Telehealth Industry Trends

Nursing Executive Center
Global Centre for Nursing Executives
Telehealth Industry Trends:

Whats New in 2016?
September 15, 2016
Jasmaine McClain, PhD

Senior Analyst, Telehealth
mcclainj@advisory.com
202-568-7811
Road Map
Industry Overview
Market Forces Influencing Adoption
3
4
2016 The Advisory Board Company advisory.com
Evaluating Telehealth Investments
Questions and Closing Comments
Industry Overview
Defining Telehealth
Industry Snapshots
Adoption Trends
Telehealth: Untangling the Terminology

Key Terms and How They Relate to Telehealth Technologies
Defining Telehealth
The use of medical information exchanged from one site to another via
electronic communications to improve a patients clinical health status.
- American Telemedicine Association
Why invest in telehealth?

Use Cases
What are the applications?

Modalities
Diagnosis and
Treatment
Real-time
Virtual Visits
Professional
Consultation
Remote Patient
Monitoring
How is telehealth offered?

Platforms
Telephonic
Web-based
Mobile,
Smart Device
Kiosk
Monitoring and
Care Coordination
Asynchronous
Store-and-Forward
Bluetooth-Enabled
Peripheral Devices
Source: Market Innovation Center research and analysis.
Modalities Differ by Recipient and Timing of Service

Typically, Synchronous Provider-to-Patient Is Most Favorably Reimbursed
Intended Recipient
Provider-to-Patient
Provider-to-Provider
Timing of Interaction
Common applications:
Synchronous
(real time)
Virtual primary care
Telestroke
Virtual urgent care
TeleICU
Virtual pre- and post-op
Telepsychiatry
4
Asynchronous
(time lag)
Secure e-messaging
Teleradiology
Remote patient monitoring
Telepharmacy
Wearables (e.g., Fitbit)
Teledermatology
10
Industry Snapshot: #1. Synchronous, Provider-to-Patient
Direct-to-Consumer Virtual Visits

Convenient, On-Demand Access to Primary and Urgent Care Services
2015 was the year that

virtual visits went from an
up-and-coming trend to a
stay in business
application for payers
and pharmacy chains.
Strategic
Benefit
Enhanced rural
access
Improved patient
convenience
New patient
capture/retention of
existing patients
Dr. Joseph Kvedar

Partners Connected Health
Popular
Vendors
Teladoc
American Well
MDLive
Doctor on Demand
Expanded PCP
capacity
Clinical Applications
Episodic
Primary Care
Urgent
Care
Chronic Disease
Management
Behavioral
Health
Source: Tahir D, Telehealth services surging despite questions about value, Modern
Healthcare, February 2015; Market Innovation Center research and analysis.
11
Industry Snapshot: #2. Synchronous, Provider-to-Provider
Real-Time Virtual Specialist Consults

Access to Specialist Expertise for Diagnosis and Treatment Planning
These online communities

give rural physicians
access to expertise and a
sounding board they didnt
have in the past, which
also reduces the
isolation factor.
Ken Simone, DO
Family medicine physician
Strategic
Benefit
Improved access
in communities with
persistent provider
shortages
Popular
Vendors
Avizia
Vidyo
Improved patient
experience from
convenient
appointments
Vsee
Zoom
Reductions in
avoidable patient
transfers
Telepsychiatry
Telestroke
TeleICU
Source: Hume R, Health Facilities Management, February 2016, available at http://www.hfmmagazine.com/display/HFM-news-article.dhtml?dcrPath

=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2016/feb/hfm-telemedicine-and-facility-design. Market Innovation Center research and analysis.
12
Industry Snapshot: #3. Asynchronous, Provider-to-Provider
Store-and-Forward Information Exchange

Messaging Services Enable Transfer of Data, Images
Asynchronous care
focuses the clinicians
interaction to the most
essential elements,
allowing batching of the
clinicians time to capture
scale economies.
Beckers Hospital Review
Strategic
Benefit
Extended hours of
specialist support
Popular
Vendors
AMD Global
Telemedicine
Expanded provider
capacity
GlobalMed
iClickCare
Improved patient
experience via
reduced wait in
access to care
Second Opinion
Telemedicine
Dermatology
Radiology
Retinopathy
Source: Carlin, P. and Regan, K. Telemedicine: A Growing Market, MD Buyline, August 2014.
http://www.mdbuyline.com/blog/telemedicine-growing-market/; Market Innovation Center research and analysis.
13
Industry Snapshot: #4. Asynchronous, Patient-to-Provider
Secure Messaging Tools

Technology-Mediated Access to Physicians Drives Patient Engagement
When you use a prompt

like texting or emailing,
you make the patient an
intimate partner in the
health care process.
Strategic
Benefit
Enhanced patient
convenience
Popular
Vendors
Expanded patient
access to primary
care services
Streamlined
medication
management
Dr. Charles Edmiston

