Q&A: How retail healthcare, telehealth trends could evolve in 2023 Emily Olsen December 16, 2022 Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, discusses the future of virtual care and how emerging retail players will affect the industry. As another year shaken by the lingering COVID-19 pandemic ends, stakeholders are still exploring how virtual care trends that accelerated in 2020 will affect the healthcare industry long term. Though telehealth use spiked out of necessity during the early months and remains higher than pre-pandemic levels, utilization has slowed over the past two years. Meanwhile, big retail companies and pharmacies are offering more care options to patients. Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, sat down with MobiHealthNews to discuss the future of virtual care, how big retail entrants will affect the industry, and the importance of care coordination between traditional health systems and emerging retail players. MobiHealthNews: What are some of your big takeaways from 2022 when you're thinking about telehealth, digital health and other tech-enabled care? Sanjula Jain: A big thing that I'm thinking a lot about is that patients aren't coming back to care, despite all the investments in more supply or access points, whether that be virtual care access points or new retail entrants or traditional urgent care. We've just had this huge mismatch between supply and demand. We're kind of post-vaccines; we have Americans returning to work to some extent. A lot of folks are going into an office a couple of days a week, folks are traveling, yet they're not going back to see their doctors. We've tried to make care more convenient and more accessible. And some of these new supply points are lower cost, and yet, they're still not engaging. I think there are many reasons for that. COVID scared away a lot of patients, and I think we're starting to see signs of more distrust in the healthcare system. And then cost and affordability, with a lot of the price pressures and inflation and recession discussions. That's going to continue to be a factor. There's a lot of health consequences for when patients don't actually engage in necessary healthcare. MHN: What do you think is the future of virtual care when you're looking at 2023 and beyond? Jain: The market for virtual care is a commoditized market. So, we're seeing that generally it's being used amongst a discrete subset of the population. And we have to think about, who are the individuals who like to use virtual care and what are they using it for? Primarily, as a health economist, I think a lot about substitute goods. We are seeing that virtual care is really only a substitute good for behavioral health. It's both a clinical and financial substitute, right? Clinically, having some distance between you and your provider in a behavioral health interaction is probably preferred when you're talking about your feelings and being very vulnerable. And there's no lab work or poking and prodding that actually needs to happen. So it's a viable clinical alternative. Financially, we've been talking a lot about payment parity. Because behavioral health interactions often don't need imaging and lab work, you're kind of making the same amount for an office visit that you are in a virtual care environment. For other use cases like primary care, we see that's not actually the case. The patient goes in for a virtual care visit, and then what really ends up happening is the physician says, "I need you to come in to get some imaging done or get some lab work done." The payment parity, despite the policy incentives to increase telehealth payment rates, it's not true parity. And so, that's why we don't see the full substitute effect. When you boil the ocean down, you see that the market for telehealth continues to be pretty discrete and concentrated to a handful of consumers. That's really where I think the future is, thinking about whether they will continue to use it. The data shows that, in the pandemic, we've seen this tapering. When Americans are given the option for in-person or virtual, they're still preferring to go in-person with that exception of behavioral health. So, I think the market is going to have to be more realistic about the total addressable market size in terms of discrete number of users, the number of visits per user, and then invest accordingly. I think that's a large part of why we've seen a lot of struggling amongst some digital health players, because I think they've overestimated the amount of utilization of virtual care modalities. But the number of discrete users just isn't up to par with what individuals had estimated it to be. MHN: Going back to those retail entrants, Amazon made a ton of news this year. Walgreens, CVS, Walmart — they're also boosting their care delivery operations. How do you think these moves will affect the healthcare industry overall? Jain: It ultimately comes down to, who is your customer or your consumer or patient persona? Who is Amazon actually going after? Who is their target patient population, and for what services? Amazon is really focusing on more low-acuity services, and health systems are particularly good at the higher acuity things like surgeries. What Amazon and other new entrants mean is that they provide the consumer with more care options. But it also creates a need to coordinate care better and create these really strong referral relationships. To go back to my earlier point about patients not coming back, of the patients we do see coming back, we're seeing them really seek out care in these low-acuity, commoditized care settings. They're going in for flu and strep, but they're not getting their screenings. It's going to be really important for groups like Amazon to coordinate with health systems to actually get patients to go follow up for those necessary services and figure out how to refer them out. MHN: How do you think the growth of these retail players will affect patients? Jain: I think it's a bit of a toss up. For some patients, they're going to view it as a better experience, because they can get what they want when they want it. But I think from a clinical perspective, it creates a lot of risks and challenges for the health of the patient. There really isn't someone owning the care or steering the patient through their healthcare journey. Have you gotten this lab workup? Have you gotten this mammogram? For some of these more retail players, it's consumer-directed. You can walk into urgent care and you can go to a telehealth visit, and it's really up to the consumer. But healthcare is complicated, and the average consumer may not have all the necessary information to go make those decisions. I think that there's a lot of positives to retail players in terms of catering to consumer preferences and providing care in a more convenient way. But for a lot of complex care, acute care — that every American is going to need at some point in their life — there is a little bit more fragmentation. MHN: Do you think there's an appetite among health systems to partner with Walgreens or CVS or Amazon and say, "If you see someone, send them to me when they need a cancer screening?" Jain: Absolutely. So, I actually just this week was with one of the health systems, talking to their leadership team. That's very much a conversation that is happening in the boardrooms — what is the right partnership structure with some of these new entrants and primary care providers? I think the challenge is, you could have those great partnerships. But ultimately, it's the consumer and the patient that's still having to make the decision. Are they going to follow up on those recommendations? Where are they going to go next? So, I think it's something that we're going to have to spend more time thinking about as an industry, how to coordinate that care for that patient over time, but with more choice and options in the market. See original article: https://www.mobihealthnews.com/news/qa-how-retail-healthcare-telehealth-trends-could-evolve-2023 < Previous News Next News >

Can virtual nursing help ease clinician burnout? Bill Siwicki November 14, 2022 The turnover rate for nurses stands at 27%. Can telemedicine save the day? No hospital or health system is immune from the challenges of the nationwide nursing shortage. As organizations look for ways to reduce the administrative burden on nurses and improve engagement and satisfaction, virtual nursing is one consideration. Many tasks performed by nurses in the inpatient setting are repetitive – a virtual nursing unit allows nurses to manage these tasks remotely. Bedside nurses and staff then are freed up to focus on patient-facing care, while those in the virtual unit can monitor patients, enter data in the medical record and more. To better understand the ins and outs of virtual nursing, we interviewed Dr. Shayan Vyas, senior vice president and medical director for hospitals and health systems at Teladoc Health. Q. What is the national nursing shortage like today? How does it play out in hospitals and health systems? A. Every health system I've spoken with, that we work with, says workforce challenges are among the top three issues keeping them up at night. This is particularly true for nursing staff. In 2021, nurses were leaving the profession at an alarming rate. According to NSI Nursing Solutions, the turnover rate for nurses increased by 8.4% in 2021 and currently stands at 27%. An increase in patient volume and occupancy rates, among other factors, have led to severe emotional and physical exhaustion and, ultimately, job dissatisfaction and burnout. A 2021 McKinsey survey found that 32% of nurses were likely to leave their current position due to insufficient staffing levels, a lack of support and the emotional toll of the job. President Obama once said that "nurses are the heartbeat of the United States healthcare system," and I really believe that to be true. They put their lives on the line to serve and care for others every single day, and we need to give them the tools to more effectively, efficiently and safely care for others and save lives. Virtual care offers new strategies to address these challenges; virtual nursing is an important component that health systems can include in their transformation and care delivery redesign initiatives. Q. What is virtual nursing, and how does it work? A. Virtual nursing, simply put, is the delivery of nursing care and services from a remote location. Virtual nurses are responsible for monitoring multiple patients while collaborating with the nurses, physicians, therapists and other staff who provide care at the patient's bedside. The virtual nursing unit can be centralized (for example, nurses work from a command center in a healthcare facility), distributed (nurses work from home or other remote locations) or hybrid. Adopting virtual nursing provides a way to mitigate potential staffing losses due to short-term injury or other conditions that require nurses to be off their feet. It is also a way to extend nurses' careers, for example, by offering nurses with developing or chronic physical limitations the option of working seated in a command center, instead of providing physically challenging care on a nursing unit. Virtual nursing programs also can help attract nurses by providing different options for shifts and work styles. This model supports organizations by enabling them to have virtual nurses work from anywhere – allowing them to provide much-needed care and services without requiring nurses to relocate so that they live close enough to a hospital to be able to go on-site for their shift. It also helps new nurses with clinical support, medication verifications and overall non-physical patient bedside care assistance. Health systems that have created virtual nursing programs to augment their bedside nurses have found virtual nursing can extend nurses' careers and improve job satisfaction for floor nurses by taking away responsibility for many tasks that do not require physical touch. This allows the bedside nurse to focus on hands-on patient care and contributes to higher patient satisfaction because of the responsiveness and additional attentiveness it enables. Virtual nursing can also allow advanced nurse practitioners like PAs and ARNPs the ability to connect virtually with a virtual intensivist, and the virtual nurse can help with many of the nonphysical contact needs of patient care. Q. How can virtual nursing reduce the administrative burden on nurses and improve engagement and satisfaction? A. While hands-on care will always be needed, many duties can be fulfilled virtually, including coordinating procedures, getting sign-offs from multiple care team members, reconciling medications, providing patient education, answering questions, initiating the discharge process and more. In many successful virtual nursing programs, administrative tasks like discharge paperwork, medication reconciliation, etc., have been shifted from bedside to virtual nurses. Virtual nursing systems enable virtual nurses to monitor patients and communicate with them, their families, and other visitors and care team members in real time, including responding to patient nurse calls. The goal is to provide a new level of support to patients, nurses and the bedside team. Several health systems with virtual nursing programs have reported high job satisfaction for their virtual nurses. Nurses say the virtual role enables them to spend more time with patients overall. The extra time, and the complementary nature of virtual and bedside nursing roles, contributes to improved job satisfaction for both bedside and virtual nurses, and positive experiences for patients. Q. Please talk a bit about one of your hospital clients using virtual nursing and the results they've achieved. A. Overall, the benefits of virtual nursing include staffing flexibility, potential retention and recruitment advantages, the ability to leverage staff resources, and favorable nurse and patient satisfaction. Another major benefit of virtual nursing is a reduced length of stay, resulting in improved throughput, as well as time saved in the discharge process. Some lesser-known benefits of virtual nursing are a differentiated and improved patient experience, with potential associated improvements to patient satisfaction and HCAHPS and NPS scores. Patients also are seeing a significant improvement in satisfaction as they no longer have to pull a bedside staff member to help answer questions or assist with administrative documentation. Our client, Saint Luke's Health System in Kansas City, Missouri, has helped address the nursing shortage by having virtual nurses support bedside nurses. The virtual nurses can assist with non-hands-on care, education, documentation, admission, discharge, answering questions, and reviewing the care plan or physician rounding with the patient and their loved ones, among other tasks. The unit has enhanced Saint Luke's bedside care response rates, increased patient and nurse satisfaction, reduced the burden on bedside nurses, and positively impacted quality and safety for a better work environment. Patients are discharged within two hours of the discharge order, some 20% faster than in other units, and they're also out of the hospital before noon at a 44% faster rate. This has, in turn, reduced the wait time for patients in the ED and reduces the time to treatment. What's more, these benefits have boosted nurse morale, improving workforce engagement, reducing fatigue, even improving Saint Luke's recruitment capabilities. We need to provide nurses, our frontline workers, with technology that improves their work, quality of life, and the level and effectiveness of bedside care. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/can-virtual-nursing-help-ease-clinician-burnout < Previous News Next News >

