Telehealth/mHealth: Innovations in Improving Access to Care. Mark Carroll, MD Mose Herne, MPH, MS Mark Horton, OD, MD Lyle Ignace, MD, MPH

Transcription

1 Telehealth/mHealth: Innovations in Improving Access to Care Mark Carroll, MD Mose Herne, MPH, MS Mark Horton, OD, MD Lyle Ignace, MD, MPH

2 Overview of Breakout Session Brief status of telehealth and mhealth in IHS Regulatory topics Credentialing and privileging Strategic opportunities Discussion

3 Facing the challenge of delivering health care where it s needed.

4 A Wide Range of Services AIDS-HIV care Behavioral Health Cardiology Dentistry Dermatology Diabetes care ENT Intensive care Rheumatology Neurology Nephrology Nutrition Ophthalmology - JVN Oncology/Palliative Care Pharmacy Radiology Rehab services Rheumatology Remote Monitoring Trauma Wound care

5 Patient-Centered Care Right care Right place Right time

6 Right Tool

7 Right Emphasis Relationships New tools and technologies must enhance relationships, especially if they are to be embraced and be effective in chronic care

8 The Mobile Revolution Audie A. Atienza, PhD

9 Audie A. Atienza, PhD

10 Audie A. Atienza, PhD

11 Audie A. Atienza, PhD

12 Remember : 1.5 Trillion Text Messages Sent in US 4.1 billion SMS messages sent daily Audie A. Atienza, PhD

13 50+ Case Studies Described Audie A. Atienza, PhD

14

15 mhealth and Patient-Centered Care: Perspective from U.S. Indian Health Care M Carroll, MD 1 ; T Cullen, MD 1 ; M Horton, MD,OD 1 ; C Lamer, RPh 1 ; S Ferguson, PhD 2 ; M Veazie, DrPH 1 I Indian Health Service; 2 Alaska Native Tribal Health Consortium THE INDIAN HEALTH SYSTEM A comprehensive health delivery system for ~1.9 million American Indians and Alaska Natives. Serving members of 564 federally-recognized Tribes in 35 U.S. states. Comprised of Indian Health Service (IHS) direct health care services, Tribally-operated health care services, and urban Indian health care services and resource centers. USING mhealth IN AN EMERGING MODEL OF PATIENT-CENTERED CARE: THE 5 RIGHTS 1. RIGHT TOOL 2. RIGHT PLACE 3. RIGHT TIME 4. RIGHT SYSTEM OF CARE 5. RIGHT EMPHASIS: Relationships A RELATIONSHIP-CENTERED APPROACH Connected Care & Remote Monitoring Critical Triggers for Quality Improvement Effective Relationships Improved Self-care and Treatment Improved Outcomes & Value mhealth IN INDIAN HEALTH: CARE WHERE AND WHEN IT IS NEEDED The IHS and its Tribal partners are committed to the appropriate use of innovative tools and technologies to improve access to quality health care for American Indians and Alaskan Natives. mhealth: the integration of mobile technology, computing devices, and emerging delivery system capabilities into a patient-centered model of care. Innovative uses of mhealth tools in Indian health care include: Mobile deployment of services The IHS Joslin Vision Network Tele-Ophthalmology program to 14 facilities in AK and NC Mobile mammography, for communities in the Dakotas Remote monitoring programs in diverse geographies, for congestive heart failure and diabetes care CONSIDERATIONS FOR EXPANDED USE OF mhealth TOOLS New tools must be integrated into initiatives to improve models of care. A key example is the IHS Improving Patient Care initiative. Use of handheld mobile technologies and wireless monitoring devices must occur in strict compliance with emerging security and privacy standards. Patient health information must be part of the IHS and Tribal Electronic Health Records, for coordinated care at the health care facility and community level. mhealth services should complement developing work for personal health records and other key activities that expand access to health information for patients and communities. Cultural acceptance of new tools and technologies is vital to program development and must be a key component to mhealth project design.