Medical College of Wisconsin
EMR vendors
TigerText
Imprivata
Voalte
Doc Halo
Operational
efficiencies
Wellness
Coaching
Routine Patient
Follow-up
Chronic Disease
Management
Medication
Management
Source: Monegain, B. KLAS names top secure messaging tools, Healthcare IT News.
October 2015. http://www.healthcareitnews.com/news/tigertext-leads-messaging-marketnow; Market Innovation Center research and analysis.
14
Remote Patient Monitoring Devices

Leveraging Data to Prevent Chronic Disease Exacerbation
Strategic
Benefit
$46B
Reduced ED
utilization, patient
readmissions
Popular
Vendors
Honeywell
HomMed
McKesson
Improved patient
management of
chronic, comorbid
conditions
Estimated RPM
market size in 2017
Cardiocom
Philips Healthcare
ScottCare
Reductions in patient
mortality
TouchPoint Care
Heart Failure
COPD
Diabetes
Source: Report: mHealth and Home Monitoring, Berg Insight. December 2015. http://www.berginsight.com/ReportPDF/ProductSheet/bi-mhealth7-ps.pdf;
Godfrey, J. et. Al., Report: State of the App Economy, 4th Edition, ACT | The App Association, January 2016. http://actonline.org/wpcontent/uploads/2016_State_of_App_Economy.pdf; Carlin, P. and Regan, K. Telemedicine: A Growing Market, MD Buyline, August 2014.
http://www.mdbuyline.com/blog/telemedicine-growing-market/; Market Innovation Center research and analysis.
15
Adoption of Wearables Stalled by Inconsistent Use

Outlook Dependent on Consistent Patient-Provider Communication
Market Size for Smart Wearables, by Year
USD, billion
$27.9
$16.3
$3.9
2015
$7.2
2016
$11.0
2017
Popular Vendors
$41.3
2018
2019
2020
Fitbit
Apple HealthKit
Samsung S Health
Philips
GE Healthcare
Siemens
The Dirty Secret of Wearables

More than half of U.S. consumers who have owned a modern activity tracker no longer use it.
A third of U.S. consumers who have owned one stopped using the device within six months of
receiving it. Consumers stop wearing devices that are too conspicuous or uncomfortable or that
need to be removed frequently.
Endeavour Partners
Sources: Endeavour Partners, September 2013, Inside Wearables,

http://endeavourpartners.net/assets/Endeavour-Partners-Wearables-White-Paper-20141.pdf;
PriceWaterhouseCoopers, The Wearable Future, October 2014,
http://www.pwc.com/us/en/industry/entertainment-media/publications/consumer-intelligence-series/index.jhtml;
Soreon Research, Smart Wearables in Healthcare; Market Innovation Center research and analysis.
16
The Time Is Ripe for Virtual Care

Projections Agree on Growth, But How Aggressive?
Year-Over-Year Medicare
Reimbursement for Telehealth Services1
Estimated U.S. Growth in

Virtual Consults2
In millions of dollars
Millions of Visits
5-YR
Growth
20.0
$17.6
15.0
16.6
604% Growth
26.9
62%
21.5
48%
5.4
157%
14.5
10.0
2.1
2015
5.0
$2.5
0.0
2020
Total
PCP Visits
Specialty Consults
1) CMS data.
2) 2015 HIS Analytics report.
Sources: Herman B, Virtual reality: More insurers are embracing telehealth, Modern Healthcare, February 2016, available at:
http://www.modernhealthcare.com/article/20160220/MAGAZINE/302209980; Global Telemedicine Market Growth, Trends and Forecasts (20152020), Mordor Intelligence, http://www.mordorintelligence.com/industry-reports/global-telemedicine-market-industry, December 2015; Japsen,
Bruce, Doctors Virtual Consults with Patients to Double by 2020, Forbes, http://www.forbes.com/sites/brucejapsen/2015/08/09/as-telehealthbooms-doctor-video-consults-to-double-by-2020/#2d4da3675d66, August 2015; Market Innovation Center research and analysis.
17
Planners Often Coordinate Telehealth Initiatives

Member-Driven Analysis from Advisory Board Telehealth Inquiries
Telehealth Questions Submitted to ABC by Role of Asker
n=237
Job Description for

Director of Telehealth
Telehealth-Specific Role
4%
11%
IT Professionals
Clinical
Leaders
22%
Ownership and oversight of

cross-service line telehealth
development initiatives
63%
Strategic
Planners
35%
36%
Percent of clinical leader

questions focused on
specific use-cases
Percent of planner questions

focus on telehealth general
education
Management of exploratory
process for new uses from grant
pursuit to pilot to scaling
Coordination with leaders across
strategic planning, clinical roles,
IT, and marketing in developing
new telehealth initiatives
1) Figures draw from analysis of Advisory Board Expert

