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CVS Health’s MinuteClinic Launches New Telehealth Offering

August 9, 2018
by Rajiv Leventhal
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CVS’ MinuteClinic, the company’s retail medical clinic, is rolling out a new telehealth healthcare offering for patients with minor illnesses and injuries, skin conditions and other wellness needs.

The MinuteClinic video visits, a telehealth offering, will provide patients with access to healthcare services 24 hours a day, seven days a week from their mobile device, CVS officials said in an announcement this week.

In recent years, MinuteClinic has been testing telehealth as a method of increasing access to care. During the initial phase of testing, a CVS Health study found that 95 percent of patients who opted to receive a telehealth visit were highly satisfied with the quality of care they received. In the same study, 95 percent of patients were satisfied with the convenience of using the telehealth service and the overall telehealth experience. Those results led the company to develop the expanded virtual care offering being launched this week, officials proclaimed.

Working collaboratively with telehealth company Teladoc, and leveraging its technology platform, patients can receive care via a MinuteClinic video visit, initiated through the CVS Pharmacy app. Officials noted that a video visit can be used to care for patients ages two years and up who are seeking treatment for a minor illness, minor injury, or a skin condition. Each patient will complete a health questionnaire, then be matched to a board-certified health care provider licensed in their state, who will review the completed questionnaire with the patient’s medical history, and proceed with the video-enabled visit.

During a MinuteClinic Video Visit, the provider will assess the patient’s condition and determine the appropriate course of treatment, and if an in-person follow up visit with a provider is needed. A MinuteClinic Video Visit costs $59.

“We’re excited to be able to bring this innovative care option to patients,” Troyen A. Brennan, M.D., executive vice president and chief medical officer of CVS Health, said in a statement. “Through this new telehealth offering, patients

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Making Care Connections Happen: How Intermountain Healthcare is Moving the Needle on Virtual Care

August 14, 2018
by Rajiv Leventhal
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Treating patients locally, rather than making them travel hundreds of miles for care, was a core driver for Intermountain’s new virtual care initiative

In March, Salt Lake City, Utah-based Intermountain Healthcare announced the launch of one of the nation’s largest virtual hospital services, bringing together 35 telehealth programs and more than 500 caregivers to enable patients to receive remote medical care.

The virtual hospital, called Intermountain Connect Care Pro, provides basic medical care as well as advanced services, such as stroke evaluation, mental health counseling, intensive care, and newborn critical care. “While it doesn’t replace the need for on-site caregivers, it supplements existing staff and provides specialized services in rural communities where those types of medical care usually aren’t readily available,” officials said in the March announcement.

Michael Phillips, M.D., Intermountain’s chief of clinical and outreach services, says that a core reason why the health system went in this “virtual” direction was because its leaders saw the evolving healthcare landscape and wanted to get out in front of it. “Our thought process behind this was that the world has changed from the days where you can only take care of people who [physically] make it to you. But literally every person on the planet is pretty much within the distance of a cell tower now. So we feel people should be able to benefit from [remote] care,” says Phillips.

Offering an example of how these services work in the clinical setting, Intermountain officials brought up the instance of an infant at a southern Utah hospital who was being supported via Connect Care Pro services and received a critical care consultation that allowed the sick baby to stay in that facility instead of being transferred to a newborn intensive care unit (ICU) in Salt Lake City. This single avoided transfer would have cost over $18,000 dollars. The parents of this baby were able to remain in their community, surrounded by their support system, instead of traveling what would have amounted to 400 miles and seven hours round-trip every time they wanted to see their baby, noted officials.

Indeed, as Phillips puts it, when most rural hospitals think about big health systems, their vision is a helicopter scooping in and flying away from the rural facility with its complicated patient. “But we believe that many of those patients can be treated locally, and there are clear benefits to that. First off, it’s better for the patient—having their family separated by 200 miles to drive to a major medical center is not good for their care and doesn’t tallow for a good support system. If they can be treated locally, they should be,” he attests.

As of now, notes Phillips, Intermountain’s virtual care services—inclusive of the Connect Care Pro, which is a direct provider-to-provider service and Connect Care, which is a direct-to-consumer service—covers all of the health system’s hospitals and another nine facilities outside of the system. “We are really covering more than 30 ICUs in all, and we have a stroke service, a neonatal resuscitation service, and [other services]. Our tele-ICU services are covering a few hundred beds with this process,” Phillips explains.

Michael Phillips, M.D.

So far, some of the top results from deploying the virtual services across Intermountain have included reduced length-of-stay, decreased ER and urgent care visits, and improved mortality rates, notes Phillips. What’s more, Connect Care leaders wanted to make sure that clinicians were performing in a telehealth visit with similar antibiotic stewardship than if they were seeing the patient in person. “We don’t want the answer just to be that we talked to you on phone, so we will write you a prescription for an antibiotic; we wanted the [prescribing process] to be as rigorous as it would be in person,” he says.

