mHealth Reimbursement : Who Will Pay?

Editor's Notes

1. http://www.vosizneias.com/111335/2012/08/07/new-york-free-wi-fi-catches-on-with-nycs-subway-riders/ Photo by Paul Lowry, Flickr
2. http://andrewsinanity.blogspot.com/2012/01/modern-day-etiquette-above-table.html
3. http://lolyard.com/1980/find-the-odd-one-out
4. http://polpix.sueddeutsche.com/bild/1.1692756.1370860225/900x600/szforum-unsocial-networks.jpg http://www.sueddeutsche.de/muenchen/dachau/sz-forum-unsocial-networks-lernen--1.1692687 Students try Tablet PC in the classroom from the students Marisa, Max, Philip and Maria from 7b of the New School Rüsselsheim, Hesse already working with tablet PC in the classroom. The State then moved to its own project. Photo: AP  (Photo: picture alliance / dpa )
5. Photo by Sarah Wilson Tech-hungry members of the Village on the Green e-communications committee study up on new advancements in tablet and mobile technology at the Longwood retirement home. http://www.wpmobserver.com/news/2013/jul/31/seniors-catching-tech/
6. Consumers are also expecting self-service options, mostly because it can be much easier for them to get the answers they need quickly without having to speak with a person
7. http://www.advisory.com/research/nursing-executive-center/expert-insights/2013/top-insights-from-the-2013-system-cne-roundtable/prevent-escalation-of-rising-risk-patients If left unmanaged, nearly a fifth of rising-risk patients will become high-risk patients each year. Yet many organizations focus their care management efforts almost exclusively on their highest-cost, highest-risk patients. While it is critical to dedicate an outsized portion of care management resources to your highest-risk patients, the fluidity between risk levels means population health managers must also focus efforts on rising-risk patients. Put another way, a key population health management strategy is effectively preventing rising-risk patients from escalating into the high-risk category.
8. HIMSS Response to Medicare PFS 2014 dated Sep 2, 2014 http://assets.fiercemarkets.com/public/healthit/himsscomments9-4.pdf In a recent case study of 44 patients using Remote Patient Monitoring Systems (RPMS) at St. Michael Health System, the average cost of care equaled $12,937 prior to enrollment. After RPMS enrollment, the average cost plummeted to $1,231.5 Clearly, there is an opportunity to expand telehealth assessments within the context of the CMMI awards to assess the expansion of bundled payments and the inclusion of telehealth services. Use Case Study: Christus Health - Improving Health at Home: Remote Patient Monitoring and Chronic Disease; September 2013. http://www.himss.org/ResourceLibrary/genResourceDetailPDFReg.aspx?ItemNumber=22361 By 2025, chronic diseases will affect half of the U.S. population, an estimated 164 million Americans Broadband, Expanded; January 2013 http://www.broadbandexpanded.com/policymakerfiles/telemedicine/Telemedicine_Stats&Data.pdf
9. Consumers are rapidly adopting mobile devices for their banking and auto insurance transactions, while conversely, there are tens of thousands of health, fitness, and medical applications with very little adoption, and if adopted, little adherence. Cross industry research provides practical insights into how healthcare insurance companies and providers will utilize the next generation mobile healthcare applications with the hope of potentially to creating both revenue opportunities and cost savings. Healthcare organizations will therefore be positioned to increase mobile transactions, transition many of those transactions from traditionally higher-cost channels and retain and attract more customers. As the healthcare industry makes additional mobile transactions possible, the potential ROI will increase as consumers shift to the faster, more convenient and less expensive mobile channel to pay bills and access care in personalized ways. There are many ways of looking at ROI of mobile health technologies. Many of them have yet to be demonstrated. The uniqueness of mobile health tech to both the clinical and financial areas of healthcare afford it opportunities to provide new business models as well as methods of assessing ROI of this sector http://www.himss.org/ResourceLibrary/mHimssRoadmapContent.aspx?ItemNumber=30385&navItemNumber=30454 References 1. http://davidleescher.com/2013/01/11/business-models-of-digital-health-technologies-implications-for-roi/ 2. http://www.himss.org/content/files/ehr-roi.pdf 3. http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html?hp&_r=5&pagewanted=all& 4. http://www.healthcaretechnologyonline.com/doc/the-roi-in-patient-self-service-0001 5. http://www.clinical-innovation.com/topics/policy/acc-cost-benefit-remote-monitoring-depends-players 6. http://www.healthcareitnews.com/news/remote-monitoring-helps-geisinger-cut-readmissions 7. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2013-ACO-Contacts-Directory.pdf 8. http://www.juniperresearch.com/viewpressrelease.php?pr=347
10. Also New Telehealth Services: Currently listed under Category 1 Category 1 procedures that were sufficiently similar to an already approved Medicare telehealth service Category 2: not similar to currently approved services) The two-way audio/visual requirement, as proposed in the NPRM, restricts the range of telehealth interactions that can occur between physician and patients (it rejects e-mail, phone conversations, and other modes of telecommunication relying only on real-time/active audio and video interactions). Further, the two-way visual/audio requirement may make telehealth services in rural areas inaccessible due to limited or unreliable broadband connectivity. HIMSS remains cautious about the narrow definition of interactive
11. $3,300 saving per Patient per year by just moving every diabetic employee over to this more advanced management system.
