Telehealth Program Strategies And Business Plans Revealed .

Telehealth Program Strategies andBusiness Plans RevealedMarch 4, 2016Rob Marchuk, VP of Ancillary Services, Adventist HealthNannette Spurrier, Sr. Telehealth Management Consultant, Blue Cirrus Consulting

Conflict of InterestRob Marchuk, MPH, MBA, FACHEHas no real or apparent conflicts of interest to report.Nannette Spurrier, MSHas no real or apparent conflicts of interest to report.

Agenda Adventist Health’s Telehealth Initiative Telehealth Market Landscape Telehealth Strategy and Business Plan Telehealth Program Implementation3

Learning Objectives Analyze the telehealth market and discuss the changing landscape oftelehealth including traditional and emerging market solutions Define the components of a telehealth strategy and business planincluding staffing models, market analysis, technology solutions, 1,3,5 yearplanning, financial models and creating the telehealth ‘Building Blocks’ for amature clinical program Describe how to implement the plan successfully including leadershipcommunication plans, internal and external marketing and creating ameasured plan for success4

Realizing the Value of TelehealthPatientPatientSatisfactionAccess tospecialists fromCostsExtendedReduction intravel costsrural locationsReduction inclinical reachmissedReduction inappointmentsunnecessaryadmissions orPhysiciansreadmissionsCostsPhysicianCosts related provedTimely onsults withSatisfactionSpecialists whenConsults withneededSpecialists whenneededAccess toAvoidanceSpecialistsRegardless transfersPatient Care5

Adventist Health’s Telehealth Initiative6

About Adventist Health Faith-based, not-for-profit, integrated health care delivery systemheadquartered in Roseville, California providing care throughout California,Hawaii, Oregon and Washington Entities include:– 20 hospitals with more than 2,875 beds– More than 275 hospital-based, rural health, and physician clinics– 14 home care agencies and seven hospice agencies– Four joint-venture retirement centers– Workforce of 31,000 includes more than 22,350 employees; 4,800medical staff physicians; and 3,850 volunteers With a focus on whole-person health Adventist Health not only strives topromote healthy individuals and families but also healthy communities7

AdventistHealthCALocations8

AdventistHealthNorthwestRegionLocations9

Adventist Health’s Rural Landscape10

Telehealth at Adventist Health Telehealth is not a new concept to Adventist Health Various telehealth models have been implemented across thesystem over the last decade Rapid increase in need and demand for telehealth services in recentyears drove the necessity for system-wide standardization In 2013 partnered with Blue Shield of California on an outpatienttelehealth initiative focused on rural communities In 2014 telehealth became a corporate initiative11

Telehealth Market Landscape Learning Objective 112

Telehealth Industry Drivers Barriers– Aging Population– Access To Broadband– Consumer Demand– Cost– Enhanced Reimbursement– Licensure– Eroding Hospital Margins– Limited Reimbursement– Provider Shortages– Network Speed– Outcome Based Reimbursement– Privacy And Security– Readmission Penalties– Resistance To Change13

Changing Landscape of Telehealth Most Rapidly Growing Sector In The Healthcare Industry– Venture Capital Market– Increase In Retail Clinics And Employer Onsite Health Centers Expanding Reimbursement– Medicare Telehealth-Based Chronic Care Management– Continued Push At The State Level Expanding Payment Options More ACOs Using Technology To Improve Care And Cut Costs14

Telehealth Market Solutions15

Telehealth Strategy and Business Plan Learning Objective 216

Why Strategy is ImportantTelehealth VisionClear Communication– Where We Want To Go– Internal Marketing– Direction On How To Get There– External MarketingStrategic Alignment Across EnterpriseFocus on Specific Clinical Problems– Rural Health Strategy– Access to Care– Payment Options in CA– Program ExpansionLeadership Buy-inSuccess Metrics– Multiple CEOs & Leaders– Consistent Criteria– Unique Physician Relationships– Comparable Data– Competing Internal Initiatives17

Adventist Health Telehealth VisionSupport the mission, vision, andvalues of AH by creating enhancedand expanded access to care for thepatients and populations we serveboth in existing and expandedmarkets.Access between patients andproviders will be delivered throughinnovative, efficient, reliable, and costeffective technologies.18

Developing the Telehealth Business PlanSet telehealth goalsReview telehealth situationDetermine why goals are attainablePlan for reaching those goals19

Identifying the Telehealth oalsTelehealth BusinessPlan & Strategy20Determining why the goalsare attainable

Needs and Readiness Assessment Sample size Goal– Approximately 30 individualsinterviewed from all three regions inCA– Align needs and readiness Objectives– Identify factors that could impactsuccess of telehealth program Approach Corporate Executives Corporate Directors Clinical Directors & Staff– Staff interviews IT Directors & Staff– Self-Assessment– On-site and phone interviews– Conducted over the course of 3days– Developed SWOT analysis21 Interview feedback was documentedalong with associated risks andrecommended action plan Gained clear understanding of telehealthacceptance and challenges with existingprograms