16 Smartphone Adoption and Usage 83% of U.S. adults have a cell phone 35% of U.S. adults have a smartphone 87% use it to access internet or 25% use it as main access to internet 9% have apps to help track or manage health 17% have used phones to look up health info Pew Internet Project

17 Text Messaging 72% of adult cell phone users send or receive text messages Pew Internet Project, Sept 14, % of consumers prefer to receive a healthrelated task reminder through text messaging Consumer Health Information Corporation

18 HHS Text4Health Task Force (est. Nov 2010) Audie A. Atienza, PhD

19 text4baby Audie A. Atienza, PhD

20 mhealth: Access and Quality of Care Expanded models of care Remote patient monitoring Real-time support for dx and rx Innovative access to information, training, and education For care teams For patients communities Improved efforts at disease outbreak tracking and epidemiology

21

22

23 Last Mile Microwave Coverage

24

25

26

27 Social Media Standard Operating Procedures (SOPs) in final approval stage Facebook (updated version) social networking YouTube -video sharing Twitter - micro-blogging Flickr - photo sharing

28

29 FDA Proposed Rules: July 2011

30 Best Practices What are new privacy and security standards? IHS planning to establish guidelines for using mhealth communications for a variety of scenarios Health promotion and education Reminders Other communications

31 Care Coordination for Hypertension Care: Improving BP Control for Patients with Diabetes Lyle Ignace, MD, MPH July 27, 2011

32 GOAL: Care Coordination for Improved BP Management Improve BP Control for diabetic patients with poor BP control

33 TOOLS: Care Coordination for Improved BP Management Home BP monitoring cuffs and data transfer device/service Improved care coordination processes

34 Care Coordination for Improved BP Management DOES HOME BP MONITORING WORK? Many studies show significant reduction in patients BP, reducing risk for stroke, heart, disease, and other health problems Example: University of Toronto, Logan et al, implemented automated mobile phone-based telementoring Home BP monitoring data sent via mobile phone to care teams for DM patients with uncontrolled BP Systolic BP decreased by 9.1 mm Hg over one year, compared with 1.6 mm Hg decrease in control

35 In-home remote monitoring Courtesy of Bonnie Britton, RN

36 Hospital Bed Days and ER Visits Hospital Bed Days 6 mos. prior to Telehealth = 199 During 6 mos. Telehealth = 99 n=64 50% decrease prior to during 6-30 mos. post Telehealth = 70 65% decrease prior to 30 mos. post ER Visits 6 mos. prior to Telehealth = 27 During 6 mos. Telehealth = 5 81% decrease prior to during 6-30 mos. post Telehealth = 23 15% decrease prior to 30 mos. post Analyzed Charges are related to diseases being monitored Courtesy of Bonnie Britton, RN RCCHC/PPTN Patient Charge Data Ending June 2009

37 Total Charges Statistically significant difference between pre-, during, and posttelehealth charges p value = mos. prior to Telehealth = $1.34 M During 6 mos. Telehealth = $ 382 k 72% decrease 6-30 mos. post Telehealth = $483 k 64% decrease Analyzed Charges are related to diseases being monitored RCCHC/PPCTN Patient Charge Data Ending June 2009 Courtesy of Bonnie Britton, RN

38 Care Coordination for Improved TIMELINE: BP Management Pilot activity with 12 Improving Patient Care initiative sites To begin late summer/fall

39 Care Coordination for Improved EMPHASIS: BP Management The key part of this pilot is the care coordination team processes, not the facilitated access to home BP data

40 IHS/JVN Program Summer 2011 Update IHS NCC Meeting 27 July 2011 Mark B. Horton, OD, MD Phoenix Indian Medical Center Director, IHS/JVN Teleophthalmology Program

41 D M P r e v e l a n c e D R E x a m R a t e DM and DR In Indian Country Parallel Epidemics 180, , , , ,000 80,000 60,000 40,000 20,000 Doubling of DM prevalence during past decade Sustained 50% DR exam rate 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% '00 '02 '04 '06 '08 '10 0% Diabetic Retinopathy is the leading cause of new blindness Blindness due to DM/DR can be eliminated by timely Dx and Tx Conventional eye exams not a likely solution for timely DX

42 DR Exam Rate DR Surveillance in IHS: FY10 IHS (2010)- 53% (43% - 63%) DR eye exam rate 80% 70% 60% 50% 40% 30% 20% 10% 0% 51% 44% ABD ALA ALB BEM 63% 46% BIL CAL 59% 47% 43% NAS NAV OKL PHX 59% 55% 57% 43% POR TUC 53% DR Surveillance std of care failed in ~half of population with DM Urban and rural All socioeconomic groups AI/AN vs general US pop

