Customized Telehealth Solutions

Another Massachusetts insurer to cover virtual doctor visits

Having a cold, allergies, rash, or urinary tract infection used to mean a visit to the doctor’s office. Now, Harvard Pilgrim Health Care members can video chat with a doctor instead.

Starting July 1, the state’s second-largest commercial insurer will cover telehealth, offering the video chat service through California-based Doctor On Demand and from doctors in the Harvard Pilgrim network that offer telehealth.

Programs like American Well allow patients to connect to doctors via their mobile phones. Harvard Pilgrim will now start covering appointments through Doctor on Demand.

The insurer is the third in the state to cover telehealth services, and shows a growing trend of allowing patients access to doctors through video chats, a far cry from the roadblocks regulations presented just two years ago.

“We believe this service will provide flexibility and value to augment the existing relationships our members have with their primary care physicians,” said Beth Roberts, Harvard Pilgrim’s senior vice president of enterprise sales & marketing, in a release.

The insurer follows in the footsteps of the state’s largest insurer, Blue Cross Blue Shield of Massachusetts, which started covering telehealth Jan. 1. Blue Cross members can connect with doctors in the network that offer telehealth, or can have a virtual doctor’s visit with a physician through Boston-based American Well. Health New England, based in Springfield, was the first health insurer to offer telehealth services in August 2015.

The reasons for telehealth are multipronged. Both insurers said telehealth could help patients in remote areas or with mobility problems can more easily access a doctor. Patients can also access a physician at any time of the day, and don’t have to take time off work to visit a doctor for a minor condition.

Patients with minor issues after hours can also avoid costly trips to the emergency room, improving patient experience and reducing health care spending.

At both insurers, the cost of a telehealth visit is the same as one to a physical doctor. While both insurers cover treatment of medical issues, Blue Cross is also encouraging users with behavioral health problems to utilize telehealth services.

“It’s access, quality and affordability that made us think we should head in this direction,” said Greg LeGrow, senior director of technology engagement solutions for Blue Cross.

Contracting with a national telehealth provider allows all patients access to telehealth, but many patients will be able to see their own doctors.

At Blue Cross, the number of physicians with telehealth capabilities is skyrocketing, going from approximately 200 to upwards of 600, thanks to an undisclosed large delivery system saying they would invest in telehealth for all of its physicians in the coming months.

Harvard Pilgrim is also covering the visit for in-network doctors that offer telehealth services.


Veterans Health Administration focused on telehealth for veterans’ homes

Looking ahead, the Veterans Health Administration is increasingly focusing on bringing care into veterans’ homes, VA higher-ups said at the mHealth and Telehealth World Conference in Boston.

“I think that the number one thing we see for where telehealth is going in the organization is increasingly into the home and into patients’ daily lives,” said Neil Evans, Chief Officer in the Office of Connected Care at the Veterans Health Administration. “Last year, 282,000 veterans had a clinical video telehealth visit. Only 6,300 of them had those visits into their home. So our telehealth is connecting our medical centers to our remote specialists, but we’re really committed to extending our penetration into our veterans’ daily lives.”

That effort includes not only home telehealth, but remote patient monitoring programs and mobile apps. Until recently, these three technological areas were all administered separately at the VA, Evans said. Now, they’re all organized under the Office of Connected Care.

“We’re developing an app which leverages WebRTC to deliver that video telehealth experience into the home on veterans’ personal devices,” Evans went on. “Likewise we’re expanding the number of veterans we serve through remote patient monitoring through, for example, a mobile text message program we call Annie, based on a two-way text message system that’s been developed at the NHS called Florence, named after Florence Nightingale. It allows us to engage veterans between visits, collect patient-generated data, and provide feedback to reinforce the care plan.”

Dr. Kevin Galpin, acting chief consultant at the VHA Office of Connected Care, said another piece of the VA’s future plans is figuring out how to incorporate family caregivers into veterans’ care via telehealth.

“You have caregivers, you have family members that want to be part of a veteran’s health, but they can’t always be at an appointment, they’re not living in the same state,” Galpin said. “Yet that person is important to them, and would love to attend office visits and be an active part of keeping that person healthy. What we see going forward is being able to invite caregivers not just to existing virtual episodes of care, which would be easier, but to the ones that are currently in-person.”

The VA is also looking into using mobile technology to connect veterans to friends and family for social weight loss or nutrition interventions, or even to do group therapy for PTSD with members of the same unit, who could work through shared experiences together.

Evans said that the VA portal currently has 3.5 million registered users and is accessed 9,000 times a day by veterans. It has processed 72 million prescription requests sincce it was launched 10 years ago. He also said that about 12 percent of VA patients in a given year receive some amount of care through telehealth. Galpin said the VA did 2 million episodes of care through telehealth last year.

