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Jerry Canaan, II, Esq.
Hancock, Daniel & Johnson, P.C.
Telehealth: Industry Trends and Predictions for 2020
Some Content Provided by the Advisory Board, with permission
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Defining Telehealth and Demand Drivers
Major Players and Expansion Priorities
Market Trends and Reimbursement
Licensure and Compliance
Future of Telehealth
Objectives
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Defining Telehealth What is “Telehealth”?
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Defining Telehealth Provider Use of Telehealth
• Stroke, mental health, and primary care remain top uses of telehealth
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Increased FDA Approval
Drivers of Telehealth Use Policy and Advocacy
H.R.1301 - Mental Health Telemedicine Expansion Act
CMS Expansion of Telehealth Coverage
Greater Medicare Advantage Flexibility
Policy and
Advocacy
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Drivers of Telehealth Use Technology and Innovation
Wearable and Ingestible Sensors
Epic Integrates Virtual Visits into Platform
Artificial Intelligence and Augmented Reality
Tech Giants Move into Telehealth
Technology
and
Innovation
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Drivers of Telehealth Use Consumer Demand and Concerns
Sizeable Minority Already Utilizing Virtual Visits
Concerns about Quality and Privacy
Ease of Access and Continuity of Care
High Interest Low Reutilization
Consumer
Demand and
Concerns
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Drivers of Telehealth Use Summary of Demand Drivers
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Major Players and Priorities Overview of Major Players and Priorities
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Major Players and Priorities Employers
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Source: Greenwell, C, Worker Illness and Injury Costs US Employers $225.8 Billion Annually, CDC Foundation (2015); Emerman, E, Large U.S. Employers Project Health Benefit Cost Increases to Hold
Steady at 6% in 2017, National Business Group on Health (2018); Current Telemedicine Technology Could Mean Big Savings Towers Watson (2014); Service Line Strategy Advisor research and analysis.
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Major Players and Priorities Payers
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Competitive Brand Differentiation
Major Players and Priorities Large systems grow across state lines
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Systems use Brand Differentiation to Attract
Patients and Build Shares
Untapped Geographies
Education and Collaboration
Clinical Research
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Major Players and Priorities Provider Organizations – Small Systems
Smaller systems aim to beat provider shortages through telehealth
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Source: Workforce Shortage Fact Sheet, Children’s Hospital Association; American Academy of Neurology, Insights Report (2018); Out-of-Network, Out-of-Pocket, Out-of-Options, National Alliance on
Mental Illness (2016); Mann, S, Research Shows Shortage of More than 100,000 Doctors by 2030, Association of Medical Colleges (2017); Service Line Strategy Advisor research and analysis.
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Major Players and Priorities Clinically Integrated Networks (CINs)
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Dr. Robert Pearl,
Executive Director and CEO, Permanente Medical
Group
"One-third of the time when the patient is in the primary care physician's office,
we're actually able to connect the specialist with the primary care physician and
the patient…that's better quality, that's greater convenience, and certainly it's
better outcomes with care immediately.”
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1. Teladoc acquired international virtual care provider Advance Medical in Spring 2018
o Allow Teladoc to develop and expand its global market into Latin America and Asia Pacifica
2. AmWell acquired Avizia in Spring 2018
o Expand American Well’s acute care capabilities and give them access to Avizia’s hospital-based cart lineup and custom workflow software for over 40 specialties
3. InTouch acquired Reach Health in Spring 2018, taking on Reach’s 200 health system customers
o Broadens InTouch’s footprint and expands services and capability to cover programs across the continuum of care
Major Players and Priorities Vendors and Developers
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Telehealth M&A Activity 2018-19
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Walmart and Doctor on Demand
Major Players and Priorities Retailers
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Rite Aid and InTouch Health
Walgreens and MD Live
CVS and Teladoc
T-Mobile, The VA, and Philips
Microsoft and Walgreens
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Major Players and Priorities Retailers
https://www.beckershospitalreview.com/healthcare-information-technology/former-apple-ceo-remote-patient-monitoring-telehealth-will-drive-future-of-healthcare.html
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Major Players and Priorities Retailers
https://www.beckershospitalreview.com/telehealth/will-amazon-s-telemedicine-program-spread-beyond-employees.html
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Trends and Reimbursement Market Challenges
https://www.statnews.com/2019/10/21/telehealth-rapid-expansion-offers-challenges/
https://www.beckershospitalreview.com/telehealth/5-challenges-hindering-telehealth-market-growth.html
Transition Towards
Value-Based Care
Licensure and Compliance
Reimbursement of Various
Care Modalities
Streamlining Consent and
Data Integration