Majority of Americans Value the Convenience Associated with Telehealth Mark Melchionna December 07, 2022 New survey results released by AHIP showed that most Americans highly value the simplicity and convenience associated with telehealth and support making pre-deductible telehealth coverage permanent. America's Health Insurance Plans (AHIP) described survey results indicating that Americans value the convenience associated with telehealth, with 69 percent saying they prefer it over in-person care for this reason. As the COVID-19 pandemic became increasingly severe, many patients and providers began to use telehealth at a higher frequency. This was supported by federal and state governments allowing flexibilities that removed barriers to this type of care, leading to improved patient access. The high level of telehealth use has continued during the pandemic, even following the drop in COVID-19 severity as vaccines and treatments became widely available. According to the FAIR Health Monthly Telehealth Regional tracker, telehealth use increased by 10.2 percent in May. A survey released by AHIP aimed to gather information regarding Americans' opinions on telehealth. Conducted by NORC at the University of Chicago and using the AmeriSpeak panel, the survey polled 1,000 Americans, 498 of whom have employer-provided or individual market coverage, regarding telehealth use within one year prior. The survey was fielded in October. Among the portion of survey respondents who were commercially insured, 40 percent claimed to have used telehealth within a year prior, and 53 percent claimed to have used it between two and five times within a year prior. About 69 percent of commercially insured telehealth users said they used telehealth due to the associated high level of convenience compared to in-person care, 78 percent stated that telehealth made the process of seeking out healthcare easier, and 85 percent said there is an adequate number of providers available via telehealth for their subjective needs. Also, 73 percent of commercial telehealth users stated that Congress should make permanent arrangements that allow for the coverage of telehealth services prior to paying their full deductible. Further, female telehealth users were almost four times as likely than men to say they participated in a telehealth appointment because they lacked childcare or eldercare, the survey shows. “Patients and providers accept – and often prefer – digital technologies as an essential part of health care delivery,” said Jeanette Thornton, executive vice president of policy and strategy at AHIP, in a press release. “Telehealth can be just as effective as in-person care for many conditions and allows patients to receive more services ‘where they are.’ That’s why health insurance providers are committed to strengthening and improving both access and use for the millions of Americans who use telehealth for their health care needs.” A report from July found similar patient opinions of telehealth. Released by CVS Health, the 2022 Health Care Insights Study reported survey results from two separate questionnaires. Around 92 percent of respondents stated that convenience is a critical factor when selecting a primary care provider. The surveys also reported that many consumers find virtual appointments more convenient than in-person visits because they didn’t have to leave home (41 percent), they didn't have to pay for transportation (37 percent), and they saved time (37 percent). See original article: https://mhealthintelligence.com/news/majority-of-americans-value-the-convenience-associated-with-telehealth < Previous News Next News >

Maximizing Telemedicine Benefits Elizabeth A. Krupinski, Southwest Telehealth Resource Center August 2021 First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The United States and the world have seen a dramatic increase in the use of telemedicine since the inception of the COVID-19 public health emergency due in most part to stay at home restrictions for both providers and patients. Prior to this, telemedicine was used in a wide variety of clinical and related patient care applications for at least 30 years, and had been seeing steady but not exponential growth. In many cases programs were initiated quite rapidly using readily available and often low-cost equipment and tools, unless there was already an existing program and platform in place. Further, the use of telemedicine was facilitated at the state and federal levels but widespread waivers and measures being put into place to reduce barriers that were previously in place such as changes in reimbursements, requirements regarding patient and provider locations, cross-state licensure and privacy/security requirements. Those of us in the field for a long time are hopeful that many of these measures will stay in place, but there are clearly some that will or already have expired. We are additionally hopeful that even though in-person practices are clearly coming back full-tilt, that everyone has seen and/or experienced the benefits of telemedicine and will continue to use it to some degree as feasible and appropriate with their patients. As this occurs, however, providers will be faced with new challenges as they take their initial telemedicine set-ups and transition to this new hybrid world of services. As noted, some things will still be allowed (e.g., certain billing codes) but others will likely return to pre-COVID status (e.g., not being able to use non-HIPAA-compliant devices and software platforms). In addition to finding the best software for future telemedicine applications, there are other things to consider when trying to maximize telemedicine benefits. From my perspective, although the technology is critical, telemedicine success has very little to do with the technology and everything to do with the people and the environment within which they practice. Thus, in order to maximize telemedicine these are the elements one should consider and focus on in addition to carefully selecting the most appropriate technology for your practice and providers. First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The use cases need to be clearly defined and must match an identified need. Then the who, what, where, why and when must be carefully delineated. Who needs to be involved (e.g., providers, billing, scheduling, IT, legal, administration), what clinical tasks can be accomplished via telemedicine, where will the technology and/or providers be located (e.g., clinic, home) and where will the patients be (e.g., primary care provider office, home, work, school), why will telemedicine be offered as an option (e.g., lack of sub-specialty providers, patients need to travel long distances, no show rates are too high) and when will telemedicine be offered (e.g., certain days/times, any opening in the schedule)? All of this can be accomplished by plotting out in a workflow diagram what the current practice is and how it needs to be adjusted in order to integrate telemedicine into that workflow. Again, the expectation is that although some practices might remain essentially virtual, the majority are going to evolve into a hybrid practice – but such a hybrid will not happen overnight or automatically. Workflow integration is going to be just as critical as integrating telemedicine technologies into a practice – it really is all about the people, setting expectations and establishing standard operating procedures and protocols for everyone that is going to be involved. Another thing that can be done to maximize a telemedicine practice is to properly train everyone on standard operating procedures and protocols, especially the providers who will be interacting with the patients. To date there are very few training programs that incorporate formally telemedicine as part of the curriculum. A number of programs are increasingly exposing trainees to telemedicine if offered at their institution, but typically as an elective or chance encounter in the clinic. There are however a number of organizations that are working on developing and promoting telemedicine competencies and the Association of American Medical Colleges (AAMC) recently developed a set of Core Competencies. Although specific to medical college trainees, they are comprehensive enough to cover nearly every other specialty/profession in many respects. Very briefly, the AAMC Telehealth Competencies consist of three domains, each with a set of explicit skills that increase in complexity and responsibility across three stages of practice: entering residency, entering practice and experienced faculty physician. The skills from each prior stage of training should carry over to the next phase as the provider becomes more expert and acquires additional skill sets. The six domains are: patient safety and appropriate use of telehealth; access and equity in telehealth; communication via telehealth; data collection and assessment via telehealth; technology for telehealth; and ethical practices and legal requirements for telehealth. Patient safety and appropriate use of telehealth includes 4 skill sets ranging from being able to explain to patients are caregivers the benefits and limitations of telemedicine to knowing when a patient is at risk and how/when to escalate care (e.g., convert to in-person) during an encounter. Access and equity in telehealth has 3 skill sets including knowing your biases and implications when considering healthcare, how telehealth can mitigate or amplify access to care gaps, and taking into account all potential cultural, social, physical and other factors when considering telemedicine. Communication via telehealth has 3 skills covering establishing rapport with patients, creating the right environment (e.g., lighting, sound) and knowing how to incorporate a patient’s social support into an encounter. Data collection and assessment via telehealth covers how to obtain a patient history, how to conduct an appropriate remote exam, and how to deal with patient-generated data. Technology for telehealth does not expect everyone to be an engineer or IT expert, but they should be able to explain equipment requirements for a visit, explain limitations and minimum requirements, and explain risks of technology failure and how to respond to them. Similarly, ethical practices and legal requirements for telehealth does not expect everyone to be a lawyer but should be able to describe local legal and privacy regulations, define components of informed consent, understand ethical challenges and professional requirements, and assess potential conflicts of interest (e.g., interest in commercial products/services). Many of these skills can be acquired by those already in practice by attending the wide variety of courses and webinars available for telemedicine skill building. It is also highly recommended that before engaging with patients for the first time via telemedicine to engage in some simulated practice sessions – from start to finish practicing each skill and developing your “style” for interacting with patients via this virtual medium. Finally, in order to maximize benefits you need to assess your program. This does not require a degree in statistics or setting up a complex experimental study. It really requires just two things – a set of metrics and a process. There are lots of metrics available and most have been studied in a wide variety of clinical applications so a good lit review will always help get you started. It is important to keep in mind that the things you measure need to reflect your goals/mission for using telemedicine and the bottom line of making a profit is not always the most appropriate metric to use. There are lots of relevant metrics and as a good starting place the article by Shore et al. “A lexicon of assessment and outcome measures for telemental health” is a great place to get some ideas. Although developed for the telemental health community the metrics provided apply quite well to nearly any specialty or practice. The metrics include such things as patient/provider satisfaction, no shows, symptom outcomes, completion of treatment, wait times, number of services, cultural access, cost avoidance and patient safety. Once you decide on metrics that are appropriate for your practice (recommend starting with 2-3 then add more as your practice grows) there is a very easy, straight-forward process for getting to outcomes. First, consider a given measure an indicator – these are concrete activities, products etc. that can be measured readily (e.g., from the patient record). For example, you could measure A1C levels in patients as a function of being enrolled in a telenutrition program. The next step is to set performance targets – these are concrete goals that are time limited and based on the indicator metrics. For example, you would like to see a 25% reduction in A1C levels in at least 50% of patients enrolled in the telenutrition course at 6 months post-baseline. Finally, you will have quantifiable outcomes (without fancy statistics) at the end of your set time period – if you meet your 25% reduction goal in 50% of patients great. If not, then maybe reassess the program or whether your goals were realistic. In any case, you now have concrete outcomes of your program demonstrating its benefits that you can provide to funders, administration, your care team and even patients and the community. In order to maximize telemedicine benefits you need to get the word out about its availability and its effectiveness! < Previous News Next News >

Most Americans Support Expansion of Asynchronous Telehealth Options Mark Melchionna July 21, 2022 A new survey shows that a majority of Americans support legislation that would expand asynchronous telehealth, thereby increasing access to care, particularly mental healthcare. Two-thirds (69 percent) of Americans are in favor of legislation to expand access to asynchronous telehealth, according to a new survey. Telehealth company Hims & Hers Health worked with polling firm Public Opinion Strategies to conduct a survey of 1,301 US adults between Feb. 13 and 17. The results indicate that optimizing telehealth and changing policies are critical. The COVID-19 pandemic significantly affected healthcare overall, resulting in an increased need for care, especially for behavioral healthcare. Dig Deeper Why Asynchronous Telehealth Has Been a Boon for Patients, Providers New Bill Seeks Nationwide Medicare Coverage for Asynchronous Telehealth Services Asynchronous Telehealth Can Extend Primary Care at Community Health Networks The survey found that only 38 percent of respondents reported having good mental health, which was lower than the 52 percent who said the same in February 2021. But about 60 percent of respondents said that accessing care is a problem. Researchers then collected data regarding virtual care methods that could help widen mental and physical healthcare access. About 55 percent of survey respondents said they have participated in a telehealth visit, higher than the 10 percent who reported the same in June 2019, 29 percent in April 2020, 43 percent in August 2020, and 51 percent in February 2021, according to the survey. In addition, asynchronous telehealth use is of high interest among survey respondents. About 69 percent of respondents favor legislation that could increase access to asynchronous telehealth. These types of legislation are most popular among Democrats (77 percent) and Black adults (76 percent), though high proportions of Republicans (60 percent) and Hispanic adults (70 percent) are also in support. In addition, a vast majority of healthcare workers (82 percent) indicated high levels of support for expanding asynchronous telehealth. “Patients want to receive care in the way that works best for them, and this is increasingly a combination of telehealth support via synchronous real-time video consultation and asynchronous interactions, as well as in-person care between providers and patients," said Galen Alexander, director of public affairs at Hims & Hers, in an email. "Telehealth, both synchronous and asynchronous, can help address some of the mental health crises our country is facing. Based on this representative survey, Americans want to be in control of their care and would like to see legislators allow for different modes of receiving care.” Previous research has also indicated an increasing need for telemental healthcare. A study published in January showed that despite a slight decline in overall telehealth use, virtual mental healthcare remained popular. It also revealed that mental health conditions were the most common telehealth diagnosis in September and October 2021. Lawmakers do appear to be taking steps to expand telemental healthcare. In May, four US Senators released a discussion draft of telehealth policies for mental healthcare initiatives that focus on increasing access and directing insurers to support virtual care. For original article: https://mhealthintelligence.com/news/most-americans-support-expansion-of-asynchronous-telehealth-options < Previous News Next News >

