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Telehealth:Usingtechnologyinthedeliveryofhealthcare
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UsingTelemedicinetoTreatChronicDiseaseinRuralCommunities
"RuralAmericansfaceauniquecombinationoffactorsthatcreatedisparitiesinhealthcarenotfoundinurbanareas.Economicfactors,culturalandsocialdifferences,educationalshortcomings,lackofrecognitionbylegislators,andthesheerisolationoflivinginremoteruralareasallconspiretoimpederuralAmericansintheirstruggletoleadanormal,healthylife.”+• In2010,theU.S.Censusestimatedthat59.5millionpeople– 19.3%ofthepopulation– livedinruralareas.+
• 10percentofphysicianspracticeinruralAmerica*• 401specialistsper100,000peopleinruralUS,comparedto910inurbanareas*
+Altarum InstituteMarch22,2016*NationalRuralHealthAssociation
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TelemedicineTelemedicine
TELEHEALTH
VirtualVisitandDigitalHealth
eConsult/ECHO
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http://uhealthplan.utah.edu/virtualvisits/
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FactorsdrivingVirtualCare
Virtual Care
Volume to value
Expanding coverage
Physician shortages Triple aim
Population health
Consumerism
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MostCommonUSObjectivesforVirtualCare
42.2% 42.2%
15.6%
95.6%
84.4%
66.7%
46.7%
8.9%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Availability of grant(s)
Consumer engagement
Financial incentives
Improve access
Improved patient
outcomes
Physician shortage
Streamlined workflow
Other
HIMSS2015Presentation:EYAdoptionModel
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Why?Decantnon-acuteGoupstreamfortimelydx/txAnd?IncreaseinBurnreferralsbecauseitbecameaneasybutton
Why?Decantnon-acuteGoupstreamfortimelydx/txAnd?IncreaseinStroke
Manyothers…
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20050.26% ofallclinicvisitsviatelemedicine
12
458
050100150200250300350400450500
2005 2014
TeleBurnVisitGrowth
TeleBurnVisits
201414% ofallclinicvisitsviatelemedicine
Launchedin2005onagrantedfundedprojectTodayisfully-selfsustaining
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MustHavesforSuccessfulLaunchandLongevity• ClinicalChampion• OperationalWorkflow
• Onbothends• Technologystrategy
• Developedtomeetclinicalneeds(notinreverse)• Supportprograminplace
• Needtoseethepeople/location• Peopleneedtoknowandtrusttheotherside
• ClearfocusonOutcomes• Whatarewetryingtoaccomplish?• Howwillwemeasuresuccess?
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WhatdoesanECHOlooklike?
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ProjectECHOPartners
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UsingTelemedicinetoTreatChronicDiseaseinRuralCommunities
• Perpetuatedbytheinabilitytofindandaffordcare,ruralpopulationsfacehigherincidencesofchronicdisease.• Obesity,diabetes,heartdisease,andalcoholandsubstanceabuseareallchronicconditionsthatdisproportionatelyaffectruralpopulations.• 86%ofallhealthcarespendingin2010wasforpeoplewithoneormorechronicmedicalconditions.• Medicalcostslinkedtoobesity~$147billionin2008.
• Annualmedicalcostsforpeoplewhoareobesewere$1,429higherthanthoseforpeopleofnormalweightin2006.
• Totalestimatedcostofdiagnoseddiabetesin2012• $245billion($176billionindirectcosts&$69billionindecreasedproductivity)
Altarum InstituteMarch22,2016
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2010U.S.Census:StateswiththeHighestRuralPopulationsComparedtoStateswiththeHighestRatesofAdultObesity
andDiagnosedDiabetes
Altarum InstituteMarch22,2016
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UsingTelemedicinetoTreatChronicDiseaseinRuralCommunities
• Telemedicineasasolutiontoruralhealthcaredelivery:• helpseliminatedistancebarrierstomedicalservicesthatwouldoftennotbeconsistentlyavailableindistantruralcommunities• potentialtoincreaseaccessibilitytoprovidersandspecialistswhocanremotelymonitorandtreatchronicdisease• withoutthehassleorcostsassociatedwithtraveling• usedmosteffectivelytomonitorandmanagechronicconditionsandpreventivehealthcarecosts
Altarum InstituteMarch22,2016
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UsingTelemedicinetoTreatChronicDiseaseinRuralCommunities
• Challengesoftelemedicineinhealthcaredelivery:• Inmanystatestelemedicineservicesarenotcoveredbyinsurancetothesameextentasin-personservices.
• Planadministratorsandprovidersneedtoworktogethertodiscusstelemedicinebenefitsanddeterminecoverageoptionsandreimbursementpolicies.• MimictheMississippiStateLegislaturepassingabillrequiringprivateinsurancetopayfortelemedicineservicesatthesamerateasitdoesforin-personcare.
• Medicarereimbursesfortelehealth serviceswithrelativelystringentrequirements.• MedicarepaysfortelemedicineservicesonlywhenpatientsliveinHealthProfessionalShortageAreas(HPSAs)andthosewhoengagein"face-to-face"interactivevideoconsultationservices
• Telemedicineisnotareplacementforanannual,in-personphysical.• rulesgoverningthepracticeofmedicinedonotneedtobethesamerulesthatgovernthepracticeoftelemedicine
• Issuesoflicensureareproblematicwhenservicescrossstatelines• Consentisavitalcomponentofhealthcareandismorecomplicatedwithatelemedicineplatform.
Altarum InstituteMarch22,2016
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TopFederalPriorities
• Reimbursementassistance• MedicareParitywouldbeidealbutprogressinpositivedirectionisslow• AdoptionoftelehealthandavoidingSSArestrictionsinMedicare
• FosteringInnovation• Allowinghealthcaresystemstoimplementvalue-drivendigitalsolutions• ExpandingAccessforHealthOutcomes(ECHO)ActcreatedbySenatorsHatch(RUtah)andSchatz(DHawaii)requiresProjectECHOtypeplatformstobeevaluated
• Clearing/Avoidingartificialnon-medicalrestrictions• i.e.”onlyrural”,“placeofservice”,etc.• Focusonmedicalprofessionaldiscretion
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Visionofthefuture• Creationofahigh-functioningnetworkcapableofconnectingcarebetweenprovidersandpatients:
BestOutcomes
Right
Time
Place
ProviderDelivery
Cost