43 DR Surveillance Reporting GPRA Performance Measure Performance Measure 2009 Target 2010 Target 2011 Target Headquarters Lead TREATMENT MEASURES Diabetes Group 6. Diabetic Retinopathy: Address the proportion of patients with diagnosed diabetes who receive an annual diabetic retinal examination. [outcome] During FY 2009, maintain the proportion of patients with diagnosed diabetes at all sites who receive an annual retinal examination at the FY 2008 level rate of 47% at all sites. During FY 2010, maintain the proportion of patients with diagnosed diabetes at all sites who receive an annual retinal examination of 55% at all sites. During FY 2010, maintain the proportion of patients with diagnosed diabetes at all sites who receive an annual retinal examination of 50.1% at all sites. Mark Horton

44 Cumulativee Annua Diabetic Retinopathy Surveillance IHS-JVN Teleophthalmology Program 78 physical/81 logical + 14 Portable Sites in 21 States IHS-JVN Exams , Program Year P R O J E C T E D

45 New IHS-JVN Developments Technical Software- RPMS/EHR interoperability Hardware- camera development Clinical- improved imaging protocols Operational- consortium deployments Business- Tribal collaborations

46 IHS-JVN CONOPS Summary Healthcare Facility JVN Server (PAO) National Reading Center (PIMC) JVN-RPMS/EHR Interoperability RPMS GIS 1 HL7 CDMP IE (Mirth) Automated Workflow JVN Image Acquisition Worstation Pt Demo 4 Image & Pt Info 3 2 Oracle DB Modality Worklist Provider DICOM PACS Image WebService JVN Application Server 8 Health Summary 5 7 JVN Diagnostic Display 6 Pull of clinical data into JVN Reader Push of JVN report and business information into RPMS/EHR RPMS GIS 9 CDMP IE (Mirth) 9 GIS RPMS EHR Consults Scheduling and Notification EHR Charge Posting EHR Charge Posting

47 Camera Development Current Technology Adapted from existing commercial device Wrong features Fragile Expensive Orphaned 40 lb - $20K - Manual - Discontinued - No Parts - In Development Designed for Tmed Light Small foot print Simi-automated Hardened $5-$10K DoD/University of Hi, others

48 New Clinical Protocols Extreme Remote Imaging protocol Mini-dilation Protocol Improve image gradeability and over-referrals Remote sites with extreme logistics Small sites with low volume imaging

49 New IHS-JVN Developments Consortium based deployments PORTLAND AREA DM PTS FY10 EXAM RATE FY10 CHEHALIS % NISQUALLY % SHOALWATER BAY 12 25% SKOKOMISH 40 5% SQUAXIN ISLAND % COWLITZ % TOTAL % Partnership for improved outcomes Operations Business Clinical

50 Tribal Collaboration Budget flat since 2002 Operational costs vs deployments and development Interest from related non-bens Urban Clinics, Hawai'i, Pacific Islanders IHCIA Reading Center franchise

51 IHS/JVN Program Summer 2011 Update IHS NCC Meeting 27 July 2011 Mark B. Horton, OD, MD Phoenix Indian Medical Center Director, IHS/JVN Teleophthalmology Program

52 REGULATORY UPDATE: Credentialing and Privileging

53 Credentialing and Privileging Requirements for Telemedicine Physicians and Practitioners Revisions to the Hospital and CAH Conditions of Participation (CMS-3227-F) June

54 Locating the Final Rule Published May 5, 2011, in the Federal Register: Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoPs): Telemedicine Credentialing and Privileging (CMS-3227-F) 76 FR 25550: 05/pdf/ pdf June 9,

55 Changes to the Hospital CoPs The hospital requirements for credentialing and privileging of medical staff are contained under the Governing Body ( ) and Medical Staff ( ) CoPs June 9,

56 Governing Body CoP Requires the governing body of the hospital ensure that an agreement exists with a distant-site hospital to provide telemedicine services and that the agreement specifies that the governing body of the distant-site hospital ensures that all current Governing Body CoP requirements ( (a)(1-7)) are met with regard to its physicians and practitioners providing telemedicine services. June 9,

57 Governing Body CoP (cont) The governing body of the hospital has the option of granting privileges based on the recommendations of its medical staff, which has relied upon information furnished by the distant-site hospital regarding privileges for individual physicians and practitioners providing telemedicine services. June 9,

58 Medical Staff CoP The hospital can rely on this information for its privileging decisions only if certain provisions (at (a)(3)) regarding the distant-site hospital, and the individual physicians and practitioners, were met regarding: Medicare-participation status of distant-site hospital Privileges of individual physicians and practitioners, including list of current privileges for each provided by distant-site hospital State License (does not apply to Indian health) Internal review for purposes of periodic appraisal of individuals providing telemedicine services, including adverse events/complaints June 9,