Center responses from Jan. 2014 - March 2015.
2) Direct-to-patient includes both synchronous and
asynchronous remote patient monitoring.
Sources: Market Innovation Center interviews and analysis.
18
What Your Peers Are Asking About Telehealth

Direct-to-Patient Primary Care Eclipses Urgency of Specialty Consults
What Telehealth Applications are
Members Asking About?1
What Modality are Members

Most Interested In? 1
n=141
n=141
Remote patient monitoring

(RPM) inquiries exceed
primary care across
specialty use-cases
Physician-toPhysician
16%
Direct-toPatient2
84%
Primary
Care
28%
CV
18%
eICU
16%
Stroke
11% Psychiatry
11% Pediatrics
9% Dermatology
4%
Women's
Health
1%
1) Figures draw from analysis of Advisory Board Expert

Center responses from Jan. 2014 - March 2015.
2) Direct-to-patient includes both synchronous and
asynchronous remote patient monitoring.
Sources: Market Innovation Center interviews and analysis.
19
Market Forces Influencing Adoption

Consumers
Vendors
Adopters
Payers
Policy-Makers
20
Stakeholder Groups Influence Telehealth Adoption

Telehealth Strategic Planning Largely Dependent on External Factors
Major External Players Influencing Adoption
Consumers
Vendors
Adopters
Payers
Legislators
Shifting needs
& preferences
to favor virtual
care delivery
Developing and
promoting
technological
advancements
Providers,
employers
seeking
competitive
advantage
Determining
coverage terms
to manage cost
of care
Establishing
licensing and
regulatory
standards
21
#1. Consumers
Current Capacity Insufficient to Meet Patient Needs
Demographics and Health of the US Population Driving Need for Care
20%
77%
85%
30%
U.S. adults living

with two or more
chronic health
conditions
U.S. adults ages

65+ with at least
two chronic
conditions
Expected U.S.
population growth
among individuals 65+
between 2000 and 2030
Average increase in
cost per case for
individuals with two
chronic conditions
Health Care Service Industry Has Significant Gaps
20%
19.5
55%
Percent of patients living in

areas with insufficient
primary care doctors
Average wait time in days for

appointment to family
practice nationwide
Percent of patients
receiving recommended
preventive care
Sources: Fox S & Duggan M, Part One: Who Lives with Chronic Conditions, Pew Research Center, November 2013. U.S. Department of Health and
Human Services Aging Administration. Aging Statistics, 2010, www.aoa.gov/AoARoot/Aging_Statistics/index.aspx HHS, Health Insurance
Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period, May 1, 2014; , Hospital Utilization, Costs, and Mortality for
Adults With Multiple Chronic Conditions, Nationwide Inpatient Sample, 2009, available at: /www.cdc.gov/pcd/issues/2013/pdf/12_0292.pdf; Merritt
Hawkins, Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates, 2014, accessed March 18, 2015, available at:
http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Surveys/mha2014waitsurvPDF.pdf; Market Innovation Center research and analysis.
22
Consumers Increasingly Prefer On-Demand Care

Survey Finds Email Visits Preferred to Clinic Near Errands or Work
Preference for Location of Services
Clinic location
near work
Clinic located
near errands
Emailing provider
with symptoms
Clinic located
near the home
Increasing Consumer Preference
Young, Wealthy, BusyStrongest Potential Telehealth Targets1
54%
49%
53%
Of 18-29 yr olds
Of those making
>$71K per year
Of those working
>35 hours per week
1) Based on proportions of respondents interested in telehealth.

Source: 2014 Primary Care Consumer Choice Survey, Market Innovation Center research and analysis.
23
Patients Favor Accessibility Over Type of Interaction

Surveys Show Strong Likelihood of Patients Shifting Care to Virtual
First, Willingness
72%
Consumers would see
a doctor via video
76%
Patients prioritize access to
care over need for human
interaction with providers
Then, Preference
67%
Patients prefer email
over webcam
70%
Patients prefer an online
visit to get prescriptions
Eventually, Shift
of total
20% Percentage
potential primary/
urgent care visits

eligible for virtual care
aged 1934
11% Patients
who would leave their
PCP in favor of one
who offers virtual visits
Key
Key Takeaways
Takeaways
Many patients arent looking for
the same type of intimate
doctor-patient relationship of old
Access to care is top concern
1) Calculated using CDC National Ambulatory Care Survey

volumes by reason for visit
Virtual interactions are preferable

for low-acuity episodes
Patients are looking for the fastest,
easiest access point no special
skills or equipment needed
Currently, about 1 in 5
outpatient visits could be
done online
Millennial patients are
starting to actively choose
tech-savvy providers
Source: Pennic J, 72% of Consumers Are Willing to See a Doctor Via Telehealth Video Conferencing, HIT Consultant, December 11,
2013; American Hospital Association Trendwatch: The Promise of Telehealth for Hospitals, Health Systems and Their Communities,
January 2015; American Well, Telehealth Index: 2015 Consumer Survey, 2015; Market Innovation Center research and analysis.
24
#2. Vendors
Technology Getting Faster, More Advanced

