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How Virtual Care is Improving Access and Affordability of Healthcare

November 20, 2018
by Lee Horner, CEO of Synzi, Industry Voice
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The Centers for Medicare & Medicaid Services (CMS) has made strides in providing more affordable, accessible care for all patients. A new rule allowing Medicare Advantage beneficiaries to access telehealth from home was recently proposed. CMS also released its CY 2019 Physician Fee Schedule final rule, which includes reimbursement for telehealth and virtual care services.

CMS’ proposed changes to Medicare Advantage will help enrollees obtain better access to healthcare via virtual care and telehealth. Instead of incurring travel costs and time to go to a healthcare facility for an appointment, Medicare Advantage beneficiaries will be able to participate in virtual visits from the comfort and convenience of their home. This change will be of tremendous value to MA enrollees who may have challenges in securing reliable transportation and may have to travel considerable distances in order to reach a provider or a hospital. This will commence in 2020 as part of the government-funded “basic benefits.”

According to CMS, the CY 2019 Physician Fee Schedule can support access to care using telecommunications technology. Medicare will pay providers for these kinds of services, including quick check-ins between patients and providers. CMS is also expanding the list of Medicare-covered telehealth services. The proposed ruling helps patients—whether rural or not—access care on their terms and helps increase provider adoption due to better reimbursement. 

The Cost of Chronic Conditions

Healthcare organizations are focused on better engaging and caring for patients with chronic conditions. Patients with chronic conditions face the risk of recurring readmissions, burdening the overall ecosystem with costs and complexities in providing the right kind of care, at the right time. The majority of older adults are living with chronic conditions; 92 percent of older adults have at least one chronic disease and 77 percent are challenged with at least two chronic conditions according to the National Council of Aging.

CMS indicates that chronic illnesses account for 75 percent of the $2.2 trillion spent annually on healthcare in the U.S. Investing in better disease management will impact health and financial outcomes, and offering affordable access to virtual care is one way to help these patients receive the treatment they need. 

Better Benefits for Patients and Providers

The recent CMS developments will help the chronic care patient population remain at home as they participate in the ongoing care needed to treat and manage their conditions. Patients will be able to receive care outside the four walls of a healthcare setting. By being able to participate in virtual visits and receive SMS, text, or email reminders about upcoming appointments, medication requirements, and diet/lifestyle recommendations, patients will be better informed, engaged, and involved in their care. As a result, these patients will be less likely to return to the emergency department or be readmitted as more providers leverage technology to monitor and motivate their patients on a consistent basis.

CMS’ initiatives will also help providers overcome some of the obstacles to telehealth and virtual care adoption. By updating the reimbursement structure, providers will be more inclined to utilize technology in their delivery of care. For example, home health agencies will recognize the benefits on their productivity and profitability.

Virtual care technology can help visiting nurses remain in more frequent touch with their patients by augmenting or even replacing many of their traditional in-home visits. The technology improves staffing productivity by enabling nurses to “put eyes and ears” on more patients vs. spending much of the day behind-the-wheel and en route to and from patients’ homes. Home health agencies will be able to expand their patient base and referral stream. By keeping patients at home—but still providing them with access to specialized care on-demand—nursing staff will help boost their revenue stream from referral sources focused on partnering with agencies that can help their CMS ratings. During a virtual visit with a patient, the nurse can quickly include a specialist to resolve patient questions in real-time and/or diagnose emerging conditions.

By addressing these concerns during the virtual visit, home health agencies are improving the timing, quality and impact of their care. Specialists will not always need to make a home visit to resolve the situation; patients will not necessarily need to return to the ER for specialized care. For many questions and conditions, nurses and specialists can remotely handle a patient’s issue in a timely and cost-effective way via technology. The use of virtual care will help home health agencies reduce patient readmissions, leading to improved quality scores and enhanced health and financial outcomes for all.   

The Value of Virtual Care

With CMS’ recent advancements in expanding access and reimbursement, patients, hospitals, and home health providers will realize the value of virtual care technology in helping patients stay on track with their treatment plan and address any issues which may cause unnecessary (and costly) readmissions. Patient and provider satisfaction will increase as the provided care is more efficient and effective for all stakeholders within the healthcare ecosystem.  

Lee Horner is the CEO of Synzi, where he is responsible for corporate strategy and development, with an emphasis on revenue growth, product direction and customer satisfaction.


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Research: Trends Point to Positive Increase in Telehealth Acceptance, Access

December 17, 2018
by Rajiv Leventhal, Managing Editor
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Current events and issues, such as the opioid epidemic, are increasing the need to provide telehealth services

Stakeholders’ recognition of telehealth benefits has continually increased, as doors are now opening for various subsets of medicine, including tele-mental health, according to new research from law firm Epstein Becker Green (EBG).