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HHS-OIG Reports on Pandemic Medicare Telehealth Trends to Inform Permanent Policies Center for Connected Health Policy Nov. 2, 2021 The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. Interestingly, it was found that though pre-pandemic requirements limiting telehealth visits to established patients were waived, 84% of visits still occurred within those parameters. In addition, as policymakers consider making some telehealth pandemic policies permanent, some stakeholders have suggested a need to require an in-person visit within a certain period of time in order to be eligible for a telehealth visit. However, the data collected by HHS-OIG shows such requirements may not be necessary, as Medicare patients were found to already have had an in-person visit on average within four months prior to the telehealth visit without such a requirement. Additional findings included: Beneficiaries most commonly received e-visits, virtual check-ins, and telephone evaluation and management services via telehealth from providers with whom they had an established relationship Beneficiaries received about 45.5 million office visits delivered via telehealth, which accounted for nearly half of all telehealth services 86% of traditional Medicare beneficiaries received a telehealth service from providers with whom they had an established relationship, compared to 81% of Medicare Advantage Beneficiaries who received home visits via telehealth, which represented only 1% of all services provided via telehealth, were the least likely to have an established relationship with their providers The average amount of time between beneficiaries’ in-person visits and their first telehealth services varied by type of service Beneficiaries who received home visits via telehealth had an in-person visit with their providers at an average of around 9 months prior to first telehealth service Beneficiaries who received nursing home visits and assisted living visits via telehealth had an in-person visit at an average of 2 months prior to their first telehealth service HHS-OIG notes that the provision of this data seeks to inform policymakers looking at long-term telehealth policy and making certain pandemic expansions permanent, especially in light of concerns around telehealth fraud and abuse. For instance, it could help in examining the necessity of one of the most controversial, and confusing, permanent federal changes made thus far as part of the Consolidated Appropriations Act, which post-PHE will require an initial in-person visit within 6-months of a tele-behavioral health visit for purposes of Medicare reimbursement. However, the requirement only applies if the service is not provided in a geographically rural area and at a qualifying medical facility. There is also an exception for treatment of substance use disorder and co-occurring mental health treatment. In addition, CMS is proposing to make the 6-month in-person visit a requirement for subsequent visits in the proposed calendar year 2022 physician fee schedule. For non-behavioral health visits, the 6-month requirement wouldn’t apply, however patients would need to be located in a rural area and eligible facility type to qualify for Medicare reimbursement. Some Medicaid programs are considering limiting telehealth use to established patients, occasionally also applying restrictions to specific modalities and services. However, the HHS-OIG findings may suggest that it is unnecessary to limit telehealth to certain patients and services to prevent fraud and abuse as standard practice may already be providing sufficient guardrails in those respects. In addition, the study findings could indicate that the issue may be more related to general standard of care concerns that apply across all services, not just those delivered via telehealth. The balance may then include looking at how to manage health care fraud generally, which elsewhere HHS-OIG has clarified that most fraud is not telehealth specific. The issue could then boil down to how much autonomy to provide clinicians when making medical determinations, including when a telehealth visit is appropriate. Typically oversight in that respect has been under the purview of clinical licensing boards, not governed by general laws, but as we shift outside of the pandemic it is possible we may see additional shifts in terms of these policy approaches. As policymakers balance these multiple findings, perspectives and concerns, it remains to be seen how such data will be applied or used to justify permanent policies. It will also be important to continue to weigh these factors against general access to care issues so as to not inadvertently limit telehealth as a means of ensuring patients can receive necessary medical services. Additional information on the HHS-OIG study can be found by viewing the brief and complete report. < Previous News Next News >

UCHealth slashes code blues up to 70% with telehealth technologies Bill Siwicki December 20, 2022 The academic medical center uses tele-sitter and virtual ICU platforms for a program it calls Virtual Deterioration. UCHealth is a non-profit healthcare organization based in Colorado made up of 12 hospitals across the state. THE PROBLEM The organization had a new use case for virtual care, a program called Virtual Deterioration. Essentially, it was trying to find patients who were deteriorating in the hospital sooner in order to provide rescue and treatment faster to give them the best outcome. "What we were seeing prior to this program was a lot of variability as we tried to detect deterioration, and then once we were detecting it, reaching out to the bedside caregivers as to what happened next," said Dr. Diana Breyer, chief medical officer of the Northern Region at UCHealth. "And so, this was very much a part of our plan to decrease that variability for patients that were staying in place for us to be able to monitor them consistently with more frequent vital signs to make sure we really had rescued them and utilized technology to keep an extra set of eyes on them," she added. PROPOSAL UCHealth already had implemented vendor AvaSure's TeleSitter platform for patient safety and the vendor's Verify for virtual ICU. It expanded use of these technologies to Virtual Deterioration. Prior to implementing the technology, the process for virtual deterioration involved staff in a remote clinical command center working in tandem with frontline staff. "And we did try a process before we employed the technology, where it was a lot of secure chat through our EHR, similar to texting, in addition to a lot of phone calls and not really being able to visualize our patients," said Amy Hassell, RN, senior director for the Virtual Health Center at UCHealth. "This approach created a lot of friction and interruption to the bedside staff who were trying to do hands-on tasks with the patient," she continued. "So we decided to bring in an audio-visual connection. We have mobile carts, and some of our hospitals have cameras in the ceiling so we can just turn on that camera when a deterioration event is occurring." With the camera in the room, physicians and nurses in the command center now can see and interact with the patient as well as the care team. "They're able to see what's occurring so that it's just like we're in the room with that care team member," Hassell explained. "When we do this, it helps us cut down on phone calls and interruptions at the bedside, allowing us to still participate and do our part of the program. "The program provides support and makes sure milestones of care are being met throughout that deterioration event, and help triage if needed," she continued. Because it's a clinical command center that operates a lot of equipment and different platforms, staff have a weekly operational meeting with the IT team that supports the area. "They were part of our planning phases; further, we did our own IT technical dress rehearsals ahead of implementation with the clinical folks each time we went live," Hassell explained. "IT is in lockstep with us and have been very helpful to getting this deployed by helping support us, navigate us through the bumps, as we push the envelope. They're great partners to us and have been since the very beginning." MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE Today, the Virtual Deterioration technology is a separate platform. There's going to be context-aware linking soon, and that will help because then staff can go right in from the patient's chart through that portal. Clinicians at the bedside use this technology. Nursing staff and physician staff are the ones pulling the monitoring equipment into the room and using it at the bedside. On the reciprocal end, it's the remote clinical command staff who are accessing that camera to participate with the team and interact with them. UCHealth is in the midst of developing a new role called the "patient technology technician." "The patient technology technician is a staff member who brings the mobile device into the room so that nurses and physicians don't have to be responsible for setting it up, and they can remain focused on the patient," Hassell said. "That's been successful. We're really trying to get all of our folks operating at the top of their license. "This role will be very helpful as we continue to scale it, so the nursing staff aren't the ones having to bring monitoring equipment to that rapid response," she added. RESULTS When UCHealth started looking at this project, it looked for deterioration in particular, such as what are the metrics being sought. One of them that is well-established in the literature is around decreasing code events in the acute care setting, Breyer noted. "Those patients ideally are brought to the ICU and if they're going to code, code there, or if they're rescued," she said. "So we have seen improvement throughout the work that we've been doing around deterioration in this space both in the northern and southern region of UCHealth where we've implemented the solution. "And that's probably our biggest metric that we're able to measure," she continued. "I'll add that in the space of deterioration, it is sometimes difficult to measure what you're doing because you're trying to show that you're now doing something that you were previously not doing. And measuring that omission can be a challenge." The other thing staff are measuring as a process metric is for those patients who stay in place and are not being moved to a higher level of care at the time of their rapid response event. "We are measuring a consistent post-RRT intervention that we previously did not have," Breyer said. "That's another area that we're monitoring. Ultimately, we would like to see this improve mortality, but that's more of a lagging indicator, and that one is a little more variable in the literature as to how much they affect these deterioration events." Hassell stresses the organization is going to have to continue to trend this and the lagging indicator of mortality within the patient population being touched. "But we have early data where we've seen our rapid response rates increase anywhere from 26% up to about an 86% increase, depending on what location you're looking at as we've done this across our system," she reported. "And then, in early data again, we've seen our code blue events in our acute care areas go down by 25% to 70%. "We've seen our code blue events drop, which helps us know we're going in the right direction, we're detecting deterioration earlier, thus reducing a bad outcome from a code blue," she continued. To Breyer's point, UCHealth has seen the post-monitoring period, because it's leaving that camera in place for six hours and virtual staff are helping oversee and watch that patient in conjunction with the frontline staff who are very busy. "And so we've seen an increase in post-rapid response vitals anywhere from a 39% increase up to 152% increase of vitals being ordered, and then working on getting them completed," Hassell explained. "It's been a large range that we've seen, but a lot of intentionality because resources are tied up in that rapid response call. "Once the patient is stabilized, and they're staying on the floor, the nurses then go see other patients that they've not seen for a while," she continued. "And so we've got to make sure that we're taking time to watch over the patient in that kind of fragile window when they still could continue to deteriorate and need a higher level of care. That's where we put a lot of focus and energy, and those are some of our early metrics." ADVICE FOR OTHERS The piece Hassell likes about the technology currently in use is that staff have been able to flex it for a different use case that's been highly valuable. "We're still working on making it an improved platform with the company, but I also think that it's been instrumental and opened up pathways for us that we wouldn't have previously had," she noted. "We weren't seeing the success that we're seeing now until we introduced the camera piece because it solved those issues we mentioned. "And so if you are considering any sort of hybrid approach from, for example, a clinical command center or nursing workflows, you want to have a great platform that you feel your staff can use and interact with seamlessly and with ease," she advised. From a technology standpoint, having it be easy and seamless for the bedside team is key, Breyer said. "While there are now great technology solutions to some of these problems, the heavy lift is the change management with your bedside team, the non-technology piece," she concluded. "And so that's where a lot of the energy for a successful project must be." Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/uchealth-slashes-code-blues-70-telehealth-technologies?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < Previous News Next News >

