Clinical Telemedicine for Rural Applications and Schools IRHA Annual Conference June 14, 2017

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1 Clinical Telemedicine for Rural Applications and Schools 2017 IRHA Annual Conference June 14, 2017

2 Keri Dostie Director of Marketing AMD Global Telemedicine Sarah Thompson School-Based Services Administrator MHS & Ambetterfor MHS Jenni Hill Account Executive, Strategy and Business Development St. Vincent

3 AMD Global Telemedicine, Inc. Over 9,000 installations in 98 countries. 26 years telemedicine experience Technology and equipment provider for clinical telemedicine encounters Clients represent the best, most successful programs worldwide.

4 Our Global Footprint

5 Discussion Topics Why telemedicine is being used worldwide to deliver health care Examples of clinical telemedicine applications for rural patients How telemedicine has made a difference for rural communities Elwood Community School telemedicine program Characteristics of a successful program

6 Telemedicine Defined Telemedicine (also referred to as telehealth or e-health ) is the use of digital technology that allows health care professionals to evaluate, diagnose, and treat patients in remote locations. Variety of Methods Used: Real-time audio/video Store-and-forward Mobile applications (mhealth) Remote monitoring

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8 10 Million Americans directly benefited from a telemedicine service over a 12-month period from Source: American Telemedicine Association

9 Reasons Telemedicine is Used Gaps in patient care 42.7% Adding additional services 27.0% Remove patient barriers to receiving care 13.5% Healthcare policy changes 7.2% Cost reduction 3.1% HIMSS Analytics 2015 Telemedicine Study

10 Most Common Medical Specialties Primary Care Dermatology Women s Health Pediatrics Cardiology Radiology Emergency Ears, Nose, Throat Ophthalmology Behavioral/Mental Health

11 Telemedicine Applications Areas Rural Clinics & Hospitals Hospital Systems Correctional Facilities Schools Health Centers Mobile Clinics Retail/Pharmacy Clinics Shipping /Transportation / Industrial SNFs and LTC Facilities

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13 Source: federal Office of Rural Health Policy, Rural Healthy People 2010 report "Healthy People 2010: A Companion Document for Rural Areas.

14 Telemedicine Benefits Rural Health Care Patient care remains in their home community Increases access to additional medical specialties Reduces out-of-pocket travel expenses Immediate and real-time access to healthcare Increases physician utilization and bring specialists to smaller community hospitals.

15 How is Clinical Telemedicine Used in Rural Healthcare?

16 Critical Access/Rural Hospitals Connect patients with additional medical specialists on the spot. Increases physician utilization by reducing transit time to various clinics/offices. Provides healthcare organizations ability to offer additional services (remote). Carl Foundation Hospital, IL Baystate Health, MA St. Luke s, MN

17 Retail/Pharmacy Clinics Medview MD, Canada Kaiser Permanente Care Corner Clinic at Walmart MercyCare Community Physicians, IA Primary care clinics are placed in retail pharmacies making it convenient for patients and brings in new customers and revenue for the pharmacies. Patients can be seen for a quick check up for things like coughs, colds, skins rashes, simple injuries, etc. If needed prescriptions can be filled before leaving the store.

18 Skilled Nursing & LTC Facilities Reduces hospital re-admissions and patient transports Increases access to specialty care Provides alternative night coverage options

19 Mobile Medical Clinics 2013: started telehealth program to link uninsured children to much needed specialists. Visits community centers, churches, and schools in the most impoverished areas of Miami-Dade County, Florida. Increased compliance rates for follow up appointments from 30% to 90%.

20 Country-Wide Deployment: Rural Bolivia Extreme geography and distances 11.5 M people over 425K sq. miles 339 rural health clinic sites across 9 states in Bolivia Address some country specific challenges; For example; Birthing rate success Elapsed time from Specification to Live = 12 months

21 School-Based Health Centers Delivers immediate access to primary care physicians without students having to miss school for an appointment.

22 Specific Examples of School-Based Telemedicine Programs

23 Elwood Schools Telemedicine Program Partnership between : Indiana Rural Health Association, Managed Health Services (MHS), St. Vincent Mercy, Aspire Indiana, Elwood Community School Corporation. Hub Site: Dr. Robert Zentz s pediatric office Spoke Site(s): Elwood Elementary and Intermediate School Presenters- school nurses

24 Lessons Learned from Implementation Have key players on board School (Superintendent, Board, Principal, Nurse) Provider Support agencies Have the right people at the table Decision makers Supporters (those who have a vested interest) Users Know your audience Understanding of who they trust, who they will listen to, best way they receive information, what is their norm IT - Firewalls, Security, etc.

25 Equipment Selection Process Vendor Demonstrations Customer Service Broader Licensing Options School Nurse Buy In

26 Reimbursement Will the visit be paid for by commercial insurance and Medicaid? YES Medicaid Location code- 03 (Determines it is a school-based health center) Normal CPT codes are used with the GT Modifier added (denotes telemedicine services) Providers will bill services provided at the hub site (where provider is) Indiana reimburses for telemedicine services according to IHCP s universal fee schedule FQHCs and RHCs: reimbursement is based on the PPS rate specific to that facility» Must update scope of area and be identified as a stand alone site to receive same rate

27 Cherokee Health Systems -Tennessee Challenges: 14,000 students across nearly 2 dozen schools. Lack of healthcare personnel onsite for daily medical issues. Communicable illnesses were spreading across the school/county and causing school closures. Sevier County

28 Cherokee Health Systems -Tennessee Results with telemedicine: Over 11,000 telemedicine encounter visits completed. 5 years without a school closure due to seasonal flu. Immediate diagnosis and treatment for communicable illnesses (strep throat, flu). On going issues (high blood pressure, diabetes, nutrition) can now be tracked and monitored.

29 Community Health Center -Michigan First school tele-health program in MI Specialties/conditions serviced: Acute illness and minor injuries: Dermatology Sports physicals Influenza ENT check ups: strep throat, ear infections Future expansion working with University of Michigan for teleepilepsy & tele-dentistry. 1,398 students enrolled 4700 patients serviced 1026 telemedicine consults

30 Community Health Center -Michigan Results: MiPHY Comparison

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32 Characteristics of a Successful Telemedicine Program

33 Characteristics of Successful Telemedicine Programs 1. Start small and build from there. 2. Vision for current and future sites. 3. Long term financial/sustainability plan. 4. Natural clinical workflow for users and patients. 5. Full-time coordinator. 6. Champion leader/user.

34 Characteristics of Successful Telemedicine Programs 7. Train ALL parties: clinicians, remote providers, IT 8. Dedicated site procedures and proper workflow. 9. Marketed program to patients and medical staff. 10. Implement into standard patient care ASAP. 11. Share learned experiences with others. 12. Learn from mistakes and adjust plan for future.

35 Telemedicine is

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37 Questions?

38 Thank You Keri Dostie, Marketing Director AMD Global Telemedicine 321 Billerica Road Chelmsford, MA