The 2018 Tele-mental Health Laws survey provides an update to state telehealth laws, regulations, and policies for mental and behavioral health practitioners and stakeholders across all 50 states and the District of Columbia. The survey’s researchers said that in the last few years, “the public’s and the healthcare industry’s recognition of the benefits of telehealth has continually increased. While the shortage of behavioral health providers has long been acknowledged, the use of telehealth technologies, including practice management systems and online patient portals, to provide greater access to behavioral health professionals has increasingly gained traction and continues to gain validation as an alternative model of care delivery.”

What’s more, EBG also found that current events and issues, such as the opioid epidemic, have put more pressure than ever before on federal and state legislators to pass laws that promote access to, and provide guidance for, providers seeking to utilize telehealth services.

The survey revealed various reasons for the increase of access to tele-mental health services, and telehealth services overall, including:

Bipartisan support: The Bipartisan Budget Act of 2018 signed into law in February expanded Medicare coverage for certain telehealth services to beneficiaries who are being treated by practitioners participating in accountable care organizations (ACOs).

Greater advocacy from Medicare & Medicaid: In June 2018, the Centers for Medicare & Medicaid Services (CMS) publicly encouraged states to utilize telemedicine and telepsychiatry to facilitate coordinated care for Medicaid recipients. As of August 2018, 49 states and the District of Columbia provide reimbursement for live video telehealth services through Medicaid fee-for-service programs.  Massachusetts is the only state not yet participating.

The opioid epidemic: Several states, including Indiana, Michigan, and Missouri, have introduced and/or passed legislation that expands remote prescribing of controlled substances for treatment of substance use disorders (SUDs). In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act.

This year’s survey also looked at positive trends in telehealth adoption and usage models, including: school sites and pediatric care; the Department of Veterans Affairs’ expanded telehealth programs (since its rollout, the VA’s telehealth program has onboarded approximately 20,000 new patients and hosts more than 6,000 virtual visits each week); and the promotion of care models for growing aging-in-place populations.

Despite the continued telehealth momentum, several barriers and policy variances do remain, the researchers stated. Some of these include: limited federal guidance on coverage and reimbursement and the lack of meaningful coverage by third-party payors, the report said. To this end, A recent MedPAC survey noted that coverage of telehealth services continues to vary widely across commercial health plans, with most covering only one or two types of telehealth-based services.

“While telehealth parity laws are currently in effect in 39 states and the District of Columbia and are intended to ensure the same coverage of (and in some cases, reimbursement for) telehealth services, there is more work ahead to achieve comprehensive coverage and access. States must continue to enact new parity laws or expand existing ones,” the researchers stated.

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KLAS: EHR Integration, Enterprise Scalability Key Challenges Facing Telehealth Vendors

December 11, 2018
by Heather Landi, Associate Editor
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Healthcare organizations report high satisfaction with their telehealth virtual care platforms (VCPs), however there are significant differences in how broad the various platforms are and in the quality of the vendors’ service. What’s more, integration with electronic health record (EHR) systems is a key challenge facing every telehealth vendor, according to a KLAS report.

In its report, “Telehealth Virtual Care Platforms 2019: Which Telehealth Vendors Have the Scalability Customers Need?,” KLAS evaluates some of the top telehealth companies including American Well, MDLive and Epic, and analyzes what capabilities will set vendors apart as more healthcare organizations adopt virtual health technology solutions.

Most virtual care platform vendors receive positive performance ratings, but the depth and breadth of their capabilities vary, and this can impact scalability for organizations looking to grow, according to KLAS. No two vendors are alike in their capabilities, offering different combinations of functionality and experience.

Of the companies KLAS evaluated, the most common type of visit varied—most of American Well’s visits were on-demand urgent care, while the majority of Epic’s visits were associated with virtual clinic visits.

A key factor of scalability is the ability to support multiple visit types, KLAS researchers note. While multiple vendors offer support for all three visit types (on-demand or urgent care, virtual clinic visits and telespecialty consultations) no single vendor has a large proportion of customers using all three (only 12 respondents across all vendors said they were doing so).

American Well, a market share and mindshare leader, and MDLIVE, two of the vendors used most frequently for multiple visit types, receive generally positive—but lower than average—performance scores. Vendors more specialized in specific visit types or component layers (e.g., Vidyo and Zipnosis) have high scores but narrower expectations from customers.

No one vendor meets all needs equally well, but several are reaching for “all-purpose” status with internal development and/or recent acquisitions (American Well acquired Avizia; InTouch acquired TruClinic), according to the report.

KLAS’ analysis also uncovered a general trend of poor integration. In most cases, the addition of a virtual care platform also means the introduction of a second EHR into the clinician workflow.

“Although integration between EMRs is generally understood to be important for care quality, patient safety, efficiency, and productivity, few interviewed VCP customers have full bidirectional transfer in place. Most say that they are too early in their virtual care programs to pursue integration or that it simply costs too much,” KLAS researchers wrote.

Only American Well, Epic, and MDLIVE have more than half of interviewed customers currently on an integrated path, KLAS found. Epic has placed virtual care capabilities directly into their top-rated MyChart patient portal, which many patients already use. Epic integration means clinicians are able to stay within their existing workflow environment as well.

