It is what it is?” EMTN Retreat, 2015 Telehealth, the national perspective “It is what it is?” Rob Sprang, MBA Director, Kentucky TeleCare Chair, Kentucky TeleHealth Network Board of Directors

How long have you been in the telehealth industry?

“It is what it is”

Apathy Acceptance of defeat Describes the present, one second of time

Past Future Present

Patrick Yerman

Special Olympian, Patrick Yerman

Population MT 1,023,579 KY 4,413,457

Comparing MT and KY *2014 America’s Health Rankings MTKY Overall health rank2247 Smoking2449 Obesity646 Cancer Deaths1150 Children in Poverty3350 Binge Drinking4510 Suicide4835 Childhood immunization4416 Lack of health insurance4128

Telehealth History in Kentucky 1996 – Telehealth launches at UK1996 – Telehealth launches at UK 1997 – Department for Juvenile Justice MH project1997 – Department for Juvenile Justice MH project 2000 – Kentucky TeleHealth Legislation2000 – Kentucky TeleHealth Legislation 2003 – Federal Prison telehealth2003 – Federal Prison telehealth 2005 – Telehealth at multi-state coal company2005 – Telehealth at multi-state coal company 2012 – Commission for Children with Special HC Needs2012 – Commission for Children with Special HC Needs 2013 – Diabetic Retinopathy Screening in primary care2013 – Diabetic Retinopathy Screening in primary care 2014 – Blue Angels high risk OBGYN project2014 – Blue Angels high risk OBGYN project Today – Decentralized statewide network. Each site is responsible for joining on their own. Medicaid reimbursement/Commercial Health insurance. Oversight by statewide Board of Directors.Today – Decentralized statewide network. Each site is responsible for joining on their own. Medicaid reimbursement/Commercial Health insurance. Oversight by statewide Board of Directors.

Kentucky Highlights State prison/Department for Juvenile Justice - MH/BHState prison/Department for Juvenile Justice - MH/BH Federal Prison services – 24 medical specialtiesFederal Prison services – 24 medical specialties

Kentucky Highlights State prison/Department for Juvenile Justice - MH/BHState prison/Department for Juvenile Justice - MH/BH Federal Prison services – 24 medical specialtiesFederal Prison services – 24 medical specialties Industrial/Workplace health services – Coal CompanyIndustrial/Workplace health services – Coal Company

Kentucky Highlights State prison/Department for Juvenile Justice - MH/BHState prison/Department for Juvenile Justice - MH/BH Federal Prison services – 24 medical specialtiesFederal Prison services – 24 medical specialties Industrial/Workplace health services – Coal CompanyIndustrial/Workplace health services – Coal Company Automated Diabetic Retinopathy Screening in Primary care clinicsAutomated Diabetic Retinopathy Screening in Primary care clinics

Kentucky Highlights State prison/Department for Juvenile Justice - MH/BHState prison/Department for Juvenile Justice - MH/BH Federal Prison services – 24 medical specialtiesFederal Prison services – 24 medical specialties Industrial/Workplace health services – Coal CompanyIndustrial/Workplace health services – Coal Company Automated Diabetic Retinopathy Screening in Primary Care ClinicsAutomated Diabetic Retinopathy Screening in Primary Care Clinics Blue Angels high risk OBGYNBlue Angels high risk OBGYN

Kentucky Telehealth Challenges Decentralized network - No network fees, no central funding No standard equipment set but basic H.323 communication platform requirements Emphasis on contract work and less emphasis on the traditional telehealth services delivered in the community Internal competition between networks Primarily a fee-for-service state

Montana’s Success Longstanding, successful program Primary emphasis on serving rural/frontier Outstanding leadership Strong regional partnerships Centralized network Standardized equipment set Common network platform with more control Universal Services application Medicaid expansion Medical licensure compact

Medical Licensure Compact

Threats Direct-to-Consumer, outside companies Pay for Performance - Adapt to a new payment model that requires a different mindset

Threats Direct-to-Consumer, outside companies Pay for Performance - Adapt to a new payment model that requires a different mindset Technology changes – Move from stand-alone CODEC to software based technologies – Medical peripheral devices Legal/regulatory issues Reimbursement Privileging/Credentialing Malpractice insurance Licensure

Opportunities to consider Contracts with prisons, employers and other self-insured groups. Remote Patient Monitoring CPT – Chronic care mgt - $42.60/mo CPT – Collect/review patient data - $56.92/mo Medicaid expansion in MT

Medicaid Expansion in KY Traditional split 70%/30%, Expansion = 100%/0% then no higher than 90% after 2020 In 2013, Kentucky uninsured = 20.4%* In 2015, Kentucky uninsured = 9.8%* What has happened in KY? 375,000+ new Medicaid enrollees** Uncompensated care dropped 55% ** State savings ($25.8M in 2014, $83.1M est. 2015)** Deloitte Consulting - $1B windfall in 7 years and 40,000 new jobs through 2021** *2014 Gallup poll **2015 Deloitte Consulting report

Medicaid Expansion impact on health systems *Center on Budget and Policy Priorities Community Health Systems - 72% drop in uninsured admissions in 12 expansion states and 0% drop in 17 non expansion states Lifepoint Hospital System – 67% drop in uninsured admissions in expansion states and 14% drop in non expansion states Tenet Healthcare – 54% drop in uninsured admissions in expansion states and 8% drop in non expansion states HCA – 48% drop in uninsured admissions in expansion states and 2% drop in non expansion states

What is the future? 1. 1.Health care payment reform and the Triple Aim Fee for Service payment system is unsustainable Outcomes are comparatively poor

The US Healthcare System World Health Organization ranking of the health system of their 191 member countries

2013 Kiaser Employer Health Benefits Survey: insurance/report/2013- employer-health- benefits/ insurance/report/2013- employer-health- benefits/ The financial burden faced by citizens

What is the future? 1. 1.Health care payment reform and the Triple Aim US payment system is unsustainable Outcomes are comparatively poor 2. 2.Technology changes in telehealth Smaller Integrated devices/wearables Connect where the patients are 3. 3.How we reach patients with telehealth Traditional telehealth Direct-to-consumer for acute primary care Remote patient monitoring Aggregate all technology into medical home

Rob Sprang, MBA Director, Kentucky TeleCare University of Kentucky