Telehealth Services Review Assess the clinical services operations and determine wheretelehealth services will be delivered. Objectives– Gain consensus around value proposition and Adventist Health market– Review current clinical services operations– Review current state of technology and infrastructure– Assess technical needs at each site Framework created to add structure to the telehealth service options Telehealth services identified Staffing model to support the implementation and ongoingprogram22

Telehealth Value PropositionPrimary CareProvidersPatientsCommunities Accessibility: carewhen and where theyneed it Keeps patients localwhenever possible Promotescoordinated care Extends broaderreach to patients Promotes rapiddiagnosis andtreatment linked toimproved patientoutcomes Maintains primaryrelationship withpatient Increases patientvolume and revenueand maximizes timeand efficiency Affordability:reduces travel time,expense and timeaway from work Timeliness: reduceswait time to accessspecialists Integrated andcoordinated care Improves outcomesand thereforeimprove health ofpopulation Establishescredibility with patient Promotes greaterpatient satisfaction Generates revenue –visit reimbursement23Specialists Reducesdocumentationredundancy by usingcommon EMRplatform with PCPs Promotescoordinated care

Functional Staffing Model24

Regulatory & Policy Review Goal Considerations for plan– Ensure regulatory impact ontelehealth is clearly understoodand monitored Objectives– Telehealth credentialing andprivileging process-Standardize credentialing andprivileging process-Utilize credentialing by Proxy-Understand cross staterequirements Reimbursement– Research state licensure fortelehealth– Payers– Security and Privacy Medicare– Telehealth Service LevelAgreements Medicaid Commercial Payers– Reimbursement policies– Rural Facilities25

Federal Telehealth ReimbursementPayerTelehealth DeliveryModelFederal RegulationsMedicareLive VideoMedicare reimburses on the specific services identified byCurrent Procedural Terminology (CPT)Store & ForwardProhibitedRemote PatientMonitoring (RPM)Reimburses for remote patient monitoring of chronicconditionsRural approved originating sites: Offices of physicians/practitionersHospitalsCritical Access Hospitals (CAH)Rural Health Clinics (RHC) 26Federally Qualified Health Centers (FQHC)Hospital based orCAH-based Renal Dialysis CentersSkilled Nursing FacilitiesCommunity Mental Health Centers

3-5 Year RolloutStrategy27

Financial Models Access To Specialty Care in Rural Settings Remote Access To Primary Care Physicians Remote Patient Monitoring– ICU– Home care28

Access to Specialty Care in Rural Settings Projected Revenue– Grants– Leaked Opportunities (referrals out of network)– Rural Health Clinic Reimbursement Projected Costs– Operational Staff– One-time Professional Fees– One-time Equipment Costs– Hardware & Software Maintenance– Equipment Depreciation– Travel & Training29

Challenges Addressed Existing operational telehealth programs - owned and supportedby various organizations Telehealth projects - being implemented at the same time thebusiness plan was being developed Other initiatives - priority Resource constraints – same people on all projects System-wide communication of plan - was difficult due to size ofhealth system and number of regions Telehealth reimbursement - commercial payer coverage wasinconsistent30

Telehealth Business Plan Implementation Learning Objective 331

Critical Success Factors Ensure Leadership Engagement Establish Governance Identify Program Champions Build Consensus (Internal Marketing) Educate Patients & Community (External Marketing) Assign Implementation Team Develop Detailed Project Plan Based On Rollout Plan– Standardize Implementation And Support Processes– Integrate Telehealth Services Into Standard Of Care Workflow– Provide Effective Training Monitor, Measure, And Communicate Success32

inicalServicesPhysicianIntegrationAdventist ngBoardFinancePerformanceMeasuresService /Clinics33

High Level Rollout PlanAdventist Health: In-NetworkTelehealth ServicesOutpatient Specialty ServicesActivity2015 2016 2017 2018 2019 2020Blue Shield Initiative: Pilot to select locationsExpand Outpatient Specialty Services to all HPSAs, RHC, FQHC, & CAHsExpand Outpatient Specialty Service linesEmergency ServicesTelestroke: pilot to select locationsPediatric telehealth: pilot to select locationsExpand telestoke service across health systemExpand pediatric telehealth across health systemInpatient ConsultationsCardiology: pilot to select locationsExpand inpatient consultations across health systemPilot other inpatient consultation services linesExpand inpatient consultation services lines across health system.Pilot Small ICU monitoring projectPrimary Care ServicesPilot remote physician visits (w/ PC & Tablet)Expand remote physician visits across health systemPilot remote clinic visits (w/PC & Tablet)Expand remote clinic visits across health systemPilot patient educationExpand patient education across health systemAncillary ServicesExpand telepharmacy across health systemPilot diagnostic servicesExpand Diagnostic services across health systemHome CarePilot/study home monitoringExpand home monitoring servicesPilot care coordinationExpand care coodination services34