Although virtual health services are certainly catching on more at health systems these days, some physicians who are used to traditional care delivery are apprehensive. At Intermountain, Phillips offers, “Providers have taken to [Connect Care] well. There is a bit of self-selection for the kinds of people who are comfortable with doing this kind of work and who are good at communicating over this medium. But I think [telehealth] will come to virtually everyone in medicine because for a lot of conditions, it’s simply a more efficient way to deliver care,” he says.

To be clear, Phillips does not believe that in-person visits will “go away” by any stretch, but that it is quite difficult to have extensive, expert coverage at every hospital and physician’s office. “But we can certainly bring that expert in with a telehealth format, virtually everywhere,” Phillips notes. “Yes, cultural changes will need to take place, and I would say that the technology is the easy part. Culture is the challenging part,” he adds.

Phillips also contends that issues around the payment portion of telehealth visits—which has sparked much discussion in healthcare and health IT circles over the years—will continue to present challenges to providers, particularly those that still operate primarily in fee-for-service environments. “We have a large at-risk population here, so the payment part might be less of an issue for us because telehealth works better in a [value]-based model than a fee-for-service one. But these are typical barriers everyone is trying to figure out. In an at-risk model, [telehealth] is efficient and if you’re not worrying about having a fee-for-service payment for each individual episode, it becomes less of a concern,” Phillips says.

In the end, Intermountain clinical and IT leaders believe that virtual care is an efficient way to provide healthcare, Phillips offers. “The technology is meant to make all the folks inside our system more productive. If you look at larger sectors in the economy, there’s only two I can think of in which the workers have not become more productive: medicine and education. And that’s about embracing technology,” he says.

Phillips believes that the cost of healthcare is largely based around how productive an organization’s workers are. Indeed, if 70 percent of the costs are “people,” there’s a need to make sure that this area is well invested so that “we can keep costs affordable for people who need to get healthcare,” he says. “You can have the best healthcare in the world but if people can’t afford it, it doesn’t do you any good. We want as many people as possible to lead healthy lives.”


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Physicians Still Reluctant to Embrace Virtual Tech, Survey Finds

July 19, 2018
by Rajiv Leventhal
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While consumers and physicians agree that virtual healthcare holds great promise for transforming care delivery, physicians still remain reluctant to embrace the technologies, according to a new Deloitte Center for Health Solutions survey.

Physicians are specifically worried about reimbursement, privacy and other issues, according to the research, which included surveys of both consumers and providers.

The surveys found that a majority of consumers (64 percent) and physicians (66 percent) cited improved patient access as the top benefit of virtual care. About half of physicians surveyed agreed that virtual care supports the goals of patient-centricity, including improved patient satisfaction (52 percent agree) and staying connected with patients and their caregivers (45 percent agree).

However, physicians’ enthusiasm wanes when it comes to using virtual care in their practices today. While 57 percent of consumers favor video-based visits, only 14 percent of physicians surveyed have the capability today, and just 18 percent of the remainder plan to add this capability.

Lack of reimbursement, along with complex licensing requirements and high cost technologies are among the key causes of physician reluctance, the research found. However, changing reimbursement models may be a catalyst for virtual care adoption. The physician survey also found that clinicians worry about medical errors (36 percent) and data security and privacy (33 percent) associated with virtual care. 

One step in the right direction could be a very recent proposed rule from the Centers for Medicare & Medicaid Services (CMS), which included recommended changes to how physicians would be reimbursed for telehealth services. The CMS proposal has so far brought a mix of enthusiasm and concerns from groups advocating for greater usage of telehealth.

 “Changes in health care reimbursement models, combined with growing consumer demand, are driving health systems to embrace virtual care, but they are struggling to get physicians on board,”. Ken Abrams, M.D., managing director, Deloitte Consulting LLP, said in a statement. “However, getting buy-in from physicians may not be as difficult as organizations might expect: most physicians who have tried the technologies associated with virtual care feel good about them. It’s important to help physicians understand how virtual care improves care quality and lessens patient or caregiver burden.”

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Telehealth Advocates Respond to CMS ‘Virtual Visit’ Proposal

July 16, 2018
by David Raths
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To get around legal restrictions on telehealth reimbursement, CMS expands its definition of ‘communication technology–based services’

Among all the proposed changes the Centers for Medicare and Medicaid Services (CMS) rolled out last week, ones related to telehealth drew considerable interest. Although it can’t use its regulatory power to change the laws that restrict telehealth services paid for by Medicare to rural settings, the agency has instead defined new “communication technology–based services” that could be used for virtual visits with established Medicare patients regardless of such patients’ location, effective Jan. 1, 2019.

