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Telemedicine Can Help Improve Provider Networks, NAIC Says

The National Association of Insurance Commissioners adopted model state legislation allowing telemedicine to be used to meet adequacy standards for health plans' provider networks. State insurance c ..

ommissioners oversee which hospitals and doctors are in-network for health plans, data that states use to determine whether networks are adequate for policy buyers.
Under the model legislation NAIC approved at its national meeting in Washington, health plans may use telemedicine to pipe in doctors from outside a geographic region.

States must adopt the legislation for it to become effective; legislatures can do that as soon as next year.

Payers Embracing Telemedicine Cost Savings, Ramping up Reimbursement in 2016

Often considered the primary obstacle to telemedicine implementation, reimbursement changes are now better viewed as one of the most prominent drivers of telemedicine expansion. Payers are finally b ..

eginning to realize what many providers have known for some time – telemedicine brings cost savings and improved patient-member satisfaction.

Private Insurers

For private insurers, the appeal of using virtual-care visits for minor health issues to reduce costs is increasingly difficult to ignore. Cigna has been covering care through telehealth provider MDLIVE for Cigna’s self-insured employers since January 2014. In April of this year, UnitedHealthcare followed suit, announcing that its self-funded employer customers will enjoy virtual visits as a covered in-network benefit, with coverage expanding in 2016 to individual and employer-sponsored plans.
By next year UnitedHealth Group predicts that 20 million of its members will have access to covered telemedicine services via its three partner networks. Anthem’s LiveHealth Online predicts similar numbers for its members across 14 states. Aetna and Humana have comparable types of coverage for certain customers.

Government Insurers

On the public side, telemedicine has been on the radar for the past two decades with broad applications. And while Medicare currently covers telemedicine only for patients in rural areas, the rate of telemedicine adoption among government programs is poised to increase rapidly starting in 2016. The Veterans Administration (VA) recently expanded use of telemedicine across state lines to increase access for patient consultations.
Additionally, the Medicare Telehealth Parity Act of 2015 is currently making its way through the House. If it becomes law, it will expand the definition of telemedicine and the types and locations of services available, as well as provide reimbursement parity under the Centers for Medicare and Medicaid Services (CMS).
Recent developments in reimbursement mean providers should make enhancements to telemedicine programs now, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of patient quality and satisfaction. Reimbursement is among five telemedicine trends driving health care transformation in 2016 and beyond.
Next, we will cover the rise of international arrangements and how they are contributing to the coming telemedicine boom.

Telemedicine links doctors to remote patients

Telemedicine has been one of the biggest digital health care trends in 2015, even though it has been around for quite some time. Telemedicine is the treatment and remote diagnosis of patients by m ..

eans of telecommunications technology. In other words, doctors can communicate with their patients over great distances using technology.

American Telemedicine Association CEO Jonathan Linkous said while telemedicine has become popular in the last few years, it has been around for almost three decades. Based in Washington, D.C., ATA is an international resource that promotes the use of advanced remote medical technologies.
“There’s a large variety, and it can be something very sophisticated in technology like the use of robots in hospitals or it can be as simple as using a cell phone to be able to communicate with a physician,” Linkous said. “There’s really a whole range of technologies that can be used, and it all depends on the application and the specific use.”

Linkous said telemedicine is just the first step in helping a patient. In emergency cases, it is always advised that patients receive urgent care in-person, but in more common cases where the patient may have the flu, a cold or a rash, it can be convenient and cost-effective to use telemedicine, he said.
“There’s a lot of research that has been done to make physicians and regulators more comfortable that, yes, you can provide quality care by using telemedicine,” Linkous said. “…There’s a greater demand, and telemedicine offers an opportunity  to meet that demand.”

Telemedicine also comes in the form of mobile apps. Some apps allow the user to video chat with a doctor anywhere in the country, and others allow the user to send a picture of a cut or scrape to a doctor. Some medical facilities like Children’s Health Medical Center in Dallas use telemedicine as a communication tool. Children’s Health has campuses throughout North Texas, including Plano.

Children’s Health uses telemedicine to keep a close watch on young patients as well as work with health care providers in various areas to help them communicate with their patients, said Julie Hall-Barrow, vice president of virtual health and innovation.
“We’ve done a great job for the last 100 years by having a great hospital and we take really good care of really sick kids, but we also want to make sure we’re keeping kids healthy and well,” she said.Hall-Barrow said in an effort to expand access points to allow children to have access to primary care and specialty care, Children’s Health launched several telemedicine programs in different departments, including in its neonatal intensive care unit and emergency rooms.

The programs assist the providers in more rural and regional communities with experts in the field of pediatrics.Another program Children’s Health piloted in 2014 and has continued this year is its telemedicine school-based program. The program is a nontraditional access point of health care, and it allows Children’s Health to be virtually embedded in 57 schools in the North Texas corridor, a number that will eventually grow to include 30 more schools, according to Children’s Health.
The school-based program provides virtual consultations with physicians through the use of mobile telehealth carts, which are fully equipped stations that capture, transfer and store diagnostic medical images and patient data between medical professionals.
With the permission of parents, the carts connect a Children’s Health Pediatric Group physician to a child who may visit the nurse’s office with an issue that is outside the nurse’s level of expertise.In order to expand the school-based program, Hall-Barrow worked closely with state Rep. Jodie Laubenberg, R-Plano, to help pass legislation that would allow for that expansion.House Bill 1878, which was authored by Laubenberg, passed during the 84th legislative session this year.
It allows the use of telemedicine services in a school-based setting, including provider reimbursement under the Medicaid program for those services.“We’re talking about making basic medical care affordable and accessible,” Laubenberg said.