12. Consumers are rapidly adopting mobile devices for their banking and auto insurance transactions, while conversely, there are tens of thousands of health, fitness, and medical applications with very little adoption, and if adopted, little adherence. Cross industry research provides practical insights into how healthcare insurance companies and providers will utilize the next generation mobile healthcare applications with the hope of potentially to creating both revenue opportunities and cost savings. Healthcare organizations will therefore be positioned to increase mobile transactions, transition many of those transactions from traditionally higher-cost channels and retain and attract more customers. As the healthcare industry makes additional mobile transactions possible, the potential ROI will increase as consumers shift to the faster, more convenient and less expensive mobile channel to pay bills and access care in personalized ways. There are many ways of looking at ROI of mobile health technologies. Many of them have yet to be demonstrated. The uniqueness of mobile health tech to both the clinical and financial areas of healthcare afford it opportunities to provide new business models as well as methods of assessing ROI of this sector http://www.himss.org/ResourceLibrary/mHimssRoadmapContent.aspx?ItemNumber=30385&navItemNumber=30454 References 1. http://davidleescher.com/2013/01/11/business-models-of-digital-health-technologies-implications-for-roi/ 2. http://www.himss.org/content/files/ehr-roi.pdf 3. http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html?hp&_r=5&pagewanted=all& 4. http://www.healthcaretechnologyonline.com/doc/the-roi-in-patient-self-service-0001 5. http://www.clinical-innovation.com/topics/policy/acc-cost-benefit-remote-monitoring-depends-players 6. http://www.healthcareitnews.com/news/remote-monitoring-helps-geisinger-cut-readmissions 7. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2013-ACO-Contacts-Directory.pdf 8. http://www.juniperresearch.com/viewpressrelease.php?pr=347
13. The business models of IMS, Surescripts and others might serve as resources to determine an ROI for technologies collecting data, though obviously the ROI would depend upon potential impact of the data on healthcare and the third party’s ROI on the data.
14. In some areas of the country payers are creating CPT codes for hospital organizations to engage in patient centric care. Many self-insured companies are pursing virtual visits as a manner to control cost and maintain productivity. Payers are creating tools and platforms to assist with concierge style forms of medicine for routine or urgent visits. However, programs like Medicare and Medicaid have continued to struggle with implementation. Hospitals have provided tools and solutions to allow patient’s access to ER wait times, or provided mobile applications to assist with sourcing information regarding a hospital or institution. The focus has largely been on push style information. Increasingly providers are looking for conversational style forms of engagement. A number of end a number of enterprise to patient (E2P) and enterprise virtual care (EVC) solutions are coming on the market. These platforms enhance traditional telehealth efforts and provide an enterprise version of unified communications systems present in many multinational corporations today. The challenge becomes selecting technology which complements existing policy frameworks, including HIPAA, HITECH, and the existing definition for telemedicine reimbursement at the State and Federal level.
15. But, in practice, it’s incredibly hard to make things easy
16. Although there is ample evidence that improved glucose control prevents long-term complications of diabetes, few reports have addressed the effect of improved control on short-term healthcare costs. Methods: A mobile health (mHealth)-enabled glucose meter combined with a disease management call center was deployed in 143 employees as part of an employer-sponsored diabetes disease management intervention. The program cost was approximately $50 per member per month over and above the cost of standard care. Results: Overall, on an intention-to-treat basis, this program was associated with an annual reduction of $1,595 (95% confidence interval [CI] –$2,827 to +$181) per person in incurred medical claims. A subanalysis documented that those who actively participated in the program (50 %) incurred a year-over-year claims cost decrease of $3,384 (95 % CI $643 to $5,149) compared with an increase of $282 among those who did not participate. Conclusions: These findings suggest that even partial improvement of diabetes testing adherence within an employed population may result in substantial attenuation of employee medical expense. The reduction in healthcare costs, even when considering those who did not comply, outweighed the program costs by several-fold.