Vendors Provide Differing Levels of Telehealth Support, Functionalities
IT Infrastructure
Broadband wired network
Network management system
Integrated enterprise EMR
Telemedicine Equipment
Computers, laptops, tablets, or mobile carts
Audiovisual equipment (e.g., webcams,

videoconference software)
Digital enabled medical equipment, peripheral

devices (e.g., otoscopes, stethoscopes, scales)
Data Management Systems
Expanded memory and processing capabilities
Data mapping across multiple sources
Analytic reporting (e.g., geospatial tracking)
Staffing and Personnel Support
Technical expertise for deployed technologies
Help desk/support hotline
Administrative support for licensing, credentialing

25
#3. Adopters
Many Players Vying for Consumer Engagement

Landscape Shaped by Interactions between Vendors and Adopters
Vendors
Retailers
18.4%
Projected growth
through 2020 in
global market for
telehealth
technologies1
Employers
& Payers
+2K
Retail clinic sites
in 43 states and
the District of
Columbia2
Providers
74%
Employers
expecting to offer
telehealth in
20163
1) FierceHealthIT, Rapid Growth Projected for Global Telemedicine Market, May 2015
2) A&M, Retail Healthcare: Growing Trend for Healthcare Service Delivery
3) Emerman, E. Health Care Benefits Cost Increases to Hold Steady in 2016, National
Business Group on Health Survey Finds, National Business Group on Health. August
2015.
4) American Well, Telehealth Index: 2015 Physician Survey Insights
Direct-to-Consumer
Service Offerings
57%
Physicians willing
to see patients
via video4
Sources: McCann E, Telehealth Sees Explosive Growth, Healthcare

IT News, June 2013 Market Innovation Center research and analysis.
26
Clinicians Express Concerns About Workload, Utility

Fears are Beyond Low Reimbursement
Provider Concerns Regarding Telehealth
Data Overload
Liability
With the prevalent use of

telemedicine, utilizing wearables
and sensors, we have to figure
out which data elements are
crucial for the patient and for the
clinicians.
Doctor-Patient Relationship
Usefulness of Data
Its just one more data set they

have to deal with, and theyre
already wrestling with lots of data
every day.
If the data fell into the wrong

hands it could expose the
hospital to privacy violationsOr
what if an ambulance chaser
claims we should have taken
action for a patient who stopped
walking daily?
For many doctors, telemedicine

seems to depersonalize the
relationship and sabotage trust.
Source: Friedberg, M et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems,
and Health Policy, RAND/AMA 2013 Physician Satisfaction Study, http://www.rand.org/pubs/research_reports/RR439.html; Sullivan, M.
Guess What? Doctors Dont Care About Your FitBit Data, Venture Beat, August 2014, http://venturebeat.com/2014/08/15/guess-whatdoctors-dont-care-about-your-fitbit-data/; Chen, P. Are Doctors Ready for Virtual Visits? The New York Times, January, 2010,
http://www.nytimes.com/2010/01/07/health/07chen.html?_r=0; Market Innovation Center research and analysis.
27
#4. Payers
Virtual Care Reimbursement Shift Quickening

Sampling of Commercial Insurers Paying for Telehealth
Outlook for Commercial
Reimbursement
There are no
consistent standards
that govern private
commercial payers
As of January 2016,
32 states and DC
mandate insurance
companies to provide
coverage for
telehealth services,
but with varying
requirements and
reimbursement rates.
Some payers are
partnering with nonhealth system
innovators to offer
covered virtual
services for select
groups of
beneficiaries.
Covering real-time video, telephonic,

and secure chat visits for non-urgent
care consultations
Individual state Blues plans

partner with variety of vendors, like
American Well
Scaled across 46 states; doctor visits

and prescriptions available in CA
National Labor Office alliance with

Teladoc
Partners with American Wells

LiveHealth Online platform
Adds Teladoc services to benefits

plans for labor trust funds, labor
unions, and independent BCBS
companies served by NLO
Covers virtual visits for enrollees in

self-funded employer health plans with
access in 47 states and DC
Expanding to employer-sponsored and
individual plan participants in 2016
Partners with Doctor on Demand and
American Well
Offers telehealth services to

patients on multiple
platforms, including patient
portal and mobile app
Invested $10M in Vidyo
telehealth platform in
December 2015
Source: Center for Connected Health Policy, http://cchpca.org/telehealth-policy; American Action Forum, http://americanactionforum.org/insights/curbingthe-provider-shortage-more-coverage-for-telehealth-services; Market Innovation Center research and analysis.
28
Examining CMS Coverage Requirements