59 Changes to the CAH CoPs Critical Access Hospitals (CAHs) have CoP requirements under the Medicare regulations that are separate and distinct from the hospital CoPs. The term credentialing is used almost exclusively throughout the CAH CoPs. June 9,

60 Changes to the CAH CoPs (cont) The new CAH requirements for credentialing and privileging are under the Agreements ( ) and Periodic Evaluation and Performance Review ( ) CoPs. June 9,

61 Changes to CAH CoPs The requirements for CAHs are similar to those for hospitals, and/or designed to make the CAH credentialing and privileging requirements consistent with current hospital requirements (abbreviated slide) June 9,

62 Changes to CAH CoPs (cont) We also amended the Periodic Evaluation and Quality Assurance Review CoP (at (b)(4)) by adding a new paragraph that allows a distant-site hospital to evaluate the quality and appropriateness of the diagnosis and treatment furnished by the distant-site physicians and practitioners providing telemedicine services to the CAH s patients under an agreement between the CAH and a distant-site hospital June 9,

63 How does the final rule differ from the proposed rule we published in May 2010? First, we finalized the requirements proposed in the May 2010 NPRM with only minor clarifying revisions (e.g, specify in the provisions that the telemedicine agreement must be written). Based on public comment, we added new provisions to the final rule that will apply to the credentialing and privileging process and the agreements between hospitals and CAHs and nonhospital, distant-site telemedicine entities that provide telemedicine services (a)(9) and (a)(4) for hospitals; (c)(3) and (c)(4) for CAHs June 9,

64 How does the final rule differ from the proposed rule we published in May 2010? (cont) The new provisions will allow for the governing body of the hospital (or the CAH s governing body or responsible individual) to rely upon the credentialing and privileging decisions made by the distant-site telemedicine entity. The telemedicine entity s medical staff credentialing and privileging processes and standards must at least meet the CoPs related to credentialing and privileging. June 9,

65 What Are the Differences Between the Proposed Requirements and the New Provisions? These new provisions will require the governing body of the hospital (or the CAH s governing body or responsible individual): Through its written agreement with the distant-site telemedicine entity Ensure that the distant-site telemedicine entity as a contractor of services Furnishes its services in a manner that enables the hospital (or CAH) to comply with all applicable CoPs and standards for the contracted services Including the credentialing and privileging requirements regarding its physicians and practitioners providing telemedicine services June 9,

66 What effect will the final rule have on the CoPs? Will allow hospitals and CAHs to make full use of the telemedicine services offered by nonhospital telemedicine entities without the duplicative and burdensome task required by the traditional credentialing and privileging process. June 9,

67 Benefits for Hospitals and CAHs Will now allow hospitals and CAHs to take advantage of these streamlined credentialing and privileging options when using the telemedicine services of: Other Medicare-participating hospitals, Non-Medicare-participating telemedicine entities, or A combination of both types of service providers June 9,

68 What is a telemedicine entity? There is no statutory definition for a telemedicine entity contained in the Social Security Act. Therefore, for the purposes of this rule, we needed to define a distant-site telemedicine entity as one that (1) Provides telemedicine services; (2) Is not a Medicare-participating hospital; and (3) Provides contracted services in a manner that enables a hospital or CAH using its services to meet all applicable CoPs, particularly those requirements related to the credentialing and privileging of practitioners providing telemedicine services to the patients of a hospital or CAH. June 9,

69 The Importance of the Written Agreement Similar to our regulations proposed for hospitals and CAHs using the telemedicine services of distant-site Medicare participating hospitals, the written agreement between the hospital or CAH and the distant-site telemedicine entity will be the foundation for ensuring accountability on both sides. June 9,

70 Summary Proposed rule published May 26, 2010 CMS received over 100 comments from various stakeholders. Final rule published May 5, 2011 Effective date: July 5, 2011 The result of outreach efforts by CMS to the telemedicine stakeholder community Allows for a streamlined process for credentialing and privileging of telemedicine physicians and practitioners under written agreements between hospitals/cahs and distant-site non- Medicare-participating telemedicine entities and distant-site Medicare-participating hospitals June 9,

71 Summary (cont) Intent is to reduce burden and eliminate duplicative credentialing & privileging efforts by hospitals and CAHs that have telemedicine services agreements with distant-site telemedicine entities and Medicareparticipating hospitals CMS believes that the final rule will reduce the burden of the traditional credentialing and privileging process while still assuring accountability. June 9,

72 Note As per both CMS and Joint Commission, hospitals/cahs may accept credentialing and privileges for telemedicine practitioners from distant hospitals/dste without appointment of telemedicine practitioners to the local hospital/cah medical staff.

