Department of Health Care Services Integrating Telehealth Efforts Joanne Peschko, MBA Health Program Specialist 1
Telehealth Programs Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Managed Care Plans Drug Medi-Cal Organized Delivery System (DMC-ODS) Medication Assisted Treatment (MAT) Expansion Project Telehealth Services Covered by Medi- Cal 2
PRIME A five-year initiative under the Medi-Cal 2020 section 1115 waiver 17 Designated Public Hospitals (DPHs) and 37 District/Municipal Public Hospitals (DMPHs) Entities may receive up to $3.7 billion in federal Medicaid funding for achieving metrics in implementing clinical projects designed to change the way care is delivered. 3
PRIME PRIME includes 3 Domains that consist of 18 clinical project areas that are tied to a required set of reporting and performance metrics DPHs are required to implement a minimum of nine projects The DMPHs are required to implement one project from any of the three Domains. 4
Marin General Hospital 5
Marin General Hospital Needs Assessment DMPH Project 2.3: Complex care management for high risk medical populations A needs assessment and census maps identified Health Professional Shortage Areas (HPSA) Decision to include Telehealth in order to expand access to health care within these shortage areas 6
Marin General Hospital Sites Marin General will become a Distant Site to provide care for patients with chronic conditions 4 FQHCs will be the Originating Sites Initial pilot will begin with 1 FQHC Primary patient needs identified include those who have been recently discharged from MGH needing care navigation services for complex care management, and those with chronic diseases needing management by specialty providers, most of whom are located at or near the hospital (i.e. endocrinology) 7
Marin General Hospital Pilot Plans are to begin with the Nurse Practitioner or Nurse Navigators for Complex Care and/or Palliative Care Navigation for PRIME. eventually expand services and specialist referrals available through MGH Telehealth 8
Marin General Hospital Telehealth Infrastructure Implement video conferencing software on mobile computer stations to be located at the Originating Site (the clinic where the patient is located) and the same installation on desktop computer stations onsite at MGH, designated as the Distant Site. Both locations will include video-conferencing software and hardware used for real-time consultations between the patient and their distant provider at MGH. These sites will also likely have an option for a second monitor to allow for review of educational materials, electronic health records, lab results, and other documents. 9
Managed Care Plans Telehealth Survey (March 2017) Type of telehealth utilized in delivery of services Resources needed to provide telehealth services Challenges encountered in implementation or provision of telehealth services Successes in providing telehealth services Internal data collection on telehealth services Initiatives to consider to reduce barriers to utilizing telehealth 10
MCP Challenges in Telehealth Implementation 12 MCPs responded (11 reported some type of telehealth service) 50% of MCPs stated that they encountered challenges that were show-stoppers Provider buy-in ( Incentives are not aligned with the PCP in a capitated system ) Vendor company instability Rural infrastructure ( areas where need is great due to geographic isolation but volumes are minimal ) Other challenges Platforms do not interface with multiple EHR systems Discordance with Medicare rules on telemedicine (Medicare is more restrictive) is a barrier to wider use 11
DMC-ODS Services Initial medical necessity determination for the DMC-ODS benefit Outpatient Services (ASAM Level 1) Intensive Outpatient Treatment Services (ASAM Level 2.1) Recovery Services Case management services 12
MAT Expansion Project Telehealth is not required it is allowable Telehealth Infrastructure Costs and Service Provision Providing for or Referring to Local Maternal Addiction Treatment 13
Telehealth Services Covered by Medi-Cal Selected Evaluation and Management (E&M) services for patient visit and consultation Selected psychiatric diagnostic interview, examination and therapeutic services Store and forward teledermatology Store and forward teleophthalmology Teledentistry Transmission costs (up to 90 min per patient, per day) Originating site facility fee Interpretation and report of X-rays and electrocardiograms Telehealth policy to be updated to align with expanded benefits under Medicare introduced in 2015 14
Questions? Joanne Peschko Joanne.Peschko@dhcs.ca.gov 15