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Trends and Reimbursement Low Reimbursement for Top-Volume CPT Codes
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Trends and Reimbursement Modalities of Telehealth Services Promote Value-Based Care
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Trends and Reimbursement Virtual Visits
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Trends and Reimbursement Remote Patient Monitoring
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Trends and Reimbursement Asynchronous Store and Forward
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Trends and Reimbursement Current Reimbursement in Virginia
https://www.cchpca.org/sites/default/files/2019-05/cchp_report_MASTER_spring_2019_FINAL.pdf
https://www.advisory.com/-/media/Advisory-com/Research/MIC/Resources/2017/2018-Telehealth-State-Policy-Profiles.pdf#page=139
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Interstate Credentialing
Licensure and Compliance Licensure and Compliance Challenges
https://www.beckershospitalreview.com/telehealth/6-telehealth-policy-barriers-to-watch-out-for.html
Streamlining Consent and Data
Integration
Malpractice
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Licensure and Compliance Virginia Professional Regulations
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
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Licensure and Compliance Virginia Professional Regulations
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
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Licensure and Compliance Virginia Professional Regulations
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
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Licensure and Compliance Interstate Credentialing
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
• Nine states issue special licenses related to telehealth
• Could allow an out-of-state provider to be granted privileges Specialty Licenses
• Twenty-nine states, D.C., and the territory of Guam have all adopted the Federations of State Medical Board’s Interstate
Medical Licensure Compact (excluding Virginia)
Interstate Medical Licensure Compact
• Thirty-one state members (including Virginia) Nurses Licensure
Compact
• Twenty-five members (excluding Virginia) Physical Therapy
Compact
• Nine members (excluding Virginia) Psychology
Interjurisdictional Compact
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Licensure and Compliance Interstate Credentialing
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
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Licensure and Compliance Streamlining Consent and Data Integration
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993051/
• Consent and Data Integration Issues
– Increasing system complexity and interaction of multiple systems
– Level of Health IT capability impacts functionality of telehealth program
Example: electronic transfer v. need to manually transfer and enter patient data
– Key Considerations
Function
Integration
Network interoperability – including medical devices, EHR/EMR, personal health records
Usability
Reliance on software
Security
Technology management
Assurance
Certification
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Licensure and Compliance
https://www.natlawreview.com/article/doctor-medical-malpractice-issues-age-telemedicine
Malpractice
• Unauthorized medical practice can result in disciplinary action in the physician’s own state and potential prosecution for unlicensed medical practice in the patient’s state
Differing Standards of Care
• Liability laws
• Statutes of limitations
• Standards of care
• Damage caps
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Licensure and Compliance
https://www.natlawreview.com/article/doctor-medical-malpractice-issues-age-telemedicine
Malpractice Insurance
• Unresolved jurisdictional issues – difficult for insurance companies to assess financial risks
• Providers should confirm that medical malpractice policies tailored for in-office encounters include telemedicine
• Many malpractice policies exclude unlicensed activities – physicians must understand state licensing provisions and coverage requirements in other states
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Licensure and Compliance Telehealth Policy Profile for Virginia
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
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Licensure and Compliance Telehealth Policy Profile for Virginia
https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH%20POLICY%20BARRIERS%202019%20FINAL.pdf
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Future of Telehealth Policy Trends
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
Increased
Participation in
Interstate Licensure
Compacts
Potential
Restructuring of
Telehealth
Reimbursement to
Bundle Payments
Bipartisian Budget
Act of 2018
Implementation for
Risk-Based
Programs
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Future of Telehealth Technology Trends
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Future of Telehealth Technology Trends
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Future of Telehealth Consumer Trends
Adapted from https://www.advisory.com/research/market-innovation-center/resources/2018/telehealth-industry-trends
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Key Takeaways
Increased telehealth use based on policy, technology, and demand
Major market players driving expansion of telehealth
Changes in reimbursement present uncertainties and opportunities
Licensure and compliance challenges prevent seamless adoption of telehealth
Technology and consumers driving the telehealth movement forward
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©2019 Hancock, Daniel & Johnson, PC
Jerry Canaan, II, Esq. HANCOCK, DANIEL & JOHNSON, P.C. (866) 967-9604
www.hancockdaniel.com
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