73 Next Steps for C & P Still awaiting new Joint Commission standards and interpretations New language has been drafted for the Indian Health Manual Facilities should review their med staff bylaws for compliance with new ruling Agreement templates are being drafted with OGC

74 STRATEGIC OPPORTUNITIES: Behavioral Health Business Planning

75

76 FORM FOLLOWS FUNCTION

77 What will be our new models of care? What will it take to implement those models of care? What will it take to support and sustain them?

78 April 2011 Telehealth Services Network This proposal was developed as a collaboration of many people. At the request of Dr. Susan Karol, IHS Chief Medical Officer, and Dr. Theresa Cullen, IHS Chief Information Officer, a Telehealth Planning Workgroup was formed. This workgroup led the planning and development of this proposal. Participants and contributors to the proposal development included: Tammy Brown, MPH, RD, BC-ADM, CDE Mark Carroll, MD Mandi Constantine, MEd Stewart Ferguson, PhD Chris Fore, PhD Jonathan Doggette Patrick Gormley Mark Horton, OD, MD Kathleen Keats, MBA, MSIT John Kokesh, MD Chris Lamer, RPh Jill Moses, MD, MPH Chris Patricoski, MD Diane Phillips, RD, LD, CDE Jay Shore, MD Peter Stuart, MD Mark Thomas, PE, MPH Mark Veazie, DrPH Chris Watson, RPh, MPH

79 Key Concepts Telehealth is a clinical mandate, not a technical initiative. We should: Provide a predictable level of service. Support local planning and decision making. Establish national coordination, planning and accountability. Improve efficiencies through regional and centralized services. Leverage existing expertise. 79

80 Telehealth Service Expansion Four key components: Clinical Telehealth Services (for primary and specialty care) Modernized Infrastructure Regional Telehealth Resource Centers for technical/coordination/training capacity National Program Support

81 Improving the Medical Home Clinical Service Telehealth Clinical Care Centers Discipline Behavioral Health Nutrition and dietetics Telehealth Modality Model of Care o Videoconferencing o Tiered model of service o Store-and-forward o Direct psychiatric care o Surge service for communities in crisis o 24/7 consultation and clinical evaluation o Education and training o Videoconferencing o Individual and group nutrition counseling services via videoconferencing Pharmacy o Videoconferencing o Store-and-forward o Remote monitoring o o o o o o Availability of advanced practice nutrition counseling On-site assistance in region with program development Regional telepharmacy service Centralized Mail Outpatient Pharmacy (CMOP) support After-hours pharmacy review Disease management assistance o o o o o Additional Description After-hours call will be shared among 5 regions for night/weekend service to emergency departments Intra-network consultation for advance practice needs (e.g. renal, geriatric care) Anticoagulation clinics Cardiovascular risk reduction monitoring Smoking cessation line April 2011

82 Improving the Medical Home (cont.) Clinical Service Specialist Consultation Population Health Consultation Discipline IHS JVN Teleophthalmology Dermatology, Cardiology, ENT, and ID Pop Health Support Network Telehealth Modality Model of Care o Store-and-forward o Expanded JVN I/T/U sites o o Portable service model for sites too small for fixed deployment Hybrid model possible for regional service delivery o Store-and-forward o As needed specialist consultation, assisting with initial consultation and ongoing treatment needs o o Videoconferencing o Store-and-forward o Network of coaches & consultants Knowledge management system o o o Additional Description Model will be based on DM prevalence and geographic specifics Services available via partial FTE or contract National coordination April 2011

83 Alternatives Analysis Behavioral Health Specialty Service Models On-site On-site + telehealth telehealth Scalability Poor Good Good Provider Challenging, expensive and Recruitment/Retention erratic Better Best 24/7 Coverage Dependent on clinic size Available Available Access to range of specialties Limited Available Available Educational Access Local/internet National/regional/ local National/regional Surge Response Poor Best Better Collegial Support Dependent on clinic size Opportunities Best Best depending on affiliation Care needed at other than Can adjust in less than full Can adjust in less than full Cost full FTE increments costly FTE increments FTE increments Limited by provider schedule Potentially available on Potentially available on Access and housing demand demand Cross-Coverage Dependent on clinic size Patient/Provider Safety Exposed to road/air travel hazards (sig in rural areas) National/regional coverage available Better National/regional coverage available Best April 2011