Teletherapy Aimed to Make Mental Health Care More Inclusive. The Data Show a Different Story Jamie Ducharme June 14, 2021 Case studies suggest teletherapy can work well when it’s integrated into the traditional, in-person medical system. For years, teletherapy has been pitched as the next frontier in mental-health care. Unlike medical disciplines requiring a more hands-on approach—say, physical therapy or surgery—talk therapy has long seemed a natural and effective fit for telehealth. And by taking appointments off the therapist’s couch and into patients’ homes via their devices, advocates argued, telehealth could make counseling more accessible and convenient for everyone, with particular benefits for those who lived in health care deserts or who couldn’t regularly drive back and forth to see a clinician. The hope was that virtual therapy could help democratize a system that allowed almost 20% of white Americans to receive mental-health care in 2019, but fewer than 10% of people identifying as Black/African American, Hispanic/Latino, Asian or Pacific Islander. Then, of course, the pandemic hit, sending the U.S. health care system into a panic and shuttering clinics and private practices nationwide. Telehealth, once psychiatry’s up-and-comer, was suddenly its lifeline. With impressive speed, a system built around face-to-face visits shifted almost exclusively online. By May 2020, 85% of the American Psychiatric Association’s (APA) surveyed clinician members said they were conducting the majority of their sessions virtually, up from just 2% prior to the pandemic. It was the perfect pressure test for the promise of virtual mental-health care. If there was ever a time for teletherapy to shine, it was during the pandemic. But the data aren’t so shiny. Telehealth has indisputably improved mental-health care access—but not to such an extent that it delivers on promises of revolutionizing the mental-health system. The same problems that kept many people—particularly those who are lower-income or of color—from seeking care before the pandemic still exist, even with the expansion of telehealth. As a result, mental-health usage in the U.S. hasn’t changed as drastically as many advocates would have liked. In a series of TIME/Harris Poll national surveys conducted this winter and spring, about half of respondents reported using telehealth since the pandemic began, compared with about 25% who said they had beforehand. Increases in telehealth usage during the pandemic, broken down by demographic groups But only about 5% said they’d gotten mental-health care for the first time during the COVID-19 crisis. That suggests the expansion of telehealth didn’t bring in an influx of new patients to the mental-health system. Government data show a similar picture: about a quarter of U.S. adults received mental-health care in the winter of 2021, according to the U.S. Centers for Disease Control and Prevention (CDC), up from about 19% in 2019. That’s an improvement, but not an enormous one. The number of U.S. adults reporting mental health problems grew significantly during the pandemic, but the number of those getting treatment did not Similarly, a March 2021 study from California’s Kaiser Permanente health system found that telehealth allowed clinicians to conduct 7% more psychiatric visits in spring 2020 than 2019—but most of those were with patients who already had a psychiatric diagnosis. Among people without a pre-existing diagnosis, volume declined by more than 40%, suggesting that virtual appointments were more helpful for people already served by the mental-health system than those outside it. On the opposite U.S. coast, telehealth allowed McLean Hospital, a psychiatric institution near Boston, to increase outpatient volume by about 15%, counting both new and existing patients, but psychiatrist-in-chief Dr. Scott Rauch says there’s “absolutely the recognition that there are some populations,” like certain older adults, “that are having difficulty accessing the technology.” In fact, despite the increased availability of telehealth, the share of American adults with an unmet mental-health need increased from August 2020 to February 2021, from 9% to almost 12%, according to CDC data. That’s understandable, given elevated levels of anxiety, depression and stress during the pandemic, but it also suggests teletherapy is not a panacea. And that means the harder work is still ahead. There are lots of ways to think about access to care. The most obvious—making it easy for a patient to speak directly with a clinician, either in person or via a device—is only one. There are also financial barriers. A single therapy session can easily top $100 (without insurance) in many parts of the country, and telehealth has done little to change that. Rightly so, argues Dr. Joe Kvedar, a former president of the American Telemedicine Association, since there’s no evidence to suggest virtual therapy is lower quality than face-to-face. Be that as it may, high price tags mean both therapy and teletherapy remain unattainable for many. Another limitation: there are simply not enough therapists to go around. More than 125 million people in the U.S. live in an area with a shortage of mental-health practitioners, according to U.S. Health Resources and Services Administration estimates. Whether they’re seeing patients virtually or in the flesh, there are a finite number of mental-health professionals with a finite number of hours in their days. Rauch, from McLean Hospital, says telehealth can increase appointment capacity somewhat, mainly because patients are less likely to cancel or no-show, but “as long as it requires an hour of clinician time to deliver an hour of clinical service, expanded access won’t be drastically enhanced.” To meet demand, the U.S. needs not only more therapists generally, but also more therapists from diverse backgrounds. A 2020 study concluded that just 10% of U.S. psychiatrists identify as Black, Hispanic, American Indian, Alaska Native, Native Hawaiian or Pacific Islander. That means many patients of color can’t find a therapist whom they trust and with whom they can form a close rapport, a barrier that dissuades many people from getting the help they need or prevents them from reaping the full benefits of therapy, says Dr. Amanda Calhoun, a psychiatry resident at Yale and a fellow on the APA’s Council on Minority Mental Health and Health Disparities. “There are many patients who want a Black therapist and they can’t get it,” Calhoun says. “If we truly want to reduce the gap [in mental-health care usage] we need to make it a trustworthy system where people feel they can connect with their therapist or psychiatrist.” Patients who do not speak fluent English, or who feel more comfortable using another language, may also struggle to find a therapist with whom they can communicate freely. Increased use of language interpretation could be an essential tool for expanding access, Calhoun says. It seems naive, or at least wildly optimistic, to think telehealth could overcome some of these entrenched structural issues. And in some cases, virtual care actually worsens disparities. Some people don’t have a reliable Internet connection or a smart device, for example. About 7% of American adults don’t use the Internet at all, according to Pew Research Center, and those without advanced education and people of color—i.e., those already often underserved by the mental-health system—are least likely to be “digitally literate,” according to a 2020 Health Affairs article. Further, elderly adults, an estimated 20% of whom have some sort of mental-health condition, may struggle to navigate virtual platforms even if they have quality Internet access. And online platforms aren’t perfect. Some people feel uncomfortable sharing their most intimate thoughts through a screen, and any digital system runs the risk of malfunctioning or being hacked. That recently happened in Finland, when a data breach led thousands of patients’ sensitive appointment notes to land in hackers’ hands. Plus, teletherapy is only convenient if you’re able to step away from work and other responsibilities to conduct the call in a private place. While the pandemic has many white collar workers drowning in time at home, surrounded by devices, that’s far from a universal experience. For essential workers, a disproportionate number of whom are people of color, it may be only slightly easier to steal away for a teletherapy appointment than it would have been to schedule an in-person visit with a clinician. Perversely, teletherapy may be making it easier than ever for people who already had access to mental-health care to get it, while leaving behind the people who arguably need it most. If teletherapy isn’t doing the trick, the question then becomes how to better serve those still not getting the mental-health care they need. Calhoun says any real solution needs to take a step backward and investigate why many people either cannot or choose not to seek help. For people of color, centuries of neglect and mistreatment by the medical institution are not easily forgotten. In the 1700 and 1800s, influential American doctors coined since-discredited diagnoses like “drapetomania” (psychosis or madness causing an enslaved person to run away) and “negritude” (essentially, the “disease” of not being white). Many contemporary providers aren’t aware of those offensive diagnostic frameworks, Calhoun says, but the cultural legacy of that racism is still widely felt in communities of color. Training more clinicians from underserved backgrounds is the single most impactful way to encourage people of color to get help, Calhoun says. But that process takes time. In the interim, she says, all clinicians need to be educated about psychiatry’s problematic past so they can acknowledge and understand why some patients may not feel comfortable seeking help, and then hopefully address those issues in their own practices. Looking beyond telehealth and focusing on community-based programs—like church-run mental-health groups or the Confess Project, a nationwide initiative that trains barbers to be mental-health advocates—may also help build that trust. Case studies also suggest teletherapy can work well when it’s integrated into the traditional, in-person medical system. For the past decade-plus, Massachusetts has run a program that allows participating primary-care providers to teleconference in a psychiatrist during a child’s checkup, for example. Such programs don’t eliminate mistrust of the medical system, but they can at least make it easier to introduce people to the mental-health system. Mental-health apps—while not appropriate for patients with serious diagnoses, and clearly not an option for those without a smartphone—can also provide a cheap (or even free) stopgap measure for people struggling to find or afford an appointment with a clinician, Rauch says. And in some cases, adds Dr. Adrienne Robertson, a family medicine physician who works with the online medical startup Nurx, through which people can request prescription medicines and diagnostic tests simply by filling out a form, eliminating face-to-face interactions with providers can actually put patients of color at ease, because they can “just [be] a patient like everyone else.” Policy also plays a role. Nordic countries, like Sweden, have among the most robust and widely used telemedicine programs in the world, boosted by affordable, state-sponsored medical networks. Unlike in the U.S., where insurance limitations and out-of-pocket costs are roadblocks for some patients regardless of platform, many people in Nordic countries have a public option for virtual care. Last year, the Centers for Medicare and Medicaid Services made it easier for Medicare holders to use telehealth services, a policy that allowed more than a quarter of Medicare beneficiaries (and more than 30% of Black and Hispanic beneficiaries) to use telehealth during the fall and summer of 2020, but it’s not clear what will happen after the pandemic ends. Permanent federal action for Medicare and Medicaid holders—many of whom are low-income or elderly adults—could open up therapy to millions of people who can’t currently afford it. And changing federal policies that currently limit clinicians to treating patients located in the state where they are licensed could help even out distribution of the mental-health workforce. All of these fixes are considerably more complex than bringing appointments online; they require rebuilding the system, rather than simply shifting it to a new platform. That work needs to happen sooner rather than later, Calhoun says. Already, according to TIME/Harris Poll data, many people are returning to in-person medical appointments, both psychological and physical. In May, more than half of respondents who’d received mental-health care said they’d had an in-person appointment since the start of the pandemic, up from 37% in February. While some patients and clinicians are sure to stick with teletherapy after the pandemic, much of the system will seemingly revert back to how it was—and without concerted effort, the same problems may persist for years to come. This article can be found at https://time.com/6071580/teletheraphy-mental-health/. < Previous News Next News >

Video Archives Telehealth Educational Series - 2021 Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search video... Now Playing 53:29 Play Video FCC Rural Health Care Program Funding Opportunities Now Playing 01:00:09 Play Video New Mexico’s Telehealth Statute Simplified: What You Need to Know Now Playing 55:32 Play Video New Mexico Broadband A Brighter Future by Gar Clarke Now Playing 57:44 Play Video Show Me the Data: How COVID-19 Impacted Telehealth Claims & What's Next Now Playing 01:02:42 Play Video Telehealth and COVID - Lessons Learned by Van Roper, PhD Now Playing 01:00:26 Play Video HIPAA still applies: Safeguarding patient data in a work-from-anywhere world Now Playing 57:21 Play Video Developing Telehealth Workflow for the Best Possible Patient and Provider Experience Now Playing 56:01 Play Video Care Integration in the Time of Covid: Focus on Patient Experience Now Playing 01:00:43 Play Video Using Remote Monitoring Technology to Improve Patient Outcomes & Retain Staff

Senator Warner Encourages DEA Action on Telehealth & Prescribing Center for Connected Health Policy May 2021 A lack of a more permanent fix to the prescribing issue could create hurdles for patients to access treatment to SUD services. Earlier this month Senator Mark Warner (D-VA) sent a letter to Attorney General Merrick Garland regarding the long-delayed regulations from the Drug Enforcement Agency (DEA) for a telehealth registry to prescribe controlled substances. In the letter, Senator Warner expressed great concern for the delay and that “the DEA’s failure to address this issue means that a vast majority of health care providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need.” The Ryan Haight Act of 2008 allowed for certain exemptions to the use of telehealth to provide controlled substances without the telehealth provider having seen the patient in-person first, however these exemptions are narrowly tailored. Two such exemptions are: when a public health emergency (PHE) is declared, and if a provider is registered on a telehealth registry that the DEA will create. Due to the current COVID-19 PHE, providers now are able to prescribe a controlled substance without an in-person visit, but the exemption will disappear once the PHE is declared over. In 2018 under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, Congress directed the DEA to promulgate final regulations for the registry by the end of 2019. Although a December 2019 regulatory posting indicated the DEA’s intent to publish the rule, the deadline came and went without even draft regulations being released for public comments. In March 2020, a PHE for COVID-19 was declared allowing one of the exceptions for prescribing to be activated. However, the PHE is not slated to last indefinitely and many, including Senator Warner, are looking for a more lasting change. Senator Warner also sent inquiries to the previous administration regarding the status of the registry regulations that went unanswered. During COVID-19, concern for the ability of patients with substance use disorders (SUD) to access services rose as demands on health services focused on responding to the pandemic and people sheltered in place. While much of the country is beginning to open up again, a lack of a more permanent fix to the prescribing issue could create hurdles for patients to access treatment to SUD services. < Previous News Next News >

