Post on 02-Dec-2014
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© 2002-2014 Nuance Communications, Inc. All rights reserved
mHealth Reimbursement – Who Will PayNick van Terheyden, MD (aka @drnic1)HIMSS mHealth CommitteeCMIO, Nuance Communications, Inc.
© 2002-2014 Nuance Communications, Inc. All rights reserved
Technology has become anintegral part of our daily lives…
© 2002-2014 Nuance Communications, Inc. All rights reserved
© 2002-2014 Nuance Communications, Inc. All rights reserved
© 2002-2014 Nuance Communications, Inc. All rights reserved
© 2002-2014 Nuance Communications, Inc. All rights reserved
© 2002-2014 Nuance Communications, Inc. All rights reserved
© 2002-2014 Nuance Communications, Inc. All rights reserved› Source: Caroline McSwain (http://carolinemcswain.wordpress.com/2010/10/25/the-internet-a-student%E2%80%99s-greatest-asset-or-worst-distraction/)
Talking on phone
Talking on phone
Surfing the web?
Surfing the web?
Watching television
Watching television
Reading a magazine
Reading a magazine
Listening to music
Listening to music
Texting a friend
Texting a friend
© 2002-2014 Nuance Communications, Inc. All rights reserved
“Consumers have turned the tables on us in self-service. We introduced IVRs, ATMs and other automation for the benefit of the company, but now we can’t keep up with customer demand for self-service”
Vice President Customer Care, Large US Airline
Supermarket AirlinesATMsOnline Hotels
65%
of consumers turn to Web first
for answers
55%
of check-ins
35%
of guests at the Hyatt
1/3
of Tesco transactions
1.75M
of ATMsworldwide
The adoption of self-service is pervasive…
© 2002-2014 Nuance Communications, Inc. All rights reserved
Segmenting the Addressable Population
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mHealth Value Proposition
– Early intervention for people at risk of congestive heart failure (CHF) - the leading cause of hospitalization in the U.S. - could save from $5 to $7 billion per year by expanding telehealth services.
– Telehealth documented itself to be efficacious as a tool for early intervention
– Miley, Madeline L., et al. "The state of emergency stroke resources and care in rural Arizona: a platform for telemedicine." Telemedicine and e-Health 15.7 (2009): 691-699
– Deployment of an mHealth Patient Monitoring Solution for Diabetes: “Improved Glucose Monitoring Leads to Reduction in Medical Expenditure”
– http://www.touchendocrinology.com/articles/deployment-mhealth-patient-monitoring-solution-diabetes-improved-glucose-monitoring-leads-r
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Establishing an ROI
– Traditional business model similar to the EHR– Financial, clinical, and organizational– decreased medication errors and improved patient
satisfaction with EHRs. – Limited evidence of any cost savings
– Partnerships with established companies– Capitalize on the small specialized digital health tech
companies that have done the research
© 2002-2014 Nuance Communications, Inc. All rights reserved
Input to Policy
– CMS-1612-P:– Revisions to Payment Policies Under the Physician Fee
Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015
– https://www.federalregister.gov/articles/2014/07/11/2014-15948/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-clinical-laboratory
© 2002-2014 Nuance Communications, Inc. All rights reserved
CMS-1612-P
– Comments Provided by HIMSS September 2, 2014– Included Comments on Telehealth– ACA provides a number of pathways to advance changes in healthcare by
implementing technology– Shift telehealth away from fee for service models and usher in an era of
patient centric continuity of care under the mantle of telehealth– Includes the increased use of technology to provide chronic care
management (CCM) alongside other existing telemedicine interventions– Applaud the work of Center for Medicare and Medicaid Innovation (CMMI)
– align the Physician Fee Schedule with the Bundled Payment for Care Improvement (BCPI) Initiative administered by CMMI to include a focus telehealth and remote patient monitoring in the four models of care.
© 2002-2014 Nuance Communications, Inc. All rights reserved
CMS-1612-P
– Geographic limits: Remove limit only for patients lacking transportation in urban areas
– Eligible Originating Site: Extend to include the patient (medical) home
– Store and Forward: Remove this limitation and include all forms of patient generated data
– Two-way audio/visuals: Remove this restriction
© 2002-2014 Nuance Communications, Inc. All rights reserved16
0 25 65 AgeIll
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Pre
-Illn
ess
Welln
ess
DeatDeathh
To put it another way….
Fun
No Fun
2009 Continua Health Alliance Brigitte Piniewski, MD
© 2002-2014 Nuance Communications, Inc. All rights reserved
Diabetic Monitoring$3,300 saving per patient per year by just moving every
diabetic employee over to this more advanced management
system
© 2002-2014 Nuance Communications, Inc. All rights reserved
Alternative Funding Models
– Executive Briefing Telehealth and mHealth– Payers Creating CPT Codes for Hospitals to Engage in Patient
Centric Care– USDA – Telehealth funding for distance learning– FCC Healthcare Fund – Telehealth funding for broadband
connectivity– OAT – Telehealth grants to demonstrate telehealth use in rural
communities– CMMI – CMS awards to foster innovative, patient centric care
http://himss.files.cms-plus.com/FileDownloads/Telehealth%20Executive%20Briefing.pdf
© 2002-2014 Nuance Communications, Inc. All rights reserved
Submission to 21st Century Cures initiative
© 2002-2014 Nuance Communications, Inc. All rights reserved
Submission to 21st Century Cures initiative– To aid with your consideration of these important issues as the
21st Century Cures Initiative progresses, the stakeholders identified consensus recommendations
– Authorize the use of Telehealth for all accountable care organizations and bundled payments program
– Telehealth and remote patient monitoring should be the cornerstone of a 21st Century healthcare system and should be a covered benefit
– Authorize remote patient monitoring for CHF, COPD, diabetes, and expand to future eligible chronic (based review of the evidence)
© 2002-2014 Nuance Communications, Inc. All rights reserved
Much like the Transcription Industry and Speech Recognition
– Zipnosis
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“Consumer behavior is the killer app when it comes to business disruption”
Brett KingAuthor “Banking 2.0”
© 2002-2014 Nuance Communications, Inc. All rights reserved
The key question: Are you going to disrupt your industry or be disrupted?
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Consequence of NOT Being Prepared When This Ship Sails
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Nick van Terheyden, MD CMIO, Nuance CommunicationsAboutMe http://about.me/obiwanTwitter http://twitter.com/drnic1LinkedIn http://www.linkedin.com/in/nickvtVoice of the Doctor http://drvoice.blogspot.com/FaceBook http://profile.to/drnickE-Mail drnick@nuance.com, drnic1@gmail.comGoogleVoice (301) 355-0877
Where You Can Find Me
© 2002-2014 Nuance Communications, Inc. All rights reserved
mHealth Reimbursement – Who Will PayNick van Terheyden, MD (aka @drnic1)HIMSS mHealth CommitteeCMIO, Nuance Communications, Inc.
© 2002-2014 Nuance Communications, Inc. All rights reserved
Backup Slides
© 2002-2014 Nuance Communications, Inc. All rights reserved
Value of mHealth
– Use Case Study: Mobile Telemedicine Provides Cost Effective Patient Care in Low-Income Neighborhoods
– http://www.himss.org/ResourceLibrary/genResourceDetailPDF.aspx?ItemNumber=30667
– Use Case Study: Christus Health - Improving Health at Home: Remote Patient Monitoring and Chronic Disease
– http://www.himss.org/ResourceLibrary/genResourceDetailPDFReg.aspx?ItemNumber=22361
– Case Study: Geisinger Health System: Reducing Patient No-Shows
– http://www.himss.org/applications/secure/?FileID=436054