Partner outside healthcare to enable, advance telehealth

BOSTON—Stakeholders often work in silos but partnering with entities outside of healthcare could enable and advance telehealth efforts, according to speakers at the mHealth + Telehealth World 2014 on July 22.

Telecommunications companies are enabling and partnering with other stakeholders while electronics companies are simplifying how the services are delivered, said Pramod Gaur, PhD, vice chair of the American Telemedicine Association’s mHealth special interest group.

“Any time you have new opportunities see how a new venture or innovation impacts others,” he recommended.

Providers also need to consider payers, he said. “The payer is no longer a large, private insurance company. Federal and state governments are the largest payers so you need to look at their perspective. They tend to set trends.”

Recent telehealth trends, according to Gaur, include insurance companies working with telehealth companies to improve access to care. Over the last 6 to 9 months, all the major private insurance companies have gotten involved, he said, which means there are now millions of lives eligible for telemedicine consultation.

Price transparency is increasing as well for more consumer-directed care. Patients want to know “not just who are licensed providers but more about their ratings.

“When insurers collaborate with providers to break down siloes and create new ways of working together they can successfully implement new payment models that boost quality and value throughout the healthcare system.” The multibillion-dollar healthcare system, Gaur said, needs smaller success stories which can be expanded upon.

The federal government funds 14 telehealth resource centers that provide assistance, coordination and referrals, said Mario Gutierrez, MPH, executive director of the Center for Connected Health Policy, one of the resource centers.

Going into telehealth is like “going down the rabbit hole,” he said. For example, Gutierr said Medicare’s telehealth services are outdated and limited to live video and then only in strictly defined rural locations. The Department of Health and Human Services’ FedTel working group has identified seven unique definitions of telehealth in use across the federal government. mHealth is defined in only three categories.  

However, there are changes happening on the regulatory side because “more and more pressure is being put on the government to open up this world of telehealth,” said Gutierrez. The Centers for Medicare & Medicaid Services have proposed new rules regarding telehealth for 2015, he said, but “keep in mind that definitions for rural still apply and it’s only for live consultation.” They also created a new billing category for non-face-to-face chronic care management, which is a unique covered service designed to pay separately for chronic care services furnished to beneficiaries with two or more chronic conditions.

Meanwhile, no two states have the same rules and regulations. Forty-one states have a definition for telemedicine, 17 states have a definition for telehealth and two states have no definition for either. ”It’s really a nightmare in terms of businesses going into a state to go through the quagmire of laws and regulations and application,” said Gutierrez. For the time being, cross-state licensing is a grey area.

The most common telehealth reimbursements are for consultations, mental health and radiology. No two states are alike. As of April, there were 192 active bills related to telehealth, most dealing with reimbursement. In Tennessee, there was an aggressive effort to change the laws to actually make telehealth more difficult. However, in California, a law was passed that lifted numerous obstacles.

“We’re still very slowly adopting telehealth,” said Gutierrez.