Specific Criteria Must be Satisfied to Qualify for Reimbursement
Core Eligibility Requirements for CMS Reimbursement
1
Geographic Location
of Originating Site
Must be provided to an
eligible beneficiary in an
eligible site
Site must be located in:
1. A Health Professional
Shortage Area outside
of a Metropolitan
Statistical Area
Type of Health
Provider at Distant Site
Physician
Nurse practitioner
Physician assistant
Nurse midwife
Clinical nurse specialist
Clinical psychologist and
clinical social worker
2. A rural census tract

(even within a MSA)
Certified registered nurse

anesthetist
3. A county outside of
an MSA
Registered dietitian or
nutrition professional
Type of Institution
for Originating Site
Office of a physician or
practitioner
Hospital
Critical access hospitals
Rural health clinic
Federally Qualified Health
Centers (FQHCs)
Skilled nursing facility
Hospital-based dialysis center

Community mental
health center
Are You Eligible?

Visit the HRSA Medicare Telehealth Payment Eligibility Analyzer website.
Sources: Medicare Telehealth Payment Eligibility Analyzer, U.S. Department of Health and Human Resources,
http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx; Market Innovation Center research and analysis.
29
#5. Legislators
Policy & Reimbursement Support Varies by State
CRITERIA
LEVEL OF STATE SUPPORT
Medicaid Coverage and Practice Standards Lead to Uneven Adoption
Good to Excellent
Average
Fair to Poor
Medicaid
Commercial
Geographic &
Reimbursement Reimbursement Patient Setting
Requirements
Licensure
& Eligible
Practitioners
Patient Informed
Consent &
Telepresenter
Prescribing
& Practice
Standards
Care
Innovation
How much does your state support telehealth?

Download your states policy profile here.
30
Medicaid and Commercial Payer Rules Differ

Some States More Supportive by Removing Restrictions to Payment
Eligible
Technologies
Setting
Requirements
Many states cover

two-way audio
and video
encounters
Type of setting
and location of
patient at time of
encounter
Most states do not

include store and
forward in their
definitions of
telehealth
The most
supportive states
have no
geographic
requirements for
reimbursement
Some states
cover remote
patient monitoring
or home health,
usually for specific
conditions like
CHF, COPD, or
end-stage renal
disease
Some states limit

the site where the
patient may be
located to clinics
or schools
Few states allow
the home as an
eligible patient
site
Type of
Service
Some states limit
the services for
which they offer
reimbursement to
chronic disease or
behavioral/mental
health
Many states limit
reimbursement to
teleradiology or
emergency
services
Most states limit
the types of
providers that are
eligible to conduct
specific services
Commercial
Parity Laws
The majority of
states have
commercial
parity legislation
in place
State statute
requiring
commercial
payers to
reimburse for
eligible
telehealth
services at the
same rate as inperson services
Payer-Led
Programs
Individual payers
may choose to
include telehealth
services in
benefit packages
regardless of
state laws
Some payers
offer their own
telehealth
services or
partner with
vendors (e.g.,
United
HealthCare &
MDLive)
31
Provider Requirements for Practicing Telemedicine

Reimbursement Contingent on the Who and How of Provider Practice
Eligible Practitioners
Licensure Requirements
Type of practitioner allowed to see

patients via telemedicine
Licensure required to practice across state

lines
Most states include MD/DO, PA, and NP

as eligible
Supportive states also include specialty

practitioners (e.g., nurse midwives) or
non-clinical practitioners (e.g., speech
pathologists)
Many states require a full state license to

practice telemedicine with patients located in
that state
Supportive states provide special

telemedicine licenses, nearby state
reciprocity, or exemptions for emergency care
Informed Consent Procedure
Practice Standards
Manner of gaining patients specific consent to

have encounter via telemedicine
Requirements for the practice of medicine via

virtual means
Most states require written and oral informed

consent as well as patient education
Most states do not require a separate set of

practice requirements for telemedicine
Supportive states allow multiple methods of

gaining consent
Supportive states allow patient-physician

relationship to be established via telemedicine
32
Telemedicine in Next-Generation ACOs

Many Calling 2016 the Year of Telehealth and ACOs
2015 MSSP Rule
Only 27% of ACOs achieved

enough savings and quality
improvements for financial
incentives
Only 20% of ACOs currently use

telemedicine services
ACO Struggles
Encouraged ACOs to use

telemedicine to achieve care
coordination and cost savings
Protected telemedicine under

fraud and abuse waiver
Next Generation ACO Model
New model tests beneficiary

incentives for seeking care at
Next-Gen. providers, including
increased availability of telehealth
services
Shows CMS support of

telemedicine and will allow
gathering of evidence on benefits
Source: Lacktman, Nate. 2016 Will be the Year of Telemedicine and ACOs, Health Data Management, December 21, 2015,
http://www.healthdatamanagement.com/news/2016-will-be-the-year-of-telemedicine-and-ACOs-51741-1.html; Wicklund, Eric. Telemedicine
a Key Component of Next-Generation ACOs, mHealth Intelligence, January 13, 2016, http://mhealthintelligence.com/news/telemedicine-akey-component-of-next-generation-acos. Market Innovation Center research and analysis.
33
CMS CY2016 Reimbursement Updates