Top of Page 1 2 3 4 5 6 7 8 9 10 11 NMTHA's Telehealth Toolkit NMTHA's Telehealth Toolkit provides: ​ Templates Best practice guidelines Gene ral resources Links to additional toolkits​ 11 telehealth topic areas, including: Client engagement Provider eng agement Provider self-care Technology Clinical specialities As part of a grant provided by the New Mexico Human Services Department (HSD), the resources below were curated and organized to match themes from interviews and surveys supported through efforts by the NMTHA and Anchorum St. Vincent . How do we address broadband and other telehealth challenges in rural New Mexico? How do we get started with telemedicine? How do we improve client engagement? How do we improve provider engagement? How do we manage our telehealth practice? How can we reduce provider burnout? How do we use/expand telehealth in schools and youth programs? What are the best ways to use telehealth for clinical specialties? What is the future of telehealth? What is the latest data on telehealth? How do we collect data on telehealth use? What telehealth platforms are best (and other technology questions)? 1 HOW DO WE ADDRESS BROADBAN D AND OTHER TELEHEALTH CHALLENGES IN RURAL NEW MEXICO? ​ To o lk i ts Rural Telehealth Toolkit T h is toolkit from the Rural Health Informat ion Hub, compiles evidence-based, promising models and resources to support organizations in identifying and implementing telehealth programs to address common challenges experienced in rural communities across the United States. Audience: Facility leadership and providers in rural areas. ​ G ene ral Resources Active Programs to Improve Telehealth Services in Remote Areas Office of the Advancement of Telehealth (OAT) provides funding to promote and improve telehealth services in rural areas. Audience: Executive leadership for clinics/facilities in rural areas. ​ Virtual Critical Care: A Lifeline for Rural Hospitals and Patients (CASE STUDY) Auburn University Health and Amwell identify methods participating rural hospitals used to reduce their transfers by more than 80%, enabling patients to receive care in their communities with minimal disruption to continuity of care. ​ Comparing Televideo and Telephone Behavioral Health Services for People with Chronic Mental Illness Powerpoint presentation from the UNM Rural Psychiatry Program, Annual Spring Conference: "Adapting Care for 2021 and Beyond." ​ HOW DO WE GET STARTED WITH TELEMEDICINE? ​ Toolkits Setting Up Tele-Be havioral Health Service This step-by-step guide provided by the Indian Health Services is meant to be comprehensive, touching upon everything that may need to be considered in s etting up Telebehavioral health services at your site. Audience: Facility directors and providers serving tribal and Indigenous populations. ​ Telehealth Program Developer Kit ​From the California Telehealth Resource Center: "The CTRC Program Developer was designed to assist in developing and implementing telehealth services. This Guide provides overview information on the process and the activities and information you will collect during each of the development phases. Each of the steps is designed to allow an organization to consider critical aspects of development and to support decision making.” ​ Telehealth Implementation Playbook ​Learn more about identifying the need for telehealth, finding a vendor, designing the workflow, implementing, and scaling from the American Medical Association. ​ A Toolkit for Building and Growing a Sustainable Telehealth Program in Your Practice ​ Telehealth services and payment, roles and responsibilities, licensing and legal requirements, technology, workflow, and family medicine scenarios. Toolkit from the American Academy of Family Physicians (AAFP) . ​ Templa tes Telemedicine Multi-S ite Agreement ​Arizona Telemedicine offers a template for consideration of the mutual covenants and agreements for involved parties. ​ Best Practice Guidelines 15 Key Steps to Creating a Business Proposal to Implement Telemedicine Here you’ll find a concise overview of 15 steps to implement a successful telemedicine program at your facility. Offered by the Northwest Regional Telehealth Resource Center. Audience: Directors and Executive leadership.​ ​ General Resources Telehealth Start-Up and Resource Guide ​Covering Telehealth vs. Telemedicine, ATA and AMA guidelines, startup to sustainability, telehealth module and outlook, reimbursement guide, Medicaid, Medicare billing, CNM code information and other resources. This start-up and resource guide was created in partnership between Telligen and gpTRAC, the GreatPlains Telehealth Resource and Assistance Center. It is intended to provide an overview and framework for implementing telehealth in critical access hospitals and rural areas, and to point the reader toward reliable and informative resources for learning about telehealth and the organizations that support the use of telehealth in various ways. ​ General Provider Telehealth and Telemedicine Tool Kit ​This document contains links to reliable information sources regarding telehealth and telemedicine. Most information is directed toward providers seeking to establish a permanent telemedicine program with specific documents useful for choosing telemedicine vendors, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. ​ The New Normal: Tips for Making Telemedicine Part of Your Permanent Practice September 2020, 1:02:46 Alaska Native Medical Center and Shoshone Family Medical Center join together via Project ECHO to help participants understand tactics to develop a well-rounded telehealth program, move telemedicine into their standard operations, outline the elements of a telemedicine quality program, understand considerations of health equity in telemedicine, proactively and reactively address patient barriers, and outline infrastructure components needed to support ongoing program success. Audience: Facility directors ready to establish a telemedicine program. ​ Telemedicine: Where Do I Start? July 2020, 1:03:41 Project ECHO, Shepherd’s Clinic, UV Medicine, and CommonSpirit Health offer an expert-guided video on how to start and subsequently navigate telemedicine. Audience: Facility directors ready to establish a telemedicine program. ​ 2 3 HOW DO WE IMPROVE CLIENT ENGAGEMENT? ​ ​ Templates Behavioral Telehealth Session Checklist Mental Health Technology Transfer Center Network provides this checklist put together by Operation PAR, Inc. to provide basic guidance on the before-, during-, and after- of a telehealth session. Audience: Behavioral health providers using telehealth and looking to improve their interactions with clients or behavioral health providers using telehealth for the first time. ​ Telehealth Instructions for Behavioral Health Patients Behavioral Health Partners offers telehealth instructions to behavioral health patients in preparation for a telehealth visit.​ ​ Patient Consent Form Telemedicine patient consent form provided by the Southwest Telehealth Resource Center. Audience: Facility directors.​ Telehealth Instructions for Behavioral Health Patients ​Behavioral Health Partners offers telehealth instructions to behavioral health patients in preparation for the telehealth visit. Audience: Behavioral health providers using telehealth and looking to improve their interactions with clients or behavioral health providers using telehealth for the first time. ​ Telehealth Visit Etiquette Checklist From the American Medical Association: "This checklist is intended for clinicians and care team members who will be hosting the telehealth visit to ensure that the professional standards of in-person care is maintained in a virtual environment.” Audience: Telemedicine and telebehavioral health providers. ​ Patient Information Sheet (English) Overview of telehealth visit for patients from the FQHC Telehealth Consortium. Patient Information Sheet (Spanish) Overview of telehealth visit for patients from the FQHC Telehealth Consortium. Best Practice Guidelines Telehealth Etiquette Video Series In this series of videos, we learn the difference between a Bad, Good, and even Better telehealth consult. While some demonstrations may seem humorous or “over the top,” all are based on actual patient scenarios. As you watch, notice the difference between the Good, the Bad, and the downright Ugly. Provided by the South Central Telehealth Resource Center and produced by Old Dominion University College of Health Sciences, School of Nursing. Audience: Telemedicine and telebehavioral health providers. ​ General Resources Telehealth Best Practice s April 2020, 0:04:06 A short video from the Hawaii State Department of Health Genomics Section highlighting best practices for healthcare providers when using telehealth to provide services. Audience: All providers. ​ 4 HOW DO WE IMPROVE PROVIDER ENGAGEMENT? ​ ​ General Resources Clinical Best Practices and the Art of the Tele-Physical Exam September 2020, 0:59:31 This video aims to help providers understand the process of conducting a telemedicine visit, select the equipment needed to conduct a physical assessment through telemedicine, collec t physical data through a videoconferencing session without peripherals , and utilize creative strategies to obtain clinical data. Provided by the University of New Mexico’s Project ECHO as a joint effort with the Center for Telehealth Innovation, Education, & Research; Old Dominion University; and the Mid-Atlantic Telehealth Resource Center. Audience: Primary care providers. Physicians' Motivations and Requirements to Adopting Digital Clinical Tools February 2020 Study by the American Medical Association on “Physicians’ motivations and requirements for adopting digital health and adoption and attitudinal shifts from 2016 to 2019.” Audience: Executive leadership. ​ Telehealth Driver Diagram Develop a sustainable, patient-centered, and equitable telehealth model and achieve an advanced level of maturity with the FQHC Consortium diagram. Top Five Tips for Managing Expectations and Challenges of Transitioning to Telehealth May, 2020, 0:17:46 Discussion of the "Top 5 tips for Managing Expectations and Coping with the Challenges of Transitioning to Telehealth." Speakers: Nancy Roget, Executive Director of the Center for the Application of Substance Abuse Technologies at the University of Nevada–Reno and Co-Director of the Mountain Plain ​​Addiction Technology Transfer Center (ATTC) Regional Center, and Paul Warren, research project director at the New York State Psychiatric Institute, Division of Substance Use Disorders, in association with Columbia University and Project Manager for the Northeast and Caribbean ATTC. Audience: Executive leadership and facility directors. ​ 5 HOW DO WE MANAGE OUR TELEHEALTH PRACTICE? ​ ​ Toolkits Organizational Assessment Toolkit for Primary and Behavioral Health Care Integration Designed by a team of integration experts and offered by the National Council for Mental Wellbeing, the Organizational Assessment Toolkit for primary and behavioral health care Integration (OATI) provides a compendium of tools that lay out a path for organizations to assess readiness for integration, as well as benchmarking opportunities for those organizations well down the line in integration efforts. Audience: Facility directors and providers looking to integrate primary care and behavioral health. Telehealth Playbook Federally Qualified Health Centers Telehealth Consortium provides a Telehealth Playbook as a how-to guide to support the adoption and sustainability of telehealth at health centers. Templates Job Description RN Coordinator - Telehealth Sample Sample from UW Health. (University of Wisconsin) Audience: Clinic administrators and directors. Job Description: Telehealth Program Coordinator Sample Sample from the FQHC Telehealth Consortium. Audience: Clinic administrators a nd directors. Job Description: The Telemedicine Navigator (TMN) Sample Sample from the FQHC Telehealth Consortium. Audience: clinic administrators and directors. Job Descriptions Multiple Telemedicine Positions Includes several sample telemedicine job descriptions from the California Telehealth Resource Center. Audience: clinic administrators, directors and executive leadership. Appointment Types & Duration Guide From the FQHC Telehealth Consortium. Audience: Clinic administrators. ​ Best Practice Guidelines Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service Prepared by the Center for Connected Health Policy and The National Telehealth Policy Resource Center to provide guidance on billing for telehealth and virtual healthcare and fee-for-service (FFS) Medicare and Medicaid programs. Audience: Facility directors and providers. General Resources 2021 Medicare Coverage and Payment for Audio Only Services (Telephone E/M) The Association of American Medical Colleges provides an overview of current Medicare coverage for audio-only services. Audience: Facility directors and providers. Billing and Coding Medicare Fee-for-Service Claims During the COVID-19 Pandemic More Medicare fee-for-service (FFS) services are billable as telehealth during the COVID-19 public health emergency. Read the latest guida nce on billing and coding FFS telehealth claims. Audience: Facility directors and providers. ​ Coding Scenario: Coding for Telehealth Visits Guide for how to bill for a variety of telehealth visits from the American Academy of Family Physicians. Audience: Facility directors and providers. C overage and Payment for Telemedicine The American Medical Association offers an overview of health plan coverage and payment for telemedicine services. Audience: Facility directors and providers. Interstate Medical Licensure Compact American Medical Association explains pathway to expedite licensing of physicians already licensed in another state. Audience: Facility directors. NCTRC Webinar - Digital Marketing: Best Practices for Direct-to-Consumer Telehealth July 2020, 0:59:09 This South Central Telehealth Resource Center presentation lays the foundation for building a digital strategy for telemedicine practice. Participants will learn how to identify opportunities to reduce friction based on consumer journey, discuss highest value marketing channels based on consumer data, define audience segments, and outline conversion goals. Audience: Executive leadership and facility directors. NCTRC Webinar - Leveraging Telehealth to Address Social Determinants November 2020, 1:00:08 The National Consortium of Telehealth Resources presents on how the healthcare industry's shift from fee-for-service (FFS) to value-based care, planning, implementing, and enhancing telehealth as a service delivery model, makes it crucial to ensure practices are on the leading edge - not the bleeding edge - of reimbursement strategies. Audience: Executive leadership and facility directors. Overview of Telehealth Billing and Reimbursement Policies August 2020, 1:03:35 The Center for Connected Health Policy, via Project ECHO, presented this installment during a 10-week series offered by the National COVID Response peer-to-peer learning. Audience: Executive leadership and facility directors. Policy Telehealth Coding and Payment Quick Guide The American Medical Association’s Advocacy team summarizes the latest updates in Federal policy , including key policy and payment considerations. Audience: Executive leadership and facility directors. Service Provider Directory Telemedicine and Telehealth The directory lists companies providing medical specialty services (e.g., radiology, rheumatology, neurology, psychiatry) and ancillary services (e.g., patient education and language interpretation) through telemedicine to healthcare providers (e.g., hospitals, clinics, nursing homes, private practices, urgent care centers). Audience: Hospital and healthcare administrators and other decision-makers who want to expand or improve their healthcare services to their patients, employees, clients, etc. by connecting them with specialty care. Telehealth and Health Equity: Considerations for Addressing Health Disparities During the COVID-19 Pandemic September 2020, 1:04:50 Centers for Disease Control and Prevention presenters discuss the intersection of telehealth and health equity, and the implications for health services during the COVID-19 pandemic. Presenters will identify long-standing systemic health and social inequities that contribute to COVID-19 health disparities while highlighting the opportunities and limitations of telehealth implementation as an actionable solution. Audience: Executive leadership, facility directors and providers. Telemedicine Policy Guidelines for creating a telemedicine policy from the American Medical Association. Audience: Facility directors. Telemedicine Quick Reference Guide Created by BlueCross/BlueShield of New Mexico to help providers with questions on telemedicine services and billing. Please note: this does not include federal or state exceptions for the Public Health Emergency for COVID. Audience: Directors and providers offering telemedicine in New Mexico. Workflows and Documentation August 2020, 1:02:00 The California Telehealth Resource Center, along with Dartmouth-Hitchcock Medical Center and Mary’s Center, offer a Project ECHO video presentation showing basics of facilitating workflow conversations, creating workflow maps, and how to pull together and lead successful teams. Audience: Executive leadership, facility directors and providers. Podcasts Top Five Clinical Best Practices for Telehealth April 2020, 0:10:08 Mary Ellen Evers, LCSW, CAADC, a registered telebehavioral health clinician for mental health and addiction services and a telebehav ioral health trainer for the Center for the Application of Substance Abuse Technologies, shares her top five clinical best practices for providing services via telehealth platforms. Audience: Providers. Top Five Tips for Group Services via Telehealth April 2020, 0:09:03 Sandes Boulanger, LCSW, MCAP, the Vice President of Clinical Services for Operation Par, Inc., located in Florida, shares her top five tips for running group sessions and support via telehealth during COVID-19. Audience: Providers. Top Five Tips for Telehealth Implementation April 2020, 0:09:22 Kathy Wibberly, the Director of the Mid-Atlantic Telehealth Resource Center located at the University of Virginia Karen S. Rheuban Center for Telehealth, gives her top five tips for successful implementation of telehealth services. Audience: Executive leadership, facility directors and providers. Top Seven Telehealth Privacy Considerations April 2020, 0:09:41 The Center for Excellence for Protected Health Information presents key points around privacy, HIPAA, and confidentiality when providing telehealth behavioral health and addiction services, with Jacqueline Seitz, JD; CoE-PHI, Christine Khaikin, JD; CoE-PHI, and Michael Graziano. Audience: Executive leadership, facility directors and providers serving behavioral health patients. Top Seven Tips for Telehealth Billing April 2020, 0:18:34 A review of best practices for billing for telehealth services to ensure reimbursement during COVID-19, presented by Kathy Wibberly, PhD, the director of the Mid-Atlantic Telehealth Resource Center located at the University of Virginia. Audience: Facility directors and providers. ​ 6 HOW DO WE REDUCE PROVIDER BURNOUT? ​ ​ Toolkit Physician Suicide and Support The American Medical Association discusses how to identify at-risk physicians and facilitate access to appropriate care. Audience: Executive leadership and facility directors. Provider Self-Care Toolkit The National Center for Post Traumatic Stress Disorder discusses how managers can support employees struggling with burnout and stress. Audience: Executive leadership and facility directors. Tips for Supporting Employee Mental Health The National Council for Mental Wellbeing offers a toolkit on Stress, Anxiety, Depression: "What it Looks Like at Work and How to Provide Support." Audience: Executive leadership and facility directors. General Resources Burnout in Healthcare Workers: Prevalence, Impact, and Preventative Strategies Article from the National Center for Biotechnology Information, U.S. National Library of Medicine . Audience: Providers and executive leadership. Equipping Physicians to Manage Burnout Resources from the American Medical Association, including a tip of the week, free learning modules, and podcasts. Audience: healthcare leaders and providers. Gratitude Practice for Nurses The Gratitude Practice for Nurses initiative is a joint effort of the American Nurses Foundation and the Greater Good Science Center at the University of California, Berkeley, aimed at cultivating the practice of gratitude within the nursing profession. Decades of research have shown that practicing gratitude is highly effective in promoting physical and psychological health, both at the individual and organizational levels. Audience: Nurses and healthcare leaders. Mental Health Support for Healthcare Providers Support from the National Alliance on Mental Health includes confidential and professional support, peer support, resources on building resiliency, and more. Audience: All medical and behavioral treatment staff and providers. Provider Burnout: Prioritizing Self-Care to Strengthen Patient Care Ideas for self-care from the American Academy of Physician Assistants. Audience: All medical and behavioral treatment staff and providers. ​ 7 HOW DO WE USE/EXPAND TELEHEALTH IN SCHOOLS AND YOUTH PROGRAMS? ​ Toolkit National Telehealth Toolkit for Educators/Faculty Created in 2019, a group of over 45 nursing faculty from 19 U.S. States, Canada, and 28 universities met to develop a telehealth toolkit with the goal of providing faculty with content needed to integrate telehealth across the curriculum for health professions programs. ​ Roadmap for Action: Advancing the Adoption of Telehealth in Child Care Centers and Schools to Promote Children’s Health and Well-Being School-Based Checklist and Resources Compiled by the Clearinghouse for Military Family Readiness at Pennsylvania State University, this document provides a variety of checklists as well as links to additional resources. Audience: Directors of school and youth programs using telehealth. ​ Best Practice Guidelines Evaluation Considerations for Delivering Virtual School-B ased OT Services via Telehealth Checklist, resources, and recommendations provided by the American Occupational Therapy Association. Audience: Directors of school and youth programs using telehealth. ​ General Resources How to Start and Implement a School-Based Telehealth Program ​ How to Build a School-Based Telemedicine Program in Your Community 0:52:21 The South Central Telehealth Resource Center, University of Arkansas for Medical Sciences, offers a video on building a school-based telemedicine program. Audience: Directors of school and youth programs looking to implement a telemedicine program. R eimbursement of School-Based Telehealth Services-Report The National Academy for State Health Policy report explores how states are increasing their Medicaid coverage of school-based telehealth services during COVID-19, determining which services can be effectively delivered through telehealth, and supporting equitable access to telehealth services for students. Audience: Directors of school and youth programs using telehealth. ​ 8 WHAT ARE THE BEST WAYS TO USE TELEHEALTH FOR CLINICAL SPECIALTIES? ​ Behavioral Health Best Practice Guide Introduction to telehealth for behavioral health care. Audience: Executive leadership and fac ility directors. Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) The Medical University of South Carolina offers a 2-part webinar series: Part 1 (0:59:26) - Provides logistics for delivering trauma-informed, evidence-based mental health services via telehealth (e.g., necessary equipment, procedures, documentation, ethical considerations) Part 2 (1:41:09) - Provides specific tips and resources for delivering Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) via telehealth. Audience: Facility directors and providers. Dentistry ADA Guide to Understanding and Documenting Teledentistry Events The American Dental Association provides Q&A with scenarios providing insight and understanding of how care is delivered and reported wh en teledentistry is a facet of the process. Audience: Dental office directors and providers. Emergency Departments Best Practice Guide: Introduction to Telehealth Practices for Emergency Departments The Health Resources and Services Administration (HRSA) provides information on getting started, billing, tele-triage, tele-emergency care, virtual rounds, e-consults, and telehealt h for follow-up care. Audience: Executive leadership, ED directors, and providers. Hospice and Palliati ve Care Best Practices for Using Telehealth in Hospice and Palliative Care Article from the National Library of Medicine highlights the work of expert clinicians from multiple hospice and palliative care organizations to develop best practices for conducting telehealth visits in inpatient and community settings. Audience: Facility directors and providers. ​ Maternal Health UMTRC Webinar: Ohio Telehealth Billing & Reimbursement Webinar for Maternal Health May 2020, 0:55:22 Ohio State University and the Ohio Department of Health provide a video on how maternal health providers in Ohio can integrate telehealth into their clinical practices, and a deep dive into telehealth reimbursement for maternal health, with an emphasis on Ohio Medicaid. Audience: Facility directors and providers. ​ Pediatrics Pediatric Telemedicine in Ambulatory and Inpatient Settings D uring COVID-19 and Beyond May 2020, 1:0 4:51 The University of Minnesota Pediatrics Grand Rounds offers a video that describes: 1. Evolution of telemedicine practice before and since COVID in pediatric ambulatory and inpatient settings. 2. Three elements of best practice for effective telemedicine visits. 3. Advantages and disadvantages of telemedicine in Pediatrics. 4. Applications for telemedicine after the COVID-19 pandemic in your practice. Audience: Facility directors and providers. Remote Monitoring Remote Patient Monitoring Toolkit The Mid-Atlantic Telehealth Reso urce Center designed a toolkit to help many different audiences quickly understand remote patient monitoring and define the responsibilities of each role. Audience: Facility directors and providers. ​ Substance Use Disorders Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders From the Center for Mental Health Services (CMHS) and Substance Abuse and Mental Health Services Administration (SAMHSA): “This guide reviews ways that telehealth modalities can be used to provide treatment for serious mental illness and substance use disorders among adults, distills the research into recommendations for practice, and provides examples of how these recommendations can be implemented.” Audience: Behavioral health providers and clinical supervisors. ​ Tele-Treatment for Substance Use Disorders Treating substance use disorders via telehealth requires expertise and training in addiction care. Telehealth Health and Human Services provide special considerations to keep in mind for telehealth substance use treatment. Audience: Facility directors and providers. ​ 9 WHAT IS THE FUTURE OF TELEHEALTH? ​ ​ Best Practice Guidelines Current State Laws and Policies for New Mexico Current state laws and policies related to telemedicine in New Mexico curated by the Center for Connected Health Policy. Audience: Ex ecutive leadership, facility directors and providers. Statute on Establishing a Patient-Physician Relationship Via Telehealth The American Medical Association offers a quick reference guide for providing care with medical ethics while maintaining the patient’s well-being via telemedicine. Audience: Executive leadership, facility directors and providers. General Resources A New Decade for Telehealth: A Loo k at the Rapid Rise in Telehealth Adoption and What's Required to Support its Growth White paper from Spectrum Enterprise, a part of Charter Communications, Inc., a national provider of scalable, fiber te chnology solutions serving America’s largest businesses and communications service providers. Audience: Executive leadership. Covering the Cost of Telehealth White paper from Spectrum Enterprise, a part of Charter Communications, Inc., a national provider of scalable, fiber technology solutions serving America’s largest businesses and communications service providers: “Healthcare leaders expect patient demand for digital services to continue rising — even after the COVID-19 public health crisis subsides. That in turn has healthcare organizations (HCOs) strategizing on how to cover the costs of the telehealth investments they’ll need to meet rising demands in the months and years ahead.” Audience: Executive leadership. ​ How Telehealth Can Support People Living in the Community The American Telehealth Association provides background education on telehealth, increases awareness of the benefits of telehealth that support community living, and raises policy considerations for States, health plans, and providers. ​ Medicare and Medicaid COVID-19 Program Flexibilities and Considerations for Their Continuation Statements of Jessica Farb, Director of Health Care, and Carolyn L. Yocom, Director of Health Care, were incorporated in the Testimony Before the Committee on Finance, U.S. Senate, in response to the COVID-19 pandemic to discuss flexibilities related to Medicare and Medicaid made available during the public health emergency. Testimony highlights the various flexibilities and waivers implemented during the COVID-19 pandemic and provides preliminary information on how these flexibilities have likely benefited providers and beneficiaries. Audience: Executive leadership, facility directors and providers. Pending Telehealth Legislation and Regulation in New Mexico and the United States A quick reference guide presented by the Center for Connected Health Policy. Audience: Healthcare leadership and all providers. ​ Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care This report, jointly developed by the American Medical Association and Manatt Health Strategies, expands on existing research by articulating a more robust framework for measuring the value of digitally enabled care that accounts for the various ways in which virtual care programs may increase the overall “return on health” by generating positive impact for patients, clinicians, payers and society going forward. Audience: Executive leadership, facility directors and providers. ​ Telehealth Needs & Opportunities: Emerging Findings from Non-Profit Behavioral Health Providers in Northern New Mexico Special Report from the New Mexico Telehealth Alliance and Anchorum St. Vincent, a community health impact organization, resulting from a needs assessment in early 2021. Audience: Executive leadership, facility directors and providers. ​ 10 WHAT IS THE LATEST DATA ON TELEHEALTH USE OR HOW DO WE COLLECT DATA ON TELEHEALTH USE? ​ Te mplates Telehealth Patient Experience Survey Sample survey from the FQHC Telehealth Consortium. Audie nce: Providers and administrators. ​ General Resources Configuring Telehealth Visits Using RPMS and EHR Presentation by the Indian Health Service from Sept. 2020 regarding standardization for national tracking and reporting. Audience: Facility directors and provid ers serving native and Indigenous populations. Measures of S uccess: 5 Key Metrics for Evaluating Telehealth Services White paper from Spectrum Enterprise, a part of Charter Communications, Inc., a national provider of scalable, fiber technology solutions serving America’s largest businesses and communications service providers. Audience: Executive leadership. ​ Measuring Patient Experience and Satisfaction with Telemedicine: A Quick Guide to Survey Selection The California Health Care Foundation provides a guide to support and inform quality improvement efforts at health centers. Audience: Executive leadership and facility directors. ​ Supporting Today’s Data-Intensive Clinical Environments Spectrum Enterprise, a part of Charter Communications, Inc., a national provider of scalable, fiber technology solutions serving America’s largest businesses and communications service providers, offers tep-by-step guidance for planning a network infrastructure that advances digital health initiatives and improves efficiency and patient outcomes. Audience: Executive leadership. Telemedicine and Non-Telemedicine Visit Experience Interview Guides The University of Rochester provides an interview guide designed to be conducted with patients, physicians, nurses, and office staff in an ambulatory setting and includes questions to assess users' satisfaction and perceptions of telehealth. Audience: Executive leadership, facility directors and providers. ​ 11 WHAT TELEHEALTH PLATFORMS ARE BEST AND OTHER TECHNOLOGY QUESTIONS? ​ Toolkits Remote Patient Monitoring Platforms: Vendor Overview Snapshot of various platforms from the FQHC Teleheal th Consortium. Telehealth Platforms: Vendor Overview Snapshot of various platforms from the FQHC Telehealth Consortium. Vendor Selection Toolkit From the Mid-Atlantic Telehealth Resource Center, this provides some quick info on selecting your telehealth vendor. Audience: Directors and executive leadership. ​ General Resources AMA Telehealth Implementation Playbook Includes a vendor evaluation checklist on pages 32-38. Audience: Directors and executive leadership. Comparing 11 Top Telehealth Platforms: Company Execs Tout Quality, Safety, EHR Integrations Article from HealthcareIT News. Audience: Executive leadership and facility directors. ​ Growing Digital Health Innovation Means It’s Time for a Bandwidth Checkup Whitepaper from Spectrum Enterprise, a part of Charter Communications, Inc., a national provider of scalable, fiber technology solutions serving America’s largest businesses and communications service providers. Audience: Directors and executive leadership. ​ Telehealth Technology Trends October 2020, 0:59:41 National Consortium of Telehealth Resources: The Telehealth Technology Assessment Resource Center (TTAC) has seen a significant shift in choosing telehealth technology for providing patient care, specifically in choosing video conferencing platforms and providing care to the patient in the home, both from the provider and the consumer perspective. TTAC gives a short overview of changing trends observed now and for the future. Audience: Executive leadership and facility directors. The Top 30 Tools for Improving Your Telehealth Implementation Telehealth tools, hardware, software, monitoring and on-demand portals from Cambridge Brain Sciences. Audience: Executive leadership and facility directors. ​