“We have doctors’ offices and urgent cares on every corner in Collin County but you don’t have that in rural areas. So these models would work really well out there, and it does not replace your primary care doctor.”

The state of telepresence: Healthcare and telemedicine

Telemedicine is a rapidly growing field and, with the aid of telepresence robots, is quickly gaining traction in hospitals and homes around the world. In rural hospital settings where a medical ..

specialist is physically unavailable, a robot can be deployed to check in on a patient with a physician from elsewhere.

In the home, a nurse can check in with a patient while they recover in a comfortable setting. This has been a hotly contested market as noted by two lawsuits over patent infringement initiated by InTouch Health against HeadThere (now Giraff AB) in 2007 and VGo in 2011.
There was effectively sued out of the country by inTouch, and relocated to Sweden where it worked with Robotden, a robotics incubator. This looks to have been a very beneficial move as for Giraff as they have been able to take advantage of the health care system to introduce their robots into homes through various research projects involving human robot interaction. They have several pilot sites throughout Europe.

The result of InTouch vs. VGo resulted in a less than favorable outcome for InTouch as they had several of their patents re-examined and scopes significantly narrowed. This no doubt encouraged them to seek a partnership with iRobot, a collaboration that resulted in the  introduction of the RP-VITA. It is like few others out there, with special on-board ports to perform diagnostics like ultrasound and stethoscopes to provide critical information in emergency situations.

Even when you’re not in the hospital you still have options. VGo recently ran a pilot project with Dartmouth College, using their robot on the sidelines of football games, bringing in medical experts on demand. This is particularly useful for injuries like concussions, which can require frequent monitoring for days after the incident.
VGo has also been highly active within schools, by allowing students to attend classes via telepresence while they recover from injury or illness at home.
A robot that hasn’t received much press is RITA (Reliable Interactive Table Assistant) by RoboValley out of the Netherlands. This is more of a caregiver robot than telepresence, but because of its primary function, I classify it as telepresence. RITA can monitor the behavior of a patient, alerting medical staff of significant changes, and allowing a care taker or physician to check in when alerts arise. This market segment has human-robot interaction obstacles and legal issues to overcome.

For example, in the US physicians must be licensed by individual states, though recent legislation regarding interstate medical licensure seeks to solve this problem by allowing an expedited process to practice across state lines. I have not seen anything with respect to practicing medicine across borders.

As the number of humans age 65+ grows throughout the world, many will look to stay at home, rather than in assisted living or nursing homes, and telepresence robots could be an important ingredient in helping them to achieve that independence. While the telepresence market is relatively small right now (less than $200M USD), it does provide a means of entry for companies that are looking to get into the assisted care market, estimated to be nearly $4B USD.

The Japanese government has allocated about $23M USD to the core technology market in an effort to develop products for its aging population. Toyota, for example, is focusing on home living assistance robots that will allow those with limited mobility the opportunity to live at home. While Japan might have the largest market in the world of 65+ citizens (over 30 million as of 2014), South Korea is estimated to be allocating nearly $6B USD to their own robotics research.
The Koreans are taking a different approach, using robots for mundane tasks of delivering food, allowing humans to provide care.
It will be up to our social and legal systems to keep the pace if we are to allow the technology a chance to provide the solution.  

USDA awards $23.4 million in grants to rural telemedicine projects

The U.S. Department of Agriculture has awarded $23.4 million in grants to 75 projects across 31 states as part of its USDA Rural Development's Distance Learning and Telemedicine program.

Since 2009, USDA has provided more than $213 million to improve distance learning and telemedicine in rural areas, including $8.6 million for rural telehealth projects last year. Among the grantees this year:

  • North Slope Borough (Alaska) will receive $420,027 to purchase video equipment to link six Native Alaskan clinics, four end-user sites and Samuel Simmonds Memorial Hospital.
  • Baptist Healthcare System in Corbin, Kentucky, will receive $182,566 to install teleconferencing and telehealth equipment for five facilities in medically underserved areas in rural southeastern Kentucky and east Tennessee.
  • The Pyramid Lake Paiute Tribe in Nevada will receive $377,772 to provide tele-pharmacy services to eight remote pharmacies in its tribal area.
  • The Finger Lakes Migrant Health Care will receive $200,452 to deliver teleconferencing equipment for medical, dental and behavioral health services to residents of rural New York.
The Office of the National Coordinator also is involved in projects to help rural areas boost broadband connectivity to support health information exchange and telehealth infrastructure, the ONC's rural health IT coordinator, Leila Samy, writes in a blog post at Health IT Buzz.

The ONC has been working through the  Collaborative Rural Health Financing Initiative, begun in 2012, to help rural communities gain financing to upgrade their broadband and health IT infrastructure, and to use health IT and Blue Button to improve care coordination for veterans.

The growing use of patient portals, online communications with providers and especially video consultations make reliable broadband more important to healthcare than ever.
However, the USDA's broadband loan program through the Rural Utilities Service, which has provided funds for telemedicine in rural areas, hasn't always met its intended purposes, a report from the Government Accountability Office found.


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