Proposed Rule Adds Procedures to List of Covered Telehealth Services
Services Affected by Rule
2015 Expansion of Service
2016 Updates
Type of Interaction
Wellness visits are covered as long

as there is an existing relationship
between the patient and physician;
the relationship can be initiated via a
virtual visit
Two new codes added to

reimburse for prolonged inpatient
or observation care
Practitioners and Services
Psychoanalysis, family psychotherapy

(both with and without the patient
present), and prolonged service
Addition of certified nurse

anesthetists to the list of
qualified telehealth providers
Geographic Service Area
Payments allowed for patients in rural

census tracts even if those tracks are
within metropolitan statistical areas
Comprehensive Care for Joint

Replacement (CCJR) model
removes geographic restrictions
for telehealth for hip and knee
surgery care coordination
Chronic Care Management
CMS will reimburse providers for

furnishing specific non-face-to-face
services to qualified beneficiaries
over a calendar month
Four codes added for services

related to home dialysis for patients
with end-stage renal disease
Source: Center for Medicare and Medicaid Services CY2015 Physician Fee Schedule
Proposed Rule, 42 CFR 410; Market Innovation Center research and analysis.
34
Legislation to Watch
State Bills
8 of the 18 states that do not currently have parity laws are considering
them for the 2016 session; other states will work to remove restrictions
on practice and patient setting
Licensure
Compacts
Compacts expedite the licensure process and increase the portability of

medical licenses across participating state lines; 17 states already
participate and 2 more are considering
Congressional
Bills
TELE-MED Act seeks to permit Medicare providers to practice telemedicine

across state lines; Telehealth Innovation and Improvement Act would
require CMMI to test effects of telehealth on cost and efficacy
MedPAC
If Medicare Payment Advisory Commission supports rulemaking to

increase Medicare coverage for telehealth, Congressional Budget Office
might conduct formal review of financial impacts
QuasiRegulatory
Accreditation programs like American Telemedicine Association and

URAC promulgate standards for virtual care implementation; payers
continue to invest more in alternative payment models
1) Center for Medicare and Medicaid Innovation.

35
Evaluating Telehealth Investments
Metric Selection
Value Proposition
Prioritization Exercise
36
Metric Selection
Not All Benefits of Telehealth Are Easily Quantifiable

Improved Strategic Positioning Is a Key Investment Selection Factor
FINANCIAL METRICS
Direct revenue
Indirect revenue
Operational efficiencies
from reimbursements
by payers, self-pay,
and contract value
from adding new

patients to panel
and patient retention
from streamlined scheduling

and improved patient
throughput
Cost avoidance
from replacing in-person
encounters and avoiding
unnecessary care
VALUE METRICS
Patient access and

convenience in the form of
reduced wait times to
appointment and/or expanded
care delivery settings
Clinical quality
Provider satisfaction
Competitive advantage
improvements from
sustained connections
with patients, more
timely preventive care
as a result of enhanced
access to specialist
expertise, improved
workflow tools
to prevent potential disruptors

from threatening market
share
Source: Service Line Strategy Advisor research and analysis.
37
Strategic Benefits for Enhancing Patient Access

Recruiting New Patients
Expands Provider Capacity
Retaining Existing Patients
Engages Patients and Providers
Boosts provider productivity through reduced

travel time, improved operational efficiencies
Meet patient demands for convenient care

options in the face of market disruptors
Bolsters referrals of high-acuity transfers

from tertiary care organizations participating
in telehealth consults
Can connect previously unassigned patients

to a health system
Improves Patient Access and

Market Capture Opportunities
Expands patient access to care

Enhances patient convenience
Pre-empts on-demand retail competition
Increases access to specialist expertise
Supports Cost Management
Encourages appropriate and cost-effective

utilization
Reduces likelihood of chronic disease
exacerbations for at-risk patient populations
38
#1. Expanding Provider Capacity
Virtual Care Can Optimize Cost-Effective Delivery

Lowest Acuity Care Shifted to Low Overhead Virtual Platform
Stanford Medicine ClickWell Care Virtual Visit Clinic Model Targets Time, Cost Savings
Patient Panel of 2,000 patients, 3,000 virtual visits 2015 YTD
60%
Stanford Medicine
launched virtual visits
at PCP clinic
of all follow-up visits

done virtually
Volume: 300 virtual

visits/month
160
155
Minutes saved
for each virtual
appointment1
Hours of physician
time saved (across
2.2 doctors)
Hours of MA timesaved (across 1 MA)
Cost Savings
30-40%
Rationale: More
convenient access to
PCPs and wellness
coaches for lowutilizing ACO
population
Savings may reflect
lower acuity of virtual
visits
Savings on cost-per
appointment
39
#2. Improving Market Capture Opportunities
Urgency for On-Demand Service Varies by Market

