Telehealth. January 7, 2016

Transcription

1 Telehealth January 7, 2016 Frances Gough, MD, Chief Medical Officer Molina Healthcare of Washington Co-Chair ATA Standard and Guidelines Committee for Primary and Urgent Care

2 Telemedicine: The use of medical information exchanged from one site to another via electronic communications to improve patients clinical health status. American Telemedicine Association (ATA) Telehealth includes not only actual physician-patient interactions, but interventions designed to support the entire healthcare continuum... education, consultation, non-clinical services. 1/6/2016 2

3 The Regulatory Environment WA Legislation Parity Law WA State Medicaid Medicare 1/6/2016 3

4 High Value Patient-Centered Care Independent Living Home & Community Based Services HEDIS/STARs Prevention Avoidable ER Emergency Room CAHPS Coordinated Care Subacute Care HEDIS/STARs Chronic Disease Outcomes Access Primary & Specialty Care Avoidable Inpatient & Readmissions Hospital 4

5 Most Medicaid ER visits are avoidable Medicaid ED visits were not urgent or emergent. 1 ER visits for children under 15 for minor conditions including respiratory, sore throat, and earaches. 2 Number one reason for inappropriate ER use is lack of access to a provider. 3 >50% of US adults with incomes less than $30,000/yr own a smart phone 4 1. National Center for Health Statistics, Hospital National Ambulatory Medical Care Survey: 2008 Emergency Department Summary Tables, Table 7 (Feb. 18, 2011) 2. National Hospital Ambulatory Care Survey published by the CDC 2008 Link: 3. Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates From the National Health Interview Survey, Renee M. Gindi, Ph.D.; Robin A. Cohen, Ph.D.; and Whitney K. Kirzinger, M.P.H., Division of Health Interview Statistics, National Center for Health Statistics, January-June Pew Research Center US Smartphone Use I

6 More than half of smartphone owners use their phone to access healthcare related information 1/6/2016 6

7 Molina s Telehealth Value Proposition Quality and Value Financial Performance Access to and timeliness of care Enhanced health outcomes Patient-centered care management Improved utilization and lower cost of care Leverage assets broadly across the enterprise Reduced physical location costs Studies have shown the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultation (ATA) Growth Customer Experience Compliance Attract and retain providers and members Potential to scale Right care, right place, right time Minimize work and family disruption Increase choice Better integration of care Accessibility Federal and State requirements (eg, Behavioral Health) 70% of surveyed patients reported being comfortable replacing select in-person visits with texts, or video. (SG2) Half of the 600 million annual primary care visits could be handled with e- visits. (Deloitte)

8 Telehealth Solutions by Member type Delivery Methods IVR Skilled (Nurse / Physician) Advice Lines Text and Reminders Self Service Mobile Apps Personal Devices Peer to Peer Video / Phone Consultation evisits (Member Device or Hub and Spoke Clinic/Kiosk)

9 Barriers Access: rural workforce is stretched Licensing requirements Fully integrated care options Sub acute care settings staffing/access to real-time data results in ER costs for conditions managed with lower level of care Inconsistent access to devices and service Medicare restrictions

10 Business Use Case Success: On Demand Virtual Urgent Care 24/7 Access to primary care providers 9 minute wait time; 21 minute visits Reduce unnecessary ED Back pain, rash, fever, UTI, conjunctivitis... Integration of services Care management High member satisfaction 50% requests managed with virtual care; 31% received prescription; >95% satisfaction High provider satisfaction Call relief, PCP follow up The provider spent the time to listen to my symptoms and gave me several treatment options. She spent more time than any doctor I've visited inperson to address my health needs. I love it.

11 Molina s Telehealth Plan Apply telehealth solutions to market and member needs Deploy a robust primary care and specialty network Develop a roadmap to accommodate current and future business needs Deploy interoperable devices with scalable and robust biotelemetry Integrate point of care analytics, services, data in one ecosystem accessible to all stakeholders 1/6/

12 Questions? For more information, please contact: Frances Gough, M.D. Chief Medical Officer Co-Chair, ATA Standards and Guidelines Committee for Primary and Urgent Care *(ATA)American Telemedicine Association 12