The Center for Connected Health Policy (CCHP) released its bi-annual summary of state telehealth policy changes for Spring 2022 Center for Connected Health Policy Spring 2022 The Center for Connected Health Policy’s (CCHP) Spring 2022 analysis and summary of telehealth policies is based on its online Policy Finder. It highlights the changes that have taken place in state telehealth policy between the Fall 2021 Summary Report, and Spring 2022. The research for this Spring 2022 executive summary was conducted between January and April 2022. This summary offers policymakers, health advocates, and other interested health care professionals an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder which breaks down policy for all 50 states and the District of Columbia. The Center for Connected Health Policy (CCHP) is releasing its Spring 2022 Summary Report of the state telehealth laws and Medicaid program policies catalogued in CCHP’s online Policy Finder tool. Prior to Spring 2021, this same information was released at least twice a year in the form of a 500+ page PDF report titled, “the State Telehealth Laws and Reimbursement Report” since 2012. With the transition to the online Policy Finder, users are able to navigate each state’s updated information as soon as CCHP makes it available. Additionally, the information from the online tool can be exported for each state into a PDF document using the most current information available on CCHP’s website. CCHP plans to continue to produce these bi-annual summary reports of the status of telehealth policies across the United States in the Spring and Fall each year to provide a snapshot of the progress made in the past six months. CCHP is committed to providing timely policy information that is easy for users to navigate and understand through our Policy Finder. The information for this summary report covers updates in state telehealth policy made between January and mid-April 2022. For full report: https://www.cchpca.org/2022/05/Spring2022_ExecutiveSummaryfinal.pdf < Previous News Next News >