Convenient Offering Draws New Patients, Optimizes PCP Capacity
MultiCares Partnership for On-Demand Care Helps Capture New Patients
Results from 5-Month Pilot, Including Patient Survey on Alternate Sites of Care
Where Patients Would
Have Gone
Office Visit
46%
Urgent Care
ER
Patients Served
New
Patients
50%
Current
Patients
50%
35%
12%
Other
6%
No Care
1.4%
40-60%
Of new patients lack a current
primary care physician
MultiCare
partnered with
vendor to provide
on-demand visits
Volume: 200-800
virtual visits/month
Rationale:
Add PCP capacity by
decanting low-acuity
visits; exclusive vendor
relationship aided
patient retention,
downstream
care capture
40
#3. Engaging Patients and Providers
Keep Patients Engaged Through Online Pre-Care

Wyoming Medicaid Uses Pregnancy Tracker App for High-Risk Moms
App Helps Mothers-to-Be
Track Babys Development with reminders of common
milestones, sample ultrasound videos
Avoid Common Risk Factors by listing symptoms and treatments,

suggesting when to call doctor
Ask the Right Questions with hot list of common patient

questions to guide meaningful discussions with providers
Get Answers Quickly by connecting with health plans call center

for quick access to in-network nurse
40%
80%
Medicaid patients who

smoke and are at high
risk for low birthweight
deliveries
Monthly retention of patients

through DueDatePlus
IMAGE CREDIT: DUEDATEPLUS
Source: Pai, A. Wyoming Medicaid Taps Wildflower for Pregnancy Tracker App, Mobihealth
News, February 12, 2014; Source: Market Innovation Center research and analysis.
41
#4. Support Cost Management
Telemonitoring Scale Encourages Self-Management

A Weighty Solution for Heart Failure Monitoring
Essentia Healths Telemonitoring Scale Program
Epic EMR
Flow
Sheets
Patients selected based

on need:
Frequent HF
hospitalization
Lack of social support
Weight taken every

day at the
same timebefore
eating, dressing, and
going to bathroom
Readings sent via cellular

network to Medtronic Care
Management Services
platform, pass through
analytics to determine need
for intervention
Chart Review
0-3%
$1M
300
30-day readmission rate

of RPM heart failure
patients
6 month savings from

program, based on BCBS
study
Number of patients in
program, of 2,200 total
heart failure patients
1) Heart failure; 2) Health Level 7; 3) Blue Cross Blue

Shield; 4) Guideline directed therapy.
Sources: Essentia Health; Market Innovation Center research and analysis.
42
Anchor Telehealth Investments in Overarching Goals

Mapping Telehealth Investments to Each Care Settings Opportunities
Common Goals for Telehealth Solutions, by Setting
Primary Care
OP Care
Improve primary
care coverage
Extend clinic
coverage from
specialists
Cut inappropriate
admissions and
transfers
Improve availability
or access to
specialist expertise
Bridge gaps in
availability or access
to specialist expertise
Streamline
information transfer
between care
settings
Encourage costeffective patient ED

utilization
Reduce patient LOS
Increase
interoperability
between
hospital/post-acute
care provider EMRs
Reduce patient noshows

Respond to retail
competition
Overcome patient
transportation
barriers
Elevate
management of
chronic disease
Improve patient
compliance with
post-discharge care
pathway
ED
IP Care
Address causes of
frequent treatment
complications
Avoid readmission
rates/penalties
PAC
Improve access for

home-bound, geriatric
patients
Support seamless
care transitions
43
On-Demand Research from the Advisory Board

Telebehavioral Health
Want Targeted Research You Can Read in
10 Minutes or Less?
Pediatric Applications
Download Our Telehealth Primer Series

Telehealth & Chronic Disease
Each primer installment describes market trends oriented around a
specific telehealth topic. The analysis is designed for use by program or
strategic leadership in health care provider organizations, and includes
definitions of key terms, discussion of investment considerations, and a
sample case study from a leading health care organization.
A new primer will be released every 4-8 weeks. To suggest topics for
future installments, please send your ideas to walsht@advisory.com.
Telehealth Reimbursement
TeleICU
Telestroke
Teleoncology
Wearables
For more information, please contact your Dedicated Advisor.
Telebariatrics
44
Telehealth Planning & Strategy Resources

