2011 Virginia Telehealth Summit presentation

1. Virginia Health Reform Initiative: Technology Update Dr. Karen Rheuban, Technology Task Force member Mr. Stephen Bowman, Joint Commission on Health Care 2011 Virginia Telehealth Summit April 5, 2011 1 K

2. Governor McDonnell appointed 24 political, health system, civic and business leaders to the Virginia Health Reform Initiative (VHRI) Advisory Council (August 2010) VHRI shall develop recommendations about implementing health reform in Virginia, and to seek innovative solutions that meet the needs of Virginia’s citizens and its government in 2011 and beyond. VHRI will Recommend Avenues to Improve Virginia’s Health System 2 S

3. 6 Areas Are Critical to Attaining High Quality Health Care at a Lower Cost VHRI Task Forces Technology Capacity Medicaid Reform Insurance Reform Service Delivery and Payment Reform Purchaser Perspectives 3 S

4. Charge to Technology Task Force IT are tools, not a solution in total.* Information tools need to be shared among patients, clinicians, and payers. Individual patient records, medical claims, and decision support tools based on aggregated data and research all have important roles to play in informing individuals, clinicians, payers and policy makers about choices they all have to make, some together, some in real time. Technology Can Enable Better Patient Care * Abbreviated directive 4 K

5. Electronic Health Records Health Information Exchanges Telemedicine Broadband All payer claims database (APCD) Technology Focus 5 K

6. APCDs are databases that may include medical, eligibility, provider, pharmacy, and/or dental data files from payers Types of payers providing data: ◦ Insurance carriers (medical, dental, TPAs, PBMs) ◦ Public payers (Medicaid, Medicare) Typically created by State mandate 6 APCD Can Support Transparency and Reform Initiatives S

7. Which hospitals have the highest prices? In what geographies is public health improving? If emergency room usage in Medicaid is higher than the commercial population, what are the drivers? What is the average length of time people are using antidepressant medications? All Payer Claims Database Can Answer Many Health Care Questions 7 Slide content from Alan Prysunka presentation to Technology Task Force November 16, 2010 S

8. Become a Medicare Demonstration site for telemedicine in areas with underserved populations. Expand telemedicine coverage to include services such as telescreening for diabetic retinopathy. Use “mapping” survey and target investments that grow access to broadband infrastructure and telemedicine services. Technology Recommendations 8 K

9. Investigate and communicate ways for physicians to qualify for small business governmental loans to acquire HIT capacity Consider an all payer claims data base via the Joint Commission on Health Care study. Technology Recommendations for Virginia 9 K

10. Provider maldistribution will be worse in rural and some poor urban areas under PPACA 10 Provider Maldistribution is a Significant Issue for Virginia S

11. Shortages projected soon for many healthcare professionals Even without the impending coverage expansions expected from federal health reform. The scale of the projected coverage expansions will render all projected health professional supplies inadequate. Care cannot continue to be provided in the exact same ways. Virginia’s Workforce Capacity 11 S

12. Mandating insurers cover telemedicine Increasing telestroke capabilities in Virginia Providing increased funding for State-supported family medicine programs Funding State loan repayment programs Increasing Medicaid reimbursement rates Educating the physician workforce about geriatric care issues 12 Previous Capacity Recommendations: Joint Commission on Health Care S

13. Department of Health Professions Healthcare Workforce Data Center Improve the data collection and measurement of Virginia’s healthcare workforce VDH Office of Minority Health and Health Equity Administers several incentive programs to attract primary health professionals to Virginia's underserved areas Loan Forgiveness Programs J1 Visa Waiver Program Nursing Scholarships Designating Shortage and Medically Underserved Areas and Populations 13 Ongoing State Efforts to Address Capacity S

14. Virginia General Assembly passed legislation to establish VHWDA in 2010. Goal: Improve recruitment and retention of health care professionals to meet Virginia’s needs Commonwealth has secured federal grant funding to sustain the work of this authority. VHRI will work closely with the VHWDA to address the workforce issues. 14 Virginia Health Workforce Development Authority (VHWDA) S

15. Reorganize care delivery practices into teams leveraging more extensive use of non-physicians Change scope of practice laws Expand use of IT technologies Increase supply of health professionals Capacity Recommendations 15 S

16. Mainly covers certain children, pregnant women, seniors, and individuals with disabilities 21% of State only portion of budget $16 billion 2nd largest program 764,000 individuals covered in 2010* Estimated 270,000 –425,000 increase in new enrollees in 2014* Virginia Medicaid Facts 16 *monthly average K

17. PPACA Increases Medicaid Eligibility in 2014 133% FPL 100% 40% 0% Note: Virginia currently provides coverage up to 200% FPL for pregnant women and children K

18. 18 Medicaid Enrollment & Expenditures: Aged and Disabled Utilize Nearly 70% of the Costs(Fiscal Year 2007) Aged 10% 21% Aged 20% Blind & Disabled Adults 14% Blind & Disabled 47% 56% Children Adults 9% 23% Children Recipients Expenditures K

19. Pursue funding and implementation of Virginia Gateway project Automating eligibility systems across health and human services agencies and provides the platform for future needs Pursue additional care coordination models for additional geographic areas, clients, and service Among health and human services agencies and other partner agencies Medicaid Recommendations for Virginia 19 S

20. Medicaid Recommendations for Department of Medical Assistance Services Require that all fee-for-service providers, after a certain date, submit electronic claims submissions and receive electronic funds transfers. Pursue demonstration projects, grants, and state plan options provided under federal health care reform Chronic care management Care coordination long term care and behavioral health services recipients Patient centered medical homes. Work with nursing facilities, hospitals, and physicians to find alternate strategies to decrease avoidable emergency care visits for nursing facility residents. DMAS evaluate the incentives and cost sharing opportunities for the current and expanded Medicaid populations. 20 S

21. Questions? 21

22. Karen S. Rheuban, MD Director University of Virginia Center for Telehealth 434.924.2481 krheuban@virginia.edu Stephen Bowman Senior Staff Attorney/Methodologist Joint Commission on Health Care 804.786.5445 sbowman@jchc.virginia.gov 22 Contact Information

23. Report of the Virginia Health Reform Initiative Advisory Council, December 20, 2010 at http://www.hhr.virginia.gov/Initiatives/HealthReform/docs/VHRIFINAL122010.pdf Virginia Health Reform Initiative: Technology Reform Taskforce meeting documents at http://www.hhr.virginia.gov/Initiatives/HealthReform/MeetingResources/MtgRes.cfm Department of Medical Assistance Services presentation to Joint Commission on Health Care September 4, 2008 at http://leg5.state.va.us/user_db/frmjchc.aspx?viewid=508 Sources 23