Telehealth helps stop suicidal ideation for many patients, study finds Bill Siwicki December 29, 2022 One person dies from suicide every 11 minutes in the U.S. A new study shows that telemedicine can be used to treat more severe mental illness – contrary to previous thought. Recently, the Journal of Medical Internet Research published some significant data highlighting the efficacy of psychiatric care delivered through telehealth: Those in the treatment group were 4.3 times more likely to have suicidal ideation remission. This is noteworthy because telehealth has not traditionally been equipped to treat those with the most severe symptoms of mental health due to the oversight necessary to actually provide safe, effective treatment, said Dr. Mimi Winsberg, chief medical officer at Brightside Health, which led the study. We spoke with Winsberg to get an in-depth look at this study and what the results mean for the future of telehealth and mental healthcare. Q. Please talk about your new study that examines the impact of telepsychiatry on reduction in suicidal ideation over time. Who was involved? What kind of care did they receive? What role did technology play? A. The study, which was published in JMIR Formative Research, sought to determine if Brightside Health's telehealth platform, which is equipped with precision prescribing clinical decision support, could successfully reduce suicidal ideation among enrolled patients, versus a control group who tracked their symptoms on the platform without receiving care. Another goal of the study was to describe the symptom clusters of patients who present with suicidal ideation in order to better understand the psychiatric symptoms associated with suicidal feelings. The study was large scale including participants of diverse geography and social demographics. It included a total of 8,581 people who completed a digital intake on the Brightside platform. Of those, 8,366 elected to receive psychiatric care from Brightside, while 215 tracked their symptoms on the platform without receiving care. Those who elected to receive psychiatric care through Brightside received a minimum of 12 weeks of treatment that included video visits with their providers, asynchronous messaging, and a prescription of at least one psychiatric medication. Brightside's technology platform was used to deliver clinically validated measures of depression and anxiety, as well as questions about clinical presentation, medical history and demographics. The proprietary precision-prescribing platform embedded in the tech platform analyzes these data points using an empirically derived algorithm to provide real-time care guidelines and clinical decision support to its providers using a computerized symptom cluster analysis. Q. The study led to some very promising outcomes. Please describe them and the success you achieved with telemedicine. A. The study found that patients enrolled in Brightside Health's telehealth platform had reduced suicidal ideation after 12 weeks of treatment. Patients who received treatment via Brightside Health were also 4.3 times more likely to have remission of their suicidal ideation than the control group who were monitored on the platform but did not receive care. The results demonstrated that a telehealth platform equipped with clinical decision support was an effective intervention for the symptom of suicidal ideation. In addition, we found that suicidal ideation had higher correlations with cognitive symptoms of hopelessness and poor feelings of self-worth, than with the physical symptoms of depression such as disrupted sleep and low energy. Q. Telehealth hasn't traditionally been equipped to treat these kinds of patients. What made the difference here? A. Historically, we have not relied on telehealth solutions to address more serious symptoms of depression. Clinicians are hesitant to treat individuals with suicidal ideation over telehealth because of the perceived risks. However, the results of this study are significant because they demonstrate effectiveness in treating these symptoms through a telehealth platform with clinical decision support, which may help alleviate concerns about the use of telehealth in addressing suicidal ideation. Telehealth can involve more than simply connecting a provider and patient via video camera. The telehealth platform used for the study was equipped with novel features such as remote patient monitoring and clinical decision support. A sophisticated telehealth intervention can assiduously track symptom presentation and outcomes with measurement-based care and offer real-time interventions along with machine learning and algorithmically based clinical decision support to select the best treatment. Q. What does all of this mean for the future of telemedicine and mental health? A. The future of mental health via telemedicine promises more widespread adoption of solutions for the majority of behavioral health conditions, even those with increasing severity of symptoms. We may see telehealth deployed for more serious mental illness, particularly when the telehealth platform can incorporate novel technologies to optimize care delivery. Additionally, as payers and providers collaborate to deliver more effective care, telehealth will likely become more than a means to deliver care, but also a way to enhance care delivery and provide highly effective care to those who need it most with expediency. At Brightside Health, we will continue to research the impact of telehealth treatment across the spectrum of mental health conditions, including those on the higher end of the severity axis. To that end, we are launching Crisis Care, a first of its kind program delivered nationally and over telehealth to treat patients with active suicidal ideation. The program is grounded in the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) framework. This study in JMIR Formative Research laid the foundation for this program, and we are seeing an obvious need for such a national program in the U.S., where one person dies from suicide every 11 minutes. We look forward to furthering this important – and life-saving – work. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telehealth-helps-stop-suicidal-ideation-many-patients-study-finds < Previous News Next News >

Expanded Medicare Telehealth Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs Sunny J. Levine Hannah E. Zaitlin Nathaniel M. Lacktman November 09, 2022 Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” This new reimbursement is intended to further the Centers for Medicare and Medicaid Services’ (CMS) objectives in its 2022 Behavioral Health Strategy, with a particular focus on improving access to substance use disorder (SUD) prevention, treatment, and recovery services. To this end, CMS added several expansion opportunities for OTPs, including telehealth coverage. However, these flexibilities do not extend to SUD treatment provided outside an OTP, such as office-based opioid treatment (OBOT) services. Details of the new coverage rules are contained in the 2023 Physician Fee Schedule (PFS) Final Rule (Final Rule), and summarized below. Background and History of Medicare Telehealth Coverage of SUD Treatment Prior to the federal COVID-19 Public Health Emergency (PHE), to initiate treatment with buprenorphine at an OTP, a practitioner needed to perform a complete in-person physical evaluation. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administrating (SAMHSA) waived this requirement for the duration of the PHE, allowing medication-assisted treatment (MAT) practitioners to initiate treatment with buprenorphine via audio-video telehealth and/or audio-only telephone communications without an initial in-person evaluation (subject to state law restrictions). This temporary exemption only applies to OTP patients treated with buprenorphine; it does not apply to new patients treated with methadone. CMS also extended coverage for SUD treatment services provided via telehealth. While Medicare telehealth services fall under Section 1834(m) of the Social Security Act, which generally limits payment for telehealth services to patients located in specific types of medical settings (originating sites) in mostly rural areas, the SUPPORT Act amended Section 1834(m), by removing the originating site and geographic limitation for telehealth services provided to individuals with a diagnosed or co-occurring mental health disorder (including a SUD) delivered on or after July 1, 2019. In 2020, CMS established a new Part B benefit category for opioid use disorder (OUD) treatment provided by OTPs. The covered benefit includes MAT for patients with OUD, a leading treatment modality that combines prescribing FDA-approved medication (e.g., methadone and buprenorphine) with counseling and other behavioral therapy, to provide a whole person approach. Subsequently, the Consolidated Appropriations Act of 2021 (CAA) permanently removed the geographic restrictions and added the patient’s home as a qualifying originating site for telehealth services provided for the diagnosis, evaluation, or treatment of a mental health disorder. Under the CY 2022 PFS final rule, CMS revised the definition of “interactive telecommunication system” to allow the use of audio-only communications technology for telemental health services under certain conditions when the beneficiary is located at their home. New Changes to Medicare OTP Telehealth Services Under the Final Rule, CMS made the following changes relating to OTP telehealth services: 1. OTPs can use the OTP intake add-on code to bill for the initiation of buprenorphine treatment through two-way interactive audio-video communication technology, as clinically appropriate, and in compliance with all applicable requirements (provided such flexibilities are authorized by DEA and SAMHSA at the time service is furnished). 2. Audio-only telephone calls can be used to initiate buprenorphine treatment at OTPs when two-way audio-video communications technology is not available to the beneficiary, and all other requirements are met. 1. CMS interprets “not available to the beneficiary” to include “circumstances in which the beneficiary is not capable of or has not consented to the use of devices that permit a two-way, audio/video interaction because in each of these instances audio/video communication technology is not able to be used in furnishing services to the beneficiary.” 3. After the initiation of buprenorphine treatment, OTPs can continue to use audio-only telephone calls to perform periodic patient assessments when two-way audio-video is not available (provided such flexibilities are authorized by DEA and SAMHSA at the time service is furnished). This flexibility will be in place until the end of CY 2023. CMS Recognized Broad Stakeholder Support for Telehealth SUD Treatment In comments to the new rules, stakeholders lauded the benefits of two-way audio-video communications technology used to initiate treatment with buprenorphine. CMS concurred, noting it is “of critical importance to individuals who have limited ability to attend in-person appointments or who are disincentivized to do so due to perceived stigma and fear.” CMS also acknowledged that audio-only flexibilities “further promote equity for individuals who are economically disadvantaged, live in rural areas, are racial and ethnic minorities, lack access to reliable broadband or internet access, or do not possess devices with video functions.” CMS declined to address comments relating to issues outside the scope of the final rule, including: 1) comments related to allowing prescribers to initiate buprenorphine treatment for SUDs without an in-person evaluation in other settings (outside of OTPs); 2) coordinating with DEA to create a special registration for telehealth providers under the Ryan Haight Act; and 3) developing an add-on code for Contingency Management. While the final rule does not extend coverage to OBOT treatment – which has proven a successful treatment option during the COVID-19 PHE – it evidences CMS’s view of technology as a viable way to provide life-saving SUD treatment to vulnerable beneficiaries. © 2022 Foley & Lardner LLP National Law Review, Volume XII, Number 313 See original article: https://www.natlawreview.com/article/expanded-medicare-telehealth-coverage-opioid-use-disorder-treatment-services < Previous News Next News >