Evans said the biggest challenge for the VA is driving provider adoption of telehealth tools, apps, and the patient portal, which he believes will drive patient adoption in turn.

“How do you encourage adoption and integration of these tools into the actual delivery of healthcare on the front lines?” Evans said. “How do we make sure telehealth is an intrinsic part of our core operations and not just a bolted add-on to the healthcare system? As our use of the portal has increased and we bring more apps online, how do we help our providers understand that this technology exists, understand how to use it, and bring on some that are slower to adopt? Because we know that when the healthcare team recommends a portal, apps, or telehealth, patient adoption and trust increases tremendously.”

source: | By: Jonah Comstock

Walgreens Is Launching a New Mental Health Platform

It’s about raising awareness, reducing stigma, and helping patients.

Walgreens launched a new mental health initiative Tuesday that aims to help connect more people with mental health resources in the community, maintain better adherence to important drug therapies, and screen millions of people for various mental health conditions.

The drug store chain is teaming up with Mental Health America (MHA), a community-based nonprofit organization dedicated to addressing the needs of people with mental health concerns, to offer a new online portal dedicated to providing screenings and information on conditions as diverse as anxiety, depression, obsessive compulsive disorder, and schizophrenia. The site will connect to MHA’s free, scientifically-based screenings to allow people to anonymously rate their conditions. Walgreens WAG 0.00% and MHA aim to screen 3 million people by the end of 2017.

The launch aligns with the start of Mental Health Month in May, which is dedicated to bringing attention to issues that affect about one-in-four Americans each year. Mental health conditions affect more people than heart disease or diabetes. On top of that, nearly half of those affected may never seek treatment, and for those that do, adherence to sometimes life-saving medications can be as low as 50%, says Walgreens CMO Harry Leider.

“Nearly 25% of our customer base is coming in every day battling a mental health condition, and many don’t even know it,” says Leider. “It’s a huge opportunity to serve our customers. It’s an opportunity where we can do good and do well at the same time.”

The Walgreens team had been working on a mental health initiative for nearly two years, trying to find the best approach to help connect customers the right resources, according to Leider. A series of elements came together to make now the right time to launch. First, MHA’s online resources and screenings are a vital element. Second, Walgreens is now able to tie in MDLIVE’s Breakthrough service, which can provide behavioral telehealth services for patients to access help faster and easier in some cases. In some communities, there’s a shortage of mental health providers and patients can wait six weeks or more to see somebody.

The initiative also gives Walgreens an important touchpoint with payers, providers, and patients: drug adherence. Medications for many mental health conditions, like depression, can take four weeks or longer to start working. Many patients end up stopping using the drug before it even has a chance to work, which could be life-threatening in some cases. Walgreens is now educating its pharmacists and nurse practitioners to work with these patients to educate them on how best to manage side effects and what to expect to better increase chances that a patient will remain adherent.

“Supporting patients with treatments sounds mundane but it’s incredibly important,” says Leider. “It’s a triple win. It helps patients get better, helps our bottom line, and ultimately helps lower medical costs for payers.”

source: | By: Laura Lorenzetti

Medicaid pays for live telehealth in most states but lack of definition creates confusion

Dive Brief:

  • The Center for Connected Health Policy released its annual guide on state telehealth laws and reimbursement policies, which found several telehealth trends in 2015.
  • While some states are expanding telehealth reimbursement, others are placing more limits and restrictions on telehealth delivered services, the report stated.
  • The survey specified 11 telehealth-related policy areas ranging from the definition of the word telehealth/telemedicine to various reimbursements, consent issues, and online prescribing.

Dive Insight:
The most predominant reimbursed form of telehealth is live video. The District of Columbia and 47 states provided reimbursement for live video in Medicaid fee-for-service last year.

According to the report, each state has its own definition of telehealth and how it is regulated, which creates confusion for telehealth participants. Alabama, New Jersey, and Rhode Island still lack a definition for telehealth/telemedicine.

Only five state Medicaid programs – Alaska, Illinois, Minnesota, Mississippi, and Washington – reimbursed for live video in Medicaid fee-for-service, store-and-forward delivered services, as well as remote patient monitoring (RPM) last year, although with certain limitations.

Only 16 states have some form of reimbursement for RPM in Medicaid programs, the report found.

Some of the other key findings in the report include:

  • 47 states have some type of reimbursement for telehealth in their public program but Massachusetts, Rhode Island and Utah do not have a definitive reimbursement policy.
  • 29 states have some form of informed consent requirement.
  • Nine state medical boards issue special licenses or certificates for telehealth.