Support from The Advisory Board Company
Planning 20/20
PLANNING TOOLS & MARKET INSIGHTS
Your
needs
What are other people doing in the telehealth

space? What telehealth opportunities should
we be considering?
What does the market adoption for telehealth

look like?
How we
can help
What are best practices for designing,

implementing, and scaling telehealth
programs?
CUSTOM TELEHEALTH BUSINESS PLANS
What is demand for telehealth services in

our market?
How do we prioritize across telehealth

investments?
How can telehealth help us achieve our

broader strategic goals given our unique
context?
What is the ROI for a telehealth investment

such as remote monitoring or virtual visits
for urgent care?
Which telehealth technology platform

should we invest in to support our existing
and future ambitions?
How do we design and implement a

telehealth program?
How do we effectively resource our

telehealth program for success?
How do we optimize and scale our

telehealth efforts to ensure sustainability?
Provide off-the shelf resources on the latest

telehealth innovations and trends
Evaluate market readiness and demand for

telehealth services
Educate key stakeholders in organization on

various telehealth topics through PLTs
Audit internal capabilities and identify gaps

by service line
Offer ready-to-use tools to support market

sizing, planning and implementation
decisions
Assess ROI potential

Recommend near-, mid-, and long-term
priorities for program implementation
Direct-to-Consumer Virtual Visits, Remote Patient Monitoring, Telebehavioral Health, Specialist

Consults/Service Line Applications, Chronic Disease Management, EICU/PICU and Telestroke
STRATEGY, IT & EXECUTION SUPPORT
Recurring strategy/content conversations

with leading ABC telehealth content experts
to share whats new before research is
published
Scope of
Telehealth
Content
Consulting & Management
Partner with health system leaders to clarify

strategic objectives and build a
comprehensive telehealth roadmap and
execution playbook
Create a clear approach for demand creation
to drive utilization through consumer and
physician engagement
Recommend and establish a strong
governance and management structure
Full implementation, IT, and program support
including: workflow & staffing model design,
system selection, project mgmt. EHR
integration, etc.
Support for Multi-Specialty
Virtual Visit Programs
45
In Closing
Please take a minute to fill out our survey, which

will pop up as you exit the webconference.
This is the best way to let us know if you have
questions, want to speak with one of our experts,
or want to receive a copy of todays presentation.
You may also contact:
Alexis DePuyt
202-568-7969
depuyta@advisory.com
Thank you for your time today!
2445 M Street NW I Washington DC 20037

P 202.266.5600 I F 202.266.5700
advisory.com

Telehealth Industry Trends

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Telehealth Industry Trends

Uploaded by

Copyright:

Available Formats

Nursing Executive Center

Global Centre for Nursing Executives

Telehealth Industry Trends:

Jasmaine McClain, PhD

Market Forces Influencing Adoption

2016 The Advisory Board Company advisory.com

Evaluating Telehealth Investments

Questions and Closing Comments

2016 The Advisory Board Company advisory.com

Telehealth: Untangling the Terminology

Why invest in telehealth?

What are the applications?

How is telehealth offered?

Modalities Differ by Recipient and Timing of Service

Virtual primary care

Virtual urgent care

Virtual pre- and post-op

2016 The Advisory Board Company advisory.com

Remote patient monitoring

Wearables (e.g., Fitbit)

Source: Market Innovation Center research and analysis.

Industry Snapshot: #1. Synchronous, Provider-to-Patient

Direct-to-Consumer Virtual Visits

2015 was the year that

Dr. Joseph Kvedar

2016 The Advisory Board Company advisory.com

Industry Snapshot: #2. Synchronous, Provider-to-Provider

Real-Time Virtual Specialist Consults

These online communities

2016 The Advisory Board Company advisory.com

Source: Hume R, Health Facilities Management, February 2016, available at http://www.hfmmagazine.com/display/HFM-news-article.dhtml?dcrPath

Industry Snapshot: #3. Asynchronous, Provider-to-Provider

Store-and-Forward Information Exchange

2016 The Advisory Board Company advisory.com

Industry Snapshot: #4. Asynchronous, Patient-to-Provider

Secure Messaging Tools

When you use a prompt

Dr. Charles Edmiston

2016 The Advisory Board Company advisory.com

Remote Patient Monitoring Devices

2016 The Advisory Board Company advisory.com

Adoption of Wearables Stalled by Inconsistent Use

The Dirty Secret of Wearables

2016 The Advisory Board Company advisory.com

Sources: Endeavour Partners, September 2013, Inside Wearables,

The Time Is Ripe for Virtual Care

Estimated U.S. Growth in

Planners Often Coordinate Telehealth Initiatives

Job Description for

Ownership and oversight of

Percent of clinical leader

Percent of planner questions

1) Figures draw from analysis of Advisory Board Expert

Sources: Market Innovation Center interviews and analysis.

What Your Peers Are Asking About Telehealth

What Modality are Members

Remote patient monitoring

1) Figures draw from analysis of Advisory Board Expert

Sources: Market Innovation Center interviews and analysis.

Market Forces Influencing Adoption

2016 The Advisory Board Company advisory.com

Stakeholder Groups Influence Telehealth Adoption

Major External Players Influencing Adoption

2016 The Advisory Board Company advisory.com