84 Alternatives Analysis Behavioral Health Specialty Service Models On-site On-site + telehealth telehealth Scalability Poor Good Good Provider Challenging, expensive and Recruitment/Retention erratic Better Best 24/7 Coverage Dependent on clinic size Available Available Access to range of specialties Limited Available Available Educational Access Local/internet National/regional/ local National/regional Surge Response Poor Best Better Collegial Support Dependent on clinic size Opportunities Best Best depending on affiliation Care needed at other than Can adjust in less than full Can adjust in less than full Cost full FTE increments costly FTE increments FTE increments Limited by provider schedule Potentially available on Potentially available on Access and housing demand demand Cross-Coverage Dependent on clinic size Patient/Provider Safety Exposed to road/air travel hazards (sig in rural areas) National/regional coverage available Better National/regional coverage available Best April 2011

85 Expanding Access to Quality Behavioral Health Services Mose Herne, MPH, MS July 27, 2011

86 Inpatient Mental Health Needs Significant challenges for IHS in meeting the inpatient mental health needs of its users Recommendations from 2011 assessment include: Expand behavioral health services in partnership with Tribes, local, State, and regional providers Capitalize on emerging technologies, i.e., telebehavioral health, to increase access to and quality of services for evaluation and treatment, enhance provider education through case consultation, and strive to prevent inpatient hospitalizations

87 Current Use of Tele-behavioral Health Improving access to behavioral health services: The National Tele-behavioral Health Center of Excellence (TBHCOE) was established to provide innovative and culturally competent technical assistance to increase: access to behavioral health services training in suicide prevention for behavioral health staff practicing in Indian Country Use of tele-behavioral health technology is on the rise Over 50 IHS and Tribal facilities in 8 IHS Areas are augmenting on-site behavioral health services with telebehavioral health services

88 TBHCE Support Activities TeleBehavioral Health Policies and Procedures Credentialing and Privileging guidelines Standardized Network Assessment TelePsychiatry formulary (in progress) Secure document sharing & messaging via AFHCAN (in progress) TeleBehavioral Health EHR template (pending) TeleBehavioral Health lab package (pending)

89 Goals of Tele-behavioral Health Improve quality and access to BH care Improve customer service Reform the IHS Transparency Tribal consultation NTAC and BH Workgroup

90 TBHCE Direct Services to I/T/U Psychiatry Adult Addictions Child/Adolescent Psychology Adult Child/Adolescent Individual Group Family

91 TBHCE Activities Coordinate 24/7 Coverage Credentialing National Standards Practice EHR Formulary AFHCAN Network Assessment Billing TA TeleVideo Support OIT Coordination mhealth Initiatives Program Evaluation New Technology Eval. Intensive case mgt Training TeleBH mhealth BH/Primary Care (CME) PHN/CHR training Cultural competence

92 TBHCE Indirect Services to I/T/U Education No-Cost CME to I/T/U Primary Care providers via televideo. Clinical Support Weekly Case Staffing to I/T/U Mental Health and Substance Abuse providers. Assessing and Treating Behavioral Health Issues in a Primary Care setting (piloting) Emphasis on dual diagnosis, suicide prevention, and chronically mentally ill (in progress)

93 Targeted Outcomes Increase access to BH services Increase quality of care through service coordination 24/7 support for mental health emergencies Use of innovative and multidisciplinary care models Prevent hospitalization/reduce length of stay Improve quality of life Leveraging existing programs, i.e. VA, SAMHSA, HRSA Collaboration across the system Customer service, i.e. directly addresses BH needs as outlined in numerous venues

94 BUSINESS UPDATE: Reimbursement Policy

95 Is telehealth cost-effective?

96 Better Question: Under what circumstances are new care models using telehealth tools costeffective?

97 DATA FROM ALASKA $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 Annual Travel Savings (by Case Role) $ Primary Care Specialty Care SFerguson PhD, ANTHC

98 Capistrant s Medicaid Grades G Capistrant, ATA, 2011 Red = A White = B Blue = C Grey = D Black = F

99 Expanding Reimbursement Incremental expansion in coverage by both Medicare and Medicaid programs CMS considering new approach to reviewing annual requests for additions to covered telehealth services Consideration within IHS for proposal to CMS re: national coverage determination for Indian health 99

100 Service to the point of need

101 Improved access for many types of care cannot occur without telehealth

102 Thank You