Champions for telehealth presented their ideas at the ATA Telehealth Capitol Connection (TCC) www.americantelemed.org briefing held April 27, 2016. Discussions centered on how to use telehealth to add value under Medicare Advantage and Next Generation ACOs.
As Neal Neuberger ATA’s Senior Policy Advisor noted “For three decades, we have been trying to improve payment policies and at the same time trying to enable telemedicine to play a role that would really impact costs and quality.”
He said, “Current Medicare payment regulations limit the use of telehealth services to rural HPSAs. However, the Next Generation ACO telehealth wavier eliminates both the originating site requirement as well as the rural HPSA requirement. As a result, next Generation ACO beneficiaries will be able to receive telehealth services in their home even if they are not in a rural area.”
Congressman Gregg Harper (R-MS) http://harper.house.gov one if the co-sponsors of the “CONNECT for Health” legislation introduced earlier this year and the sponsor of the “Telehealth Enhancement Act of 2013” mentioned that there are a number of dedicated advocates to move telehealth forward in his state. For example, the Center for Telehealth at the University of Mississippi Medical Center provides telehealth services in over 30 medical specialties.
Former Representative Allyson Y. Schwartz, President and CEO of Better Medicare Alliance (BMA) http://bettermedicarealliance.org, an independent non-profit coalition advocating for Medicare Advantage (MA), reports that 18 million Medicare-eligible beneficiaries which is almost one third of Medicare, have chosen MA over traditional Fee-for-Service (FFS) Medicare.
The beneficiaries value the affordability, simplicity, and care coordination that is available. As a result, there is a 91 percent satisfaction rate with MA, 19 percent reduction in hospital inpatient days, a 28 percent reduction in hospital admission for the chronically ill and diabetic patients, and 10 percent of the MA population avoid hospital visits altogether.
MAs achieve cost savings by operating a home monitoring integrated system which enables the reinvestment of savings that can be used to introduce telehealth. So far, the data on telehealth and in-home care show improved health outcomes
John Jesser, Vice President, for Provider Engagement and Cost of Care at Anthem Blue Cross and Blue Shield www.anthem.com, touted “LiveHealth Online” www.livehealthonline.com launched in 2013. The online system uses board certified doctors in most states and D.C. available 24/7 365 days a year to connect with patients on their computers, mobile devices, or even in workplace kiosks.
The online doctors can handle acute conditions, exacerbations of chronic conditions, triage, and give general advice to their patients. The average telehealth visit costs $2- to $49 and is often a more affordable option than going to a retail clinic or to an urgent care facility.
From a policy viewpoint, Gary Capistrant, Chief Policy Officer at ATA, discussed the new CMS initiative called Comprehensive Primary Care Plus (CPC+) designed to improve how primary care is delivered and paid for in the U.S.
The CPC+ model is going to be implemented in up to 20 regions and will accommodate up to 5,000 practices. This initiative will open more opportunities to use telehealth but will also use health IT and a robust learning system to help improve care.
An expert on state issues, Latoya Thomas, Director for ATA’s State Policy Resource Center, said “State Medicaid plans don’t have the same regulatory rules as Medicare which has resulted in proposed legislative changes being made in the states. It is anticipated that new legislative changes will affect remote patient monitoring in a positive way.
As Thomas mentioned, “New York a multi-geographic state, has passed legislation requiring telehealth to be reimbursed the same as in person visits and is now integrating home patient monitoring under their Long Term Care plan”.
Kentucky legislators have just paved the way for their Medicaid program to cover remote patient monitoring. The new law allows the state to seek approval from CMS for a remote patient monitoring pilot, and authorizes the agency to develop rule-making for the new initiative. The pilot is expected to begin no later than July 1, 2017.
To view the video for the April 27, 2016 ATA briefing, go to https://vimeo.com/164570338.