The Skinny on Telehealth Business Planning Amelia Bischoff, Manager Telehealth, Palmetto Health Christianna Novakovic, Telehealth Program Coordinator, Greenville Health System Michelle Hager, Managing Partner, Blue Cirrus Consulting

Conflict of Interest Michelle Hager Worked with Greenville Health System and Palmetto Health System to create their business plan and strategy for telehealth. No other conflicts of interest or disclosures to report.

Telehealth Strategy Development Palmetto Health & Greenville Health

Confronting Barriers to Change Cultural Resistance Service Delivery Silos Scarce Resources Protection Instinct Financial Comfort with the past/ known Historical delivery model ED and inpatient financial engines Providers, management & staff Reimbursement models Threat (vs. opportunity) Amelia Decision-making and Leadership Time

Cultural Resistance The Problem The Solution Technology solution variation Overloaded providers Health system versus consumer preferences Fragmented or absent telehealth strategy Standardize platforms internally and externally Joy at Work –cultural impact Provide educational services and administrative support Consumer needs and preferences lead growth Strategic alignment across the enterprise –driven by leadership

Service Delivery Silos Programs embedded into service lines without system-wide coordination and management Business plan development and support structure created New medical group brought together clinicians, academics and leaders Reimagining virtual care, capitalizing strengths, and aligning priorities Amelia

Protection Instinct: Reimbursement Model Fee-for-Service Developer takes product to physician and generates interest Payer approached for coverage Service covered and FFS payment secured Service and coverage taken to health system finance Investment approved and funding secured New product or service line incorporated into clinical workflow Christianna

Changing Incentives Christianna Move away from fee-for-service towards shared risk and population health

Movement Toward Value-Based Value based, manage care contracts developed with payer Capitation, bundled, or shared savings contract secured Clinicians observe opportunity for telehealth to make processes more efficient Investment approved and funding secured Developers or vendors sought for needed technology Christianna

Application & Tools Michelle

Telehealth Market – The Growth Industry is expanding at an exponential rate: Anticipated $197 Billion in net savings over next 25 years to US healthcare systems From 250,000 Patients served in 2012 to an estimated 3.2 Million by 2018 worldwide North America accounts for 40% of global market – Largest market Recent 2016 projection indicates the global telehealth market is expected to reach $1 Billion by 2017 (Accenture) 2020 $34.27 Billion 2018 $2 Billion 2015 $428.6 Million 2012 $240 Million Global Market Value IHS: World Market for Telehealth – 2014 Edition Morder Intelligence (Global Telemedicine Market – Growth, Trends & Forecasts ( 2015-2020) Aug 2015 Accenture 2016

Reimbursement Challenges “The results of a survey conducted by Anthem and the American Academy of Family Physicians' Robert Graham Center revealed 9 out of 10 physicians would use telehealth, if they were properly reimbursed.” (HITN 2015) Image Reference: National Conference of State Legislatures January 2016

The Telehealth Value Proposition Accessibility: care when and where you need it Affordability: reduces travel time/expense and time away from work. Timeliness: reduces wait times to access care. Coordinated and Integrated care. Patients 1 Promotes coordinated care. Maintains primary relationship with the patient. Maintains credibility with the patient. Promotes greater patient satisfaction. Generates revenue and visit reimbursement. Providers 2 Keeps patients local. Promotes rapid diagnosis and treatment linked to improved outcomes. Improved outcomes improve the health of the population. Community 3

Workflow Patient Criteria Clinical Workflow Selection Sustainable Solution Patient Criteria Selection Clinical Workflow Interoperability Technical Workflow Future/Present State

Needs Assessment

Cost/Benefit Analysis

Prioritization

Decision Model

Contact Information Amelia Bischoff, MHA Manager, Telehealth Clinical Informatics Office: 803-296-5355 Amelia.bischoff@palmettohealth.org Christianna Novakovic, MHA, CAPM Telehealth Program Coordinator Greenville Health System | Clinical Integration (864)797-7871 CNovakovic@CCIHealth.org Michelle Hager Managing Partner Blue Cirrus Consulting Michelle.hager@blue-cirrus.com 864-335-8070 @bcirrus