telehealth: industry trends and predictions for 2020 · telehealth: industry trends and predictions...

11/18/2019

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©2019 Hancock, Daniel & Johnson, PC • hancockdaniel.com

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


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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


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Major Players and Priorities Overview of Major Players and Priorities


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Major Players and Priorities Employers


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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http://www.cdcfoundation.org/pr/2015/worker-illness-and-injury-costs-us-employers-225-billion-annually

https://www.businessgrouphealth.org/news/nbgh-news/press-releases/press-release-details/?ID=348

https://www.businessgrouphealth.org/news/nbgh-news/press-releases/press-release-details/?ID=348

,%20https:/www.towerswatson.com/en-US/Press/2014/08/current-telemedicine-technology-could-mean-big-savings

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Major Players and Priorities Payers


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Competitive Brand Differentiation

Major Players and Priorities Large systems grow across state lines


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


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)


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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https://www.childrenshospitals.org/-/media/Files/CHA/Main/Issues_and_Advocacy/Key_Issues/Graduate_Medical_Education/Fact_Sheets/CHGME_Workforce_Shortage_Fact_Sheet.pdf

https://www.aan.com/siteassets/home-page/conferences-and-community/member-engagement/learn-about-aan-committees/board-planning/2018-insights-report.pdf

https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/Mental-Health-Parity-Network-Adequacy-Findings-/Mental_Health_Parity2016.pdf













https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/










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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


Telehealth M&A Activity 2018-19

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Walmart and Doctor on Demand

Major Players and Priorities Retailers


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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https://www.beckershospitalreview.com/healthcare-information-technology/former-apple-ceo-remote-patient-monitoring-telehealth-will-drive-future-of-healthcare.html

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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


Reimbursement of Various

Care Modalities

Streamlining Consent and

Data Integration

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Trends and Reimbursement Low Reimbursement for Top-Volume CPT Codes


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Trends and Reimbursement Modalities of Telehealth Services Promote Value-Based Care


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Trends and Reimbursement Virtual Visits


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Trends and Reimbursement Remote Patient Monitoring


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Trends and Reimbursement Asynchronous Store and Forward


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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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https://www.cchpca.org/sites/default/files/2019-02/TELEHEALTH POLICY BARRIERS 2019 FINAL.pdf






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Licensure and Compliance Interstate Credentialing


• 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


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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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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993051/

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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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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


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Licensure and Compliance Telehealth Policy Profile for Virginia


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Future of Telehealth Policy 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


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Future of Telehealth Technology Trends


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Future of Telehealth Consumer 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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www.hancockdaniel.com | (866) 967-9604

©2019 Hancock, Daniel & Johnson, PC

Jerry Canaan, II, Esq. HANCOCK, DANIEL & JOHNSON, P.C. (866) 967-9604

[email protected]

www.hancockdaniel.com

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telehealth: industry trends and predictions for 2020 · telehealth: industry trends and predictions...

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