Many provider organizations are in the early phases of their virtual care programs where showing an ROI is an important milestone and one that organizations want to achieve as soon as possible, KLAS notes. “A key promise from vendors is that their technology and accumulated expertise will result in a fast start and continuous acceleration. When this comes at significant cost or progress is slower than expected, provider organizations can experience disappointment,” the KLAS researchers wrote.

When it comes to getting their money’s worth and achieving desired outcomes, Epic and InTouch are rated highest among fully rated vendors, and swyMed and Vidyo perform well among their smaller groups of respondents, KLAS researchers note.

“For each vendor, the current value proposition is somewhat narrow but well understood: Epic’s use is limited to existing patients of Epic EMR customers; InTouch is used primarily for consults; swyMed is used by respondents primarily for mobile, first responder needs; Vidyo delivers video-conferencing tools,

which are typically combined with other VCP solutions. SnapMD is seen as a low-cost option, but some customers say the impact has been limited. Commentary from VSee customers suggests a similar experience,” KLAS researchers wrote in the report.

Many healthcare organizations are early on in their virtual care journeys, and their ability to achieve desired results depends on guidance from vendors. According to KLAS’ analysis, swyMed and InTouch receive the most praise for taking initiative in proactively guiding customers and also in quickly responding to support problems.

While respondents praise American Well’s platform scalability, some customers blame the vendor’s “exponentialgrowth for staffing shortages that have led to implementation holdups and backlogged service requests. Some SnapMD customers say hard-to-beat pricing comes with a support model that is spare in terms of providing tailored guidance, according to the KLAS report.

Most vendors offer two additional options that can help accelerate customers’ expansion and growth—supplemental services, including added-cost advisory and outsourced services, and tools that automate patient-facing tasks that traditionally require additional staff. I

KLAS found that few customers mentioned these options in top-of-mind conversations. “Respondents who spoke of their vendor’s supplemental services most often referred to marketing support or strategic planning services from vendors American Well, MDLIVE, or Zipnosis. Those who referred to task automation report patient-self-service capabilities around check-in, scheduling, surveys, and/or patient flow from InTouch Health (TruClinic), Epic, MDLIVE, or Zipnosis,” the KLAS researchers wrote.

 

 

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Study: Neonatal Telehealth Reduces Hospital Transfers, Saves Money

December 11, 2018
by Heather Landi, Associate Editor
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Neonatal video-assisted resuscitation reduces transfers from hospitals without newborn intensive care units and provides significant cost savings, according to study published in the November issue of Health Affairs.

The study authors, led by Jordan Albritton of Intermountain Healthcare, examined a newborn telehealth program implemented at eight Intermountain Healthcare community hospitals in November 2014–December 2015 and the impact on the transfer of newborns from those eight hospitals to level 3 newborn intensive care units.

Studies show that 10 percent of newborns require assistance breathing at birth, and 1 percent require extensive resuscitation. At Intermountain Healthcare, approximately 1–2 percent of all babies born in suburban and rural hospitals are transferred to newborn intensive care units (NICUs) for higher-level care, according to the study.

In response to the need to improve outcomes for complex newborn patients, an innovative telehealth program was established at Intermountain Healthcare in 2013 to provide synchronous, video-assisted resuscitation (VAR), bringing a neonatologist to the bedside. As a result, access to specialized neonatal services in rural and suburban settings is no longer limited to telephone calls or the arrival of a neonatal transport team, the study authors wrote.

While telehealth can facilitate video connections between neonatologists at tertiary care centers and providers at smaller hospitals, there is little empirical evidence about the benefits of telehealth programs for neonatal resuscitation, according to the study authors.

Although Intermountain Healthcare began using telehealth technologies in 2013, the current VAR program was implemented in the period November 2014–December 2015. Today, neonatologists from four level 3 NICUs provide VAR support for nineteen referring hospitals.

As part of the study, the researchers evaluated eight hospitals that contained either well-baby (level 1) or special care (level 2) nurseries staffed by physicians, advanced practice clinicians, nurses, respiratory therapists, and other health care professionals. T

The study found that video-assisted resuscitation was associated with a reduction of 0.70 transfers per facility-month and a 29.4 percent reduction in a newborn’s odds of being transferred. Annually, this resulted in 67.2 fewer transfers and an estimated cost savings of $1.2 million per year.

The study authors conclude that reducing transfers keeps families closer to home, increases community hospital revenue, and reduces risk associated with transfers.

“This program helps keep newborns in level 1 or 2 nurseries, which in turn allows families to stay closer to home, improves social support, and increases the revenue of community hospitals while reducing costs and risks associated with transfers,” the study authors wrote. “Payers should consider reimbursement for pediatric subspecialty telehealth consults for neonates in level 1 and 2 nurseries. Through improvements in care quality and cost savings, this service would likely pay for itself many times over.

However, the authors also note that lack of reimbursement for telehealth services limits widespread implementation.

“Policy changes are necessary to align payment incentives and promote the use of telehealth services,” the study authors wrote.

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