reimbursement for teleconsultation by health insurance companies : a story from the usa - by dr....

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IMPACT OF HEALTH INSURANCE AND GOVERNMENT REIMBURSEMENT EXPANSION ON VIRTUAL VISIT TELEMEDICINE MARKET,

THE USA PERSPECTIVE

Pramod K. Gaur Ph.D. Adjunct Professor, Pace University

Chair, mHealth SIG, American Telemedicine Association

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Key Stakeholders for Scalable and Sustainable Telehealth Program

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Wellness and Prevention Care

Chronic Disease End Of Life Care

Acute andSub-Acute Care

TPM Goal Improve

Overall Health and Wellbeing

Stay Healthy

Get Healthy

Living with

Illness

Mobile Health Apps

Evidence Based Telemedicine

Remote Patient Monitoring

75%

20% 5%

Reimbursement for TPM Services

1. Federal Government – Medicare• Traditional Medicare• Managed Medicare• DoD/VA

2. State Governments – Medicaid• Traditional Medicaid• Managed Medicare• Medicaid - Medicare Dual Eligible

3. Large Employers – Self Insured• Over 90% plans have Telehealth Coverage Now

4. Insurance Companies• Risk Based Policies for Individuals and Small

Businesses Provide Telehealth Coverage

5. Self Pay – Consumers can get a Teleconsult for $49

Telehealth Reimbursement: PAYERS

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1. Traditional Fee for Service2. Capitated/Negotiated Rates• ACO• PCMH• Bundle Payment• Episode of Care

3. Employer Wellness/Prevention Incentives4. Pre-Tax Spending Accounts• Health Savings Account• Flexible Savings Account

5. Self Pay - High Deductible Plans

PAYERS: Reimbursement Models

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PAYERS: Reimbursement Models

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PAYERS: Latest Reimbursement News

Aetna Enters Into Agreement to Provide Value-Based Care

Cigna Telehealth Connection Expands Access and Choice to Millions Including Adding Access to Behavioral Health Consults

United Healthcare Offers Compelling Medicare Products for 2017

Aetna to Transform Members’ Consumer Health Experience Using iPhone, iPad and Apple Watch

Telehealth Visits covered by 29 Blue Cross Blue Shield Plans

UPMC launches telehealth startup to keep nursing home patients out of the hospital

More Than Half of Kaiser Permanente's Patient Visits Are Done Virtually

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QUESTIONS