In its proposed rule about virtual visits, CMS is seeking comment on whether telephone interactions are sufficient or whether interactions enhanced with video or other kinds of data transmission should be required. CMS also proposes to create a new code to permit separate Medicare payment for store-and-forward technology such as when a dermatologist examines an image of a patient’s skin asynchronously.

The CMS proposal brought a mix of enthusiasm and concerns from groups advocating for greater usage of telehealth. “What they have done is creative and brilliant, and it goes further than CMS has ever gone previously to ensure that seniors have services everyone else in the marketplace has,” said Krista Drobac, executive director of the Alliance for Connected Care. On the other hand, she expressed concern that CMS paying for brief e-visits is going to create an environment where providers are going to weigh whether it is worth it to invest in telehealth systems. “What they will probably find is that the reimbursement is not enough to transform their practice and make telehealth part of their work flow,” she said.

Drobac believes CMS has gone as far as it can go within the existing law. She said Congress needs to give the Secretary the authority to waive the telehealth restrictions on all provider codes. “On the one hand, I am excited about the progress; on the other hand, it makes me even more determined that Congress act. CMS has gone as far as any of us could have asked on a regulatory level.”

Drobac also noted that CMS has plans to make the program budget-neutral by cutting base payments for providers to counter increased spending on virtual visits. “The more this gets used, the lower those E&M code reimbursements might be,” she said.

Aside from actual proposal itself, Mei Wa Kwong, executive director of the nonprofit Center for Connected Health Policy, was intrigued by the reasoning CMS used for how they can make this proposal and not face the same limitations other telehealth services do. “That raises the question: are we creating two separate things, communication technology vs. telehealth. Are they going to be separate? They started down this path a few years earlier with chronic care management and remote patient monitoring,” she said.

The way the virtual check-in proposal stands now stands, providers would have to have a telehealth system set up. “But CMS asked for comments on whether they could be done on the phone, which I think would be a lot more common,” Kwong said. “The reimbursement for that proposal is $14 per check-in. People have asked me whether physicians would see that as worthwhile to go through the administrative tasks and I don’t have an answer. There are still a lot of questions.”

In its proposal, CMS noted that the virtual visit service could be used as part of a treatment regimen in follow-up visits for patients on medication-assisted therapy for opioid use disorders. “We have been very active on that issue on Capitol Hill,” Drobac said. “We have been an advocate for the e-TREAT Act, which is part of the Senate opioid bill. That would lift the telehealth restrictions for substance use disorders. It would give CMS even more authority to work in the substance use disorder area. We are pushing for Congressional action on that.”

Kwong said virtual visits could be very useful for patients, “but there are a bunch of policy complications related to medication-assisted therapy. It might not be as widely used as they hope.”

Overall, how the proposed rule is tweaked could make a big difference, she added. If the asynchronous store-and-forward service can be used for new patients, that would benefit the direct-to-consumer companies, she said. “Is CMS policy going to be that you can establish a patient-provider policy this way? If so, it could have a wider impact. Or if they allow the patient check-ins via phone, that could have a wider impact.”
 
Other provider organization and informatics group represenatives weighed in on the subtle nuances of the proposal:

“I think all types of patients can benefit from a policy like this, as it gives them an opportunity to touch base with a provider without having to schedule an office visit,” said Darryl Drevna, director of regulatory and public policy at the American Medical Group Association (AMGA). “Previously, the way that telehealth was paid was if an office visit was scheduled and then the payment would get wrapped up in that office visit. Here, you can look at the film or have a call with your patient, as sort of a triage, and if you don’t end up having to schedule an office visit, you’ll still get reimbursed for that. So, this is a positive; this is something that we’ve long supported, to expand the use of telehealth as a program.”

“Telehealth advocates have been clamoring for CMS to jump in with both feet on reimbursement of telehealth, and I think this proposal does that,” said Jeff Smith, vice president of public policy at the Bethesda, Md.-based American Medical Informatics Association (AMIA). “Whether or not they are jumping six feet in the water or have both toes in the water is up for debate. But I think telehealth advocates will score this as a major win, and it is a major win.”

“It’s always good when things like telemedicine are expanded and there are more options to treat patients, but what we’re going to be looking at with a proposal like this is: what are the criteria and what is the payment amount?” said Anders Gilberg, senior vice president, government affairs, for the Medical Group Management Association (MGMA). “Some of those additional flexibilities and additional codes for telemedicine can be quite useful, as long as the complexity and the rules and the hoops you have to jump through are not overwhelming so that the return on investment to even provide those [telemedicine services] is there.”

 

 

 

 


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