mHealth Reimbursement : Who Will Pay?

© 2002-2014 Nuance Communications, Inc. All rights reserved

mHealth Reimbursement – Who Will PayNick van Terheyden, MD (aka @drnic1)HIMSS mHealth CommitteeCMIO, Nuance Communications, Inc.


Technology has become anintegral part of our daily lives…

© 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


“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…


Segmenting the Addressable Population


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


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


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


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.


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

ness

Pre

-Illn

ess

Welln

ess

DeatDeathh

To put it another way….

Fun

No Fun

2009 Continua Health Alliance Brigitte Piniewski, MD


Diabetic Monitoring$3,300 saving per patient per year by just moving every

diabetic employee over to this more advanced management

system


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


Submission to 21st Century Cures initiative


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)


Much like the Transcription Industry and Speech Recognition

– Zipnosis


“Consumer behavior is the killer app when it comes to business disruption”

Brett KingAuthor “Banking 2.0”


The key question: Are you going to disrupt your industry or be disrupted?


Consequence of NOT Being Prepared When This Ship Sails


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 [email protected], [email protected] (301) 355-0877

Where You Can Find Me


mHealth Reimbursement – Who Will PayNick van Terheyden, MD (aka @drnic1)HIMSS mHealth CommitteeCMIO, Nuance Communications, Inc.


Backup Slides


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

mHealth Reimbursement : Who Will Pay?

Healthcare

Transcript of mHealth Reimbursement : Who Will Pay?