Commentary: Rethinking the Impact of Audio-Only Visits on Health Equity by Lori Uscher-Pines and Lucy Schulson December 17, 2021 New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. Prior to the outbreak of the COVID-19 pandemic in 2020, audio-only visits were rarely included in definitions of telehealth and seldom reimbursed. As clinicians were granted numerous flexibilities to deliver various care modalities at the onset of the pandemic, telephone calls were elevated to the status of reimbursable audio-only visits. Although audio-only visits were used across the health care system, federally qualified health centers (FQHCs) that provide primary care and behavioral health services to millions of Medicaid and uninsured patients were particularly likely to deliver audio-only visits in the spring of 2020. They were also more likely to rely on them as the pandemic progressed (PDF) because of patient and clinic barriers to video telehealth and a supportive policy environment. Almost two years into the pandemic, FQHCs in multiple states are reimbursed at the same Prospective Payment System (PPS) (PDF) rate for in-person, video, and audio-only visits. The new flexibility to deliver audio-only visits was a welcome change. It was widely recognized that, due to the digital divide, audio-only visits would play an essential role in maintaining access to care for many populations. An audio-only visit was far better than the alternative at the time: no visit at all. Currently, experts who call for the permanent reimbursement of audio-only visits cite concerns for the underserved. They argue that given the widespread lack of broadband, limited digital literacy, and reduced access to devices, requiring video visits may leave certain patients behind and exacerbate inequities in health care. While this argument had merit in the first year of the pandemic, the risk benefit calculation of audio-only visits has changed, and it is increasingly important to protect patients from potentially lower-quality audio-only visits. We discuss how ongoing delivery of audio-only visits can reduce the quality of care among low-income populations and contribute to health disparities. At the same time, the reliance on audio-only visits may be preventing innovation that could improve video and in-person health care visits for all populations. Ongoing delivery of audio-only visits can reduce the quality of care among low-income populations and contribute to health disparities. Share on Twitter In the spring of 2020, audio-only visits were a lifeline at a time of uncertainty and helped address a critical need when the delivery system was desperate for quick solutions. Numerous data sources showed high use of audio-only visits in this period (11–48 percent of visits), particularly among low-income and older adults. Even though estimates of audio-only use from claims data were high, they were likely underestimates of the total number of visits being delivered. This is the case because of challenges and inconsistencies with coding telehealth visits and the tendency for scheduled video visits to become audio-only visits when technical difficulties arise. For example, using claims data, Medicare estimated that one in three telehealth visits in the spring of 2020 were audio-only visits. However, data from the Medicare Current Beneficiary Survey showed that the majority of beneficiaries (56 percent) who had telehealth visits reported that they were exclusively audio-only. The Variation in Use Across Settings As the COVID-19 pandemic continued, audio-only visits retreated in some settings but remained dominant in others. Studies of the commercially insured demonstrated that as in-person visits rebounded in 2021, telehealth visits in general, and audio-only visits in particular, declined and play an increasingly minor role. In contrast, in the summer of 2021, 32 percent of FQHCs (PDF) across the United States reported that the majority of their total visits continued to be audio-only. A study of 43 large FQHC networks in California demonstrated ongoing, high-volume delivery (PDF) of audio-only visits in primary care despite receiving technical assistance and funding to grow their telehealth programs. Quality Concerns with Audio-Only Visits Audio-only visits can increase access to care, but this key advantage may come at the expense of quality. Evidence of the quality of audio-only visits in primary care is scant but concerning. First, clinicians report that audio-only visits are not as effective. Challenges range from the relatively minor (for example, not being able to assess facial expressions) to major issues (for example, not being able to verify the patient's identity). Studies have shown that clinicians can miss visual cues and struggle with establishing rapport with patients, and visits are shorter. Additionally, patients report lower satisfaction and comprehension rates. Even as new data emerge about the quality of audio-only visits, it is clear that some patients, including many commercially insured patients, are largely getting more evidence-based, tested services (in-person and video visits) while low-income patients are getting an untested service. Furthermore, cervical cancer screening rates, child weight assessment and counseling, and depression screening and follow-up at FQHCs declined with telehealth (predominantly audio-only) use. Drivers of Audio-Only Visits The variation in audio-only use across different populations is likely not fully explained by differences in which conditions are clinically appropriate for audio-only visits or by patient readiness for video visits. Rather, reimbursement, provider preferences, and organizational priorities are playing a significant role in determining how many in-person visit slots there are, and by extension, which patients get audio-only, video, or in-person visits. In October 2021, 33 percent of FQHC visits in California and 24 percent in Arizona, two states that reimburse FQHCs the full PPS for audio-only visits, were conducted virtually. Contrast that with South Dakota (a state that stopped reimbursing for audio-only visits in its Medicaid program as of July 2021 (PDF)), which only saw 5 percent of visits conducted virtually in the same time period. Although the digital divide is a significant problem in the United States that requires focused attention, it cannot fully explain the variation. A recent paper in Medical Care showed that provider behavior and organizational factors, as opposed to patient digital barriers, are playing the largest role in audio-only visits. Sixty-six percent of Medicare beneficiaries who were exclusively offered audio-only visits during the pandemic had access to telehealth-compatible devices and to the internet. Creating Conditions for High-Quality Telehealth Care At present, 22 state Medicaid programs allow for reimbursement for audio-only visits, with nine states adding reimbursement to permanent policy since the spring of 2021. The trend is to increase access to audio-only visits in the interest of health equity. However, telehealth experts have pointed out that failing to rein in audio-only visits risks escalating costs and creating a two-tiered system (PDF) in which affluent patients get video and in-person visits and low-income patients get telephone calls. It may be that this two-tiered system is already coming to fruition and is now harder to justify in the name of emergency response than it was in the spring of 2020. In March 2021, we argued that reimbursement of audio-only visits should continue for several years beyond the public health emergency to avoid exacerbating disparities in access. However, given emerging data about the prominence of audio-only visits in low-income communities, we now have concerns about this approach. Generous parity reimbursement for audio-only visits may be creating perverse incentives to deliver substandard care to the most underserved. It also may be stifling innovation that could be occurring in the delivery of video and in-person visits. Generous parity reimbursement for audio-only visits may be creating perverse incentives to deliver substandard care to the most underserved. Share on Twitter The patients who have challenges accessing video visits are the same patients who face barriers accessing in-person care. Instead of offering scheduled audio-only visits, health systems could be incentivized to address the social determinants of health that create barriers to higher-quality visits. For example, they could partner with community groups to provide transportation to appointments, provide access to low-cost electronic devices, invest in accessible telehealth platforms, create telehealth access points in the community, and train telehealth navigators. Audio-only visits are a powerful tool for emergency response, and over time researchers and clinicians will identify situations in which audio-only visits alone, or as a component of hybrid care models, can support comparable care. But in the coming months, it may be time to consider limiting audio-only visits in the pursuit of health equity. Lori Uscher-Pines is a senior policy researcher and Lucy Schulson is an associate physician policy researcher at the nonprofit, nonpartisan RAND Corporation. This commentary was first published on December 17, 2012 on Health Affairs Blog. Copyright ©2021 Health Affairs by Project HOPE—The People-to-People Health Foundation, Inc. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis. < Previous News Next News >

Why is an Alliance needed? NMTHA assists with ensuring telehealth program dollars are applied effectively and efficiently through : Clinical coordination Technical coordination Health information technology Administrative Services Federal, State, and private funds are spent on telehealth programs with little or no attention to coordination with other programs, efficient reuse of existing resources, and delivering the best level of cost-effective services. Existing and proposed programs create a patchwork of telehealth solutions with overlaps, gaps, and little long-term accountability. No entity coordinates telehealth statewide and ensures that telehealth programs and dollars generate the best possible health benefits for New Mexicans. How can New Mexico ensure dollars spent on telehealth programs are applied effectively and efficiently? ​ New Mexico needs an organization to provide the following telehealth-related services: ​ Clinical Coordination: Identifying healthcare delivery needs, finding organizations to deliver healthcare services, monitoring the delivery, and ensuring improved health outcomes. Technical Coordination: Identifying the proper technical solution for healthcare service delivery including equipment evaluation, telecommunications connectivity, reuse of existing resources, scheduling, network management, support, and maintenance. Health Information Technology: Managing information exchange among healthcare providers and ensuring compliance with federal, state, and other standards. Administrative Services: Reimbursement issues, administrative policy and procedures, legislative issues, and general management of the telehealth process. Every dollar spent on coordination ensures that dollars spent on specific telehealth programs generate the greatest improvement in health across all programs and regions of the State. Be part of the solution! Join the New Mexico Telehealth Alliance JOIN NOW

What you need to know about standing up a virtual nursing unit Bill Siwicki February 15, 2022 Jennifer Ball, RN, director of virtual care at Saint Luke's Health System of Kansas City, describes the workings and many benefits of the telehealth approach. The U.S. nursing shortage has reached critical levels during the pandemic battle, paired with an aging population. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees. To serve its inpatient population and overcome the nursing shortage, St. Luke's Health System of Kansas City has developed an innovative approach leveraging virtual care. The organization created and implemented one of the nation's first virtual nursing units to reduce the burden on bedside nurses and much more. In her HIMSS22 educational session entitled "Lessons Learned from Launching a Virtual Nursing Unit," Jennifer Ball, RN, director of virtual care at Saint Luke's Health System of Kansas City will offer attendees next month a deep dive into the workings of the virtual nursing unit. She has been a nurse for 35 years, with a clinical background in ICU, trauma and ED, and has 25 years of experience in nursing management. To read the full article: https://www.healthcareitnews.com/news/what-you-need-know-about-standing-virtual-nursing-unit < Previous News Next News >

Amazon's telehealth arm quietly expands to 21 more states By Katherine Khashimova Long March 8, 2021 An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector. An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector.The service, Amazon Care, launched a year ago as an app providing on-demand chat and video consultations with medical professionals for Amazon's then-54,000 Puget Sound employees. Users can also book in-person visits at their home or office with clinicians. Payment for the service routes through Amazon.com. In recent weeks Amazon Care has incorporated in Alaska, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Maine, Maryland, Montana, New Hampshire, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont and Wyoming, according to records filed with state agencies. The online health magazine Stat was first to report Amazon Care's expansion. Amazon did not respond to questions about whether access to the newly expanded service will continue to be limited to Amazon employees. But there are indications that Amazon may begin offering the service to a broader audience. In December, Business Insider reported that Amazon had pitched other companies, including Seattle-based Zillow, on the health care app. Amazon has been hiring health care practitioners, research scientists and product managers for the app around the country—including in California, Georgia and Texas, according to Stat. And with a nationwide group of home health care providers, Amazon Care on Wednesday announced it would begin lobbying lawmakers to ease regulations on what kind of health services can be performed outside of a doctor's office—potentially widening the services Amazon Care can provide. Amazon has not yet received professional licenses that would allow it to operate facilities like medical testing labs in the 21 states it has filed to do business. However, that paperwork may be coming down the line: In its Georgia business registration, Amazon indicated it planned to start doing business in the state this July. Amazon began nosing around the lucrative field of health care in 2017, when it made several high-profile hires from the sector. Former One Medical Vice President Christine Henningsgaard joined Amazon, as did Missy Krasner, from the digital health-records management company Box.Henningsgaard, who left Amazon in 2019 to start the maternity-focused health care venture Quilted Health, refers to herself on her LinkedIn profile as part of the "founding team" of Amazon Care, which she described as "bringing customer obsession, advanced technology, and last mile logistics to health care." Around the same time, the company formed an ill-starred health care consortium with Berkshire Hathaway and JPMorgan Chase. The organization, later dubbed Haven, had a stated goal of offering better service and rates from health care providers on behalf of the triumvirate's nearly 1.2 million employees; Haven dissolved last month. Amazon purchased online drugstore Pillpack for $753 million in mid-2018; the next year, the company won landmark approval allowing its voice-activated artificial intelligence, Alexa, to transmit private patient information. When the coronavirus began infecting Amazon's hundreds of thousands of warehouse workers last summer, the company built hundreds of its own on-site laboratories to test employees. In November, Amazon launched an online pharmaceutical delivery service, sending drugstore share prices tumbling. Just weeks later, Amazon's cloud-computing division unveiled a health data management service for doctors and hospitals that complies with patient confidentiality regulations. Amazon Care has likely been in the works since at least early 2018, when Amazon hired Seattle geriatrician Dr. Martin Levine. Amazon Care clinicians are employed by Care Medical, formerly Oasis Medical, a company Levine founded shortly after he joined Amazon, according to business records. Amazon replaced Levine early last year with Dr. Sunita Mishra, a former executive at Providence St. Joseph, where she led the development of the health system's mobile app for on-demand medical care. Levine is now chief medical officer at The Polyclinic health system, which operates 14 sites around the Puget Sound region. Weeks after Mishra joined Amazon, the company expanded access to Amazon Care to all of its now-80,000 Washington state workers. < Previous News Next News >

Teladoc Reports $133M Net Loss in Second Quarter, but Visit Numbers Are Up Kat Jercich, Healthcare IT News July 2021 Meanwhile, Amwell announces its acquisition of SilverCloud Health and Conversa Health. The virtual care giant Teladoc released its earnings report this week, showing a net loss of $133.8 million for the second quarter of 2021. Total net loss for the first half of 2021 was $333.5 million, compared to $55.3 million for the same time period last year. At the same time, the vendor said its $503 million second-quarter revenue earnings had more than doubled compared with 2020. This change led Teladoc to forecast its total yearly revenue to be in the range of $2 billion to $2.025 billion, with a predicted net loss between $3.35 and $3.60 per share. Its visit numbers were also up, at 3.5 million: 28% higher than the second quarter of 2020, during the first wave of the pandemic. The company expected 13.5 million and 14 million total visits this year. After the earnings report, Teladoc's shares fell more than 7% in the extended session Tuesday, as reported by MarketWatch. Still, execs voiced optimism, driven in part by the launch of myStrengthComplete and what the company described as a "significant new agreement" with the Health Care Service Corporation. "Teladoc Health delivered a strong second quarter, marked by exciting new client wins, product launches, and tremendous progress on our quest to be the category-defining provider of whole person virtual care," said CEO Jason Gorevic in a statement. "We have solid momentum heading into the second half as the market embraces the unified care experience that only Teladoc Health has the breadth and scale to achieve," he added. New Amwell acquisitions Teladoc competitor Amwell was also in the news this week for its $320 million acquisition of SilverCloud Health and Conversa Health. SilverCloud Health delivers a range of digital cognitive behavioral health programs, which the company says are evidence-based and clinically validated. According to SilverCloud, the programs are used by more than 300 organizations, including Kaiser-Permanente, Optum and Providence Health. Amwell will use the platform to enrich its own behavioral health offerings and develop new programs. Conversa Health, meanwhile, uses automated patient interactions to ensure patients stay on track before and after live or virtual visits. It is used, the company says, by organizations including Northwell Health, UCSF Health, UNC Health, University Hospitals and Prisma Health. Amwell says it will use Conversa's technology to advance initiatives aimed at longitudinal care, clinical quality and population health. The acquisitions will also enable Amwell to create new digital workflows and programs and expand its client base to include those of Conversa and SilverCloud – especially in the U.K. "We believe that future care delivery will inevitably blend in-person, virtual and digital care experiences; and as such, we are uniquely building a global platform to support such advanced, coordinated care," said Ido Schoenberg, chairman and co-CEO at Amwell. "By integrating SilverCloud Health and Conversa Health into our platform, we are demonstrating Amwell’s fundamental and repeatable design to continually scale digital healthcare services across the different sites of care," he added. "These acquisitions will amplify the presence and reach of care teams and reaffirm that as the needs of the healthcare marketplace evolve so too will the Amwell platform." < Previous News Next News >