Over the 2016 legislative session, 44 states have introduced more than 150 telehealth-related pieces of legislation. Many of the bills address different aspects of reimbursement in regards to private payers and Medicaid. Many states have proposed legislation for adoption of the Federation of State Medical Board’s model language for an Interstate Medical Licensure Compact.

source: | By: Nina Flanagan

California Insurance Marketplace Aims To Kick Out Poor-Performing Hospitals

California’s insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a novel proposal that is drawing heavy fire from medical providers and insurers.

The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.

“The first few years were about getting people in the door for coverage,” said Lee, a key figure in the rollout of the federal health law. “We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don’t want to throw anyone out, but we don’t want to pay for bad quality care either.”

It appears to be the first proposal of its kind in the country. The exchange’s five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital “outliers” on cost and quality starting in 2018. Medical groups and doctors would be rated after that.

Providers who don’t measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.

By 2019, health plans would be expected to expel poor performers from their exchange networks.

The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.

Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.

But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.

Lee said it’s time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven’t been tough enough on hospitals and doctors.

Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.

Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn’t have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.

“California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “There may be a dominant hospital system that’s charging through the nose, but without them you don’t have an adequate network. It will be interesting to see how Covered California threads that needle.”

The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A study in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.

“I don’t know of anyone even close to trying this,” said Dan Polsky, the study’s author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. “I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.”

Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren’t penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.

Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.

The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.

“The devil is in the details, and the rapidity of this concerns us,” said Dr. David Perrott, chief medical officer at the state hospital trade group. “We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn’t been worked out.”

California physicians warn that the exchange’s proposal could further reduce networks that are already too thin for patients.

“Right now, one of the biggest problems in health care is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,” said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.

Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California’s idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.

“It’s the right goal but the wrong approach,” Bacchi said. “Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.”

This story was provided by NPR at:
produced by Kaiser Health News, which publishes California Healthline, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: @chadterhune.

Bipartisan Senate bill seeks to expand telemedicine services

A bipartisan group of U.S. senators Wednesday are introducing a bill aimed at expanding telemedicine service through Medicare benefits.

“Telehealth is the future of healthcare. It saves money and improves health outcomes,” co-sponsor Sen. Brian Schatz (D-Hawaii) said.

“Our bipartisan bill puts us on a path to transform healthcare delivery, making it less costly and more convenient for patients and providers.”

The bill, called the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (PDF), would expand the use of remote patient-monitoring for some patients with chronic conditions, increase telemedicine services in community health centers and rural health clinics, and provide basic telemedicine benefits through Medicare Advantage.

According to a news release from Schatz’s office, the bill would have the added benefit of helping providers meet the goals of the Medicare Access and CHIP Reauthorization Act and the Merit-based Incentive Payment System.

Avalere last week released a study on the financial benefits of CONNECT.

The study estimates it will provide $1.8 billion in savings to Medicare over a decade.

The CONNECT Act carries the early support of several industry groups, including America’s Health Insurance Plans, the American Heart Association and Kaiser Permanente.

“This bill would ensure that patients and their physicians are able to use new technologies that remove barriers to timely quality care. Importantly, the bill would maintain high standards whether a patient is seeing a physician in an office or via telemedicine,” said Dr. Steven J. Stack, president of the American Medical Association.

U.S. Reps. Diane Black (R-Tenn.), Peter Welch (D-Vt.), and Gregg Harper (R-Miss.) introduced companion legislation in the House of Representatives.
By Joseph Conn | February 3, 2016 | ModernHealthcare |

According to ABC 10, the future of healthcare in America is being considered in a bipartisan bill co–sponsored by U.S. Senator Gary Peters.

Peters and Sen. Cory Gardner (R-Colorado) introduced the Telehealth Innovation and Improvement Act. The bill is designed to make it easier for people to receive health care in rural places through telehealth services, such as sitting at home on your computer.

Peters believes that this bill would expand quality healthcare for people of all ages and improve patient outcomes.

“We can actually provide quality healthcare services to people in their own home,” said Peters. “You wouldn’t have to make the trip to Marquette or a clinic at some other place that may be a half hour, hour, or an hour and a half away from you. If you can connect to a healthcare provider, whether it’s in Marquette, Detroit or another place and stay in your own home; that saves money. It’s an incredible advantage to the patients as well.”

If the bill is eventually passed, Peters said that there would be a prototype program put in place first before it’s launched nationwide.


$750,000 HIPAA settlement emphasizes the importance of risk analysis and device and media control policies

Cancer Care Group, P.C. agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR). Cancer Care paid $750,000 and will adopt a robust corrective action plan to correct deficiencies in its HIPAA compliance program. Cancer Care Group is a radiation oncology private physician practice, with 13 radiation oncologists serving hospitals and clinics throughout Indiana.

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