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mHealth Reimbursement : Who Will Pay?

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In this billion dollar industry, there is no shortage of investment. How to make these investments grow is an area where more clarity is required.

See facts & stats about how mHealth services e.g. remote monitoring reduces pay outs for both the single (gov) and private (insurer) payers to develop an irresistible pitch and win payer clients
Explore the payment model The Centre of Medicaid has adopted for telemedicine services to see if this can be extended for broader health management and expand your services
Assess how corporations are rolling out mHealth services throughout their workforce to reduce absenteeism and health plan payouts to align sales strategies and build market momentum

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mHealth Reimbursement : Who Will Pay?

  1. 1. mHealth Reimbursement – Who Will Pay Nick van Terheyden, MD (aka @drnic1) HIMSS mHealth Committee CMIO, Nuance Communications, Inc. © 2002-2014 Nuance Communications, Inc. All rights reserved
  2. 2. © 2002-2014 Nuance Communications, Inc. All rights reserved Technology has become an integral part of our daily lives…
  3. 3. © 2002-2014 Nuance Communications, Inc. All rights reserved
  4. 4. © 2002-2014 Nuance Communications, Inc. All rights reserved
  5. 5. © 2002-2014 Nuance Communications, Inc. All rights reserved
  6. 6. © 2002-2014 Nuance Communications, Inc. All rights reserved
  7. 7. © 2002-2014 Nuance Communications, Inc. All rights reserved
  8. 8. Talking on phone Talking on phone Surfing the web? Surfing the web? Watching television Watching television Listening to music Listening to music Reading a magazine Reading a magazine Texting a friend Texting a friend © 2002-2014 Nuance Communications, › Source: Caroline McSwain (http://carolinemcswain.wordpress.com/2010/10/25/the-internet-a-student%E2%80%99s-greatest-asset-or-worst-distraction/) Inc. All rights reserved
  9. 9. The adoption of self-service is pervasive… Online ATMs Hotels Supermarket Airlines 65% “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 © 2002-2014 Nuance Communications, Inc. All rights reserved 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 ATMs worldwide
  10. 10. Segmenting the Addressable Population © 2002-2014 Nuance Communications, Inc. All rights reserved
  11. 11. 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 © 2002-2014 Nuance Communications, Inc. All rights reserved
  12. 12. 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
  13. 13. © 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
  14. 14. © 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.
  15. 15. © 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
  16. 16. To put it another way…. 0 25 65 Age © 2002-2014 Nuance Communications, Inc. All rights reserved 16 Illness Pre-Illness Wellness DDeeaatthh Fun No Fun 2009 Continua Health Alliance Brigitte Piniewski, MD
  17. 17. 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
  18. 18. Alternative Funding Models © 2002-2014 Nuance Communications, Inc. All rights reserved – 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
  19. 19. Submission to 21st Century Cures initiative © 2002-2014 Nuance Communications, Inc. All rights reserved
  20. 20. 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
  21. 21. Much like the Transcription Industry and Speech Recognition – Zipnosis © 2002-2014 Nuance Communications, Inc. All rights reserved
  22. 22. © 2002-2014 Nuance Communications, Inc. All rights reserved “Consumer behavior is the killer app when it comes to business disruption” Brett King Author “Banking 2.0”
  23. 23. © 2002-2014 Nuance Communications, Inc. All rights reserved The key question: Are you going to disrupt your industry or be disrupted?
  24. 24. Consequence of NOT Being Prepared When This Ship Sails © 2002-2014 Nuance Communications, Inc. All rights reserved
  25. 25. Nick van Terheyden, MD CMIO, Nuance Communications AboutMe http://about.me/obiwan Twitter http://twitter.com/drnic1 LinkedIn http://www.linkedin.com/in/nickvt Voice of the Doctor http://drvoice.blogspot.com/ FaceBook http://profile.to/drnick E-Mail drnick@nuance.com, drnic1@gmail.com GoogleVoice (301) 355-0877 © 2002-2014 Nuance Communications, Inc. All rights reserved Where You Can Find Me
  26. 26. mHealth Reimbursement – Who Will Pay Nick van Terheyden, MD (aka @drnic1) HIMSS mHealth Committee CMIO, Nuance Communications, Inc. © 2002-2014 Nuance Communications, Inc. All rights reserved
  27. 27. © 2002-2014 Nuance Communications, Inc. All rights reserved Backup Slides
  28. 28. © 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.as px?ItemNumber=30667 – Use Case Study: Christus Health - Improving Health at Home: Remote Patient Monitoring and Chronic Disease – http://www.himss.org/ResourceLibrary/genResourceDetailPDF Reg.aspx?ItemNumber=22361 – Case Study: Geisinger Health System: Reducing Patient No- Shows – http://www.himss.org/applications/secure/?FileID=436054

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