Telehealth

• Potential cost-savings = $1 billion with 1% reduction in charges across costly hospitalizations and emergency room visits (2012-13 AHCA data) –Critical Connections to Care

• Rapid population growth• Geographic disparities across 67 counties• Aging & disabilities populations• Public health preparedness• Emergency management access

Florida’s Efforts to Move Telehealth Forward

• Years of introduced legislation

• 2014 Legislative Session

• Board of Medicine

• Industry conferences and discussions

• Florida TeleHealth Workgroup

GAUGING FLORIDA’S STATE OF HEALTH

Population, Economy, Physical Well-being

Florida Compared: Demographics, Health, Business

FL CA GA NY TN TX VA

Population (7/2013) 19,552,680 38,332,521 9,992,167 19,651,127 6,495,978 24,448,193 8,260,405

Population Rank 4 1 8 3 17 2 12

% State Population 65+ (7/2013) 3,647,617 4,791,731 1,195,955 2,832,481 952,376 2,966,167 1,105,381

# Medicaid Enrolled in Thousands (6/2013 KFF - pre open enrollment data) 3,290.00 7967.7 1,536.30 5,141.70 1,305.60 3,644.20 851.4

Geographic Disparity (2012 report) 48 42 37 14 17 39 40

Disparity in Health Status (2013 report) 41 48 18 24 11 46 37

Chief Executive Ranking Best States for Business 2 50 10 49 3 1 11

CNBC Ranking Best States for Business 20 32 1 40 14 2 8

ALEC Ranking Best State Economic Outlook 16 47 9 50 19 13 11

Tax Foundation Ranking Business Tax Environment 5 48 32 50 15 11 26

Florida Lags Behind

American Telemedicine Association GradesCoverage and Reimbursement (C grade)

COVERAGE & REIMBURSEMENT

FL# States

Higher Grade# States Lower

Grade# States Equal

Grade# States N/A

*Overall Grade C 28 + D.C. 3 18

Parity Topics

Private Insurance F 21+DC 0 28

Medicaid C 24+DC 8 17

Medicaid Service Coverage & Conditions of Payment

Patient Setting F 38+DC 0 11

Eligible Technologies

F 22 0 26+DC

Eligible Providers F 26+DC 0 23

Informed Consent F 34+DC 0 12 3

Telepresenter C 36+DC 0 10 3

42+ Policy Decision PointsSpectrum of Options

Coverage, Cost, & Parity• Medicaid • Medicaid-Medicare dual eligibles• Patient costs• Private insurance coverage mandate• Private insurance parity vs. different

rates not comparable to face-to-face services

• State employee health plan coverage

Definitions, Locations, & Transmissions• Telehealth/telemedicine definition• Services defined• Distance/geography Restrictions• Originating site (e.g., clinician office,

home)• Distant Site• Live videoconferencing• Remote monitoring• Store and forward• Other permitted transmissions• Excluded transmissions

Policy Decision Points -Continued

Provider Related• Other health care practitioners• Out-of-state practitioners• Physicians/practitioners• Practice of medicine (what crosses into

practice)• Practitioner registration/telehealth registry• Practitioner sanctioning • Practitioner training• Prescriptions – Controlled

Substances/Legend Drugs• Prior relationship with patient• Professional Liability Coverage• Standard of care & quality of care• Supervision requirements• Telepresenter requirements

Technology, Privacy, Recordkeeping, Other• Equipment/technology requirements• Fiscal impact monitoring• HIPAA compliance/privacy• Informed consent• Interstate compact• Medical/health records• National licensure• Population Uses/Rules (e.g., prison

population)• Rulemaking Authority • Specialty Rules (e.g., eye care, mental

health)• State reporting (e.g., legislative, state

agency)• Statewide network• Venue/jurisdiction

Laying the Cornerstone

• Telehealth as foundational in health care delivery that works

• Long-term, sustainable health care system

Ability of licensed practitioners to deliver care

Ability of Floridians to get needed, timely care

TELEHEALTH CORNERSTONE CONFERENCE

What do policymakers need to know?

On what policy decision points can we achieve consensus?

What is needed to keep the discussion going while Florida refines decisions?

What barriers currently exist and how can we overcome them?

STATE OF THE NATION

American Telemedicine AssociationLatoya Thomas

Florida TeleHealth WorkgroupSoutheastern Telehealth Resource Center/

Florida State UniversityRena Brewer & Mike Smith

STATE OF THE STATE

3 Workshops – 3 LensesDifferent Angles for a Clearer Picture

• Lens 1, Subject Matter: Child health, aging & disability, access to care, chronic disease management/ emergent issues

• Lens 2 – Industry: Providers, practitioners, payers, business/innovation

• Lens 3 – Consensus-Building: Out-of-state providers, scope, financials, technology & innovation

Lunch Panel – How to Build TelehealthPolicy Discussion Highlights

Speaker Pro Tempore Matt Hudson

State Representative John Wood

Mike Smith – Florida TeleHealth Workgroup

Phillis Oeters – Baptist Health South Florida

Justin Senior – Agency for Health Care Administration

Dr. Mark Stavros – Florida State University

Tom Feeney – Associated Industries of Florida

KEY POLICY MESSAGES

• Not every issue requires legislation,

• There will not be consensus on all issues

• Top policy priorities going into the 2015 Legislative Session:

– defining telehealth/telemedicine and what telehealth success entails

– examining avenues for funding incentives and reimbursement

– revisiting logical and safe licensure options

– writing legislation to be technology neutral

KEY TAKE-HOME POLICY MESSAGES

– making it easier for practitioners who engage in telehealth

– leveraging existing technology (e.g., electronic health records)

• Legislation should – seek to make telehealth more available– avoid language that imposes arbitrary

restrictions – not detract from the current successful

provision of telehealth occurring across the state (First do no harm)

– consider the convening of an continuous advisory body while preliminary legislation goes forward

– Lay the cornerstone by moving on policy issues for which there is clearer consensus

NEXT STEPS: MOVING FROM CONFERENCES TO CORNERSTONE

It’s Time for Telehealth

Building ToolsRight Tool Depends on Job

• Policymakers– ROI data– Information & decision tools– Real people/constituents (bringing the message

home)

• Patients– Social marketing push/market demand– Safety & awareness

• Practitioners– Assurance of standards of practice within

specialty– Clear guidelines, including reimbursement

Building Tools• Providers

– Better understanding of costs (up front and long-term) & ROI

– Negotiating contracts & options

• Payers– ROI financial and outcome based

– Patient demand; contract demand; alternative business models

• Businesses & Innovators– Understanding of cost pass-through ESI,

utilization, & employee productivity

– Telecom successes, ROI potential

– Grant partners & contracts

Building Tools• Telehealth Champions (Everyone in this

room!)– Share your successes– Inventory & data collection– Find creative collaborations – Realistic policy expectations

• Walking before running• Getting creative• Avoid polarized silos • All-or-nothing bets

– Framing telehealth as win-win• Health care generally is zero sum• Telehealth can be uniquely different

Florida TaxWatch

Tamara Y. Demko, JD, MPH, ABDtdemko@floridataxwatch.org

Telehealth reports and conference materials are available at floridataxwatch.org