State of Affairs Answering Key Questions on States’ Telehealth Networks

Case Studies Nebraska Statewide Telehealth Network Northern Sierra Rural Health Network Utah Telehealth Network Alaska Federal Health Care Access Network Upper Peninsula Telehealth Network

How are they set up? Every one of the organizations studied is/is part of a non-profit organization with 501c3 status. –Ex. Northern Sierra Rural Health Network is a non- profit tax exempt corporation in of itself. –Ex. Alaska Federal Health Care Access Network is part of Alaska Native Tribal Health Consortium, so it has non-profit status. Most organizations researched were part of a non-profit organization, rather than one themselves.

How are they supported financially? –Substantial grant funding allows for the creation of the telehealth network. Funding sources include: –Federal grant funds »Office for the Advancement of Telemedicine »Office of Rural Health Policy »Many others –Universal Service Fund/State Service Fund –State grant funds –Other (Telehealth/Telemedicine Centers, Blue Cross, Regional Health Occupations Resource Center, Northern Sierra Air Quality Management District, etc.) 1 Most organizations highly recommended that member organizations pay fees, even if it is not monetarily necessary. – Once the grant funding runs low, the networks run into the problem of sustainability. –At this point, they start charging membership fees. –Diversifying services –Renting equipment to community members. –Providing varied services to the community. Usual sequence of events… 2

How they are managed? NSRHN – Executive Board –Under them is Executive Director –Under her are the program directors –Other planning methods include: Strategic Plan Business Plan Having AHEC & RHIO status NSTN –Several committees manage the organization –Loose body that does not have a functioning governing entity and works together by agreement –Members, interested organizations, & government make decisions –Changing over to a governing board in the future UTN- Advisory Board & University of Utah Health Sciences Center –under the guidance and direction of the UTN Advisory Board but receives administrative supervision from the University of Utah Health Sciences Center (UUHSC). UUHSC Steering Committee addresses University of Utah telehealth issues Utah Digital Health Services Commission looks broadly at e-health issues, including telehealth AFHCAN- Director reports to CEO of larger organization –Department within consortium of ANTHC which has a board of directors & bylaws/ Variety of management techniques… A set governing entity is necessary for a successful telehealth network.

Do they do group contracting/purchasing on behalf of their membership to get economies of scale? Yes –Network broadband costs were included in contract. –Videoconferencing equipment was covered by most networks. –Some networks used bid capabilities as state/federal entities to receive reduced equipment rates (on all types of equipment) and then shared these with members. Yes No Maybe So No –Several organizations did not do contracts for non- videoconferencing equipment Maybe So –In general, even those organizations that did not consider themselves involved in group contracting provided broadband & videoconferencing equipment.

Do all their members sign contracts with them? One organization had only a memorandum of agreement. YES! Even with a contract in place, organizations advised constant contact with member organizations to re-enforce terms.

Advice Upper Peninsula Telehealth Network notes strengths… –“Widespread support among top administrators –A grassroots approach –Independent, self-sustaining regional hub of service –Strong local health services –Culture of UP –Telehealth and IT staff –Continuum of strong telehealth leadership –Link between organizational and telehealth strategic goals –Sustainability & reimbursement” …and challenges for programs throughout the country –Financial constraints of health care organizations –Dedicated staff to promote and implement telehealth program –Affordable Bandwidth –Awareness of telehealth for providers and public NSRHN: “Must have a good leader at the spoke site and commitment from directors.”