1. Driving Telehealth Adoption Through the Triple Aim Jonathan Neufeld, PhD, HSPP Upper Midwest Telehealth Resource Center IRHA Annual Conference - August 13, 2015 1

3. telehealthresourcecenters.org Links to all TRCs National Webinar Series Reimbursement, Marketing, and Training Tools

4. The Triple Aim In business, three things matter: Quality, Performance, and Price. You can pick any two. 4

5. A Realistic Approach Services done right will improve Patient Experience (Better Care) Providing the right services will improve Population Health Better Health will lead to Lower Cost 5

6. Telehealth in a Triple Aim Context The right tool changes everything… 6

7. Three Domains of Telehealth Hospitals & Specialties Specialists see and manage patients remotely Integrated Primary Care Mental health and other specialists work in primary care settings (e.g., PCMH’s, ACO’s) Transitions & Monitoring Patients access care (or care follows patients) where and when it is needed to avoid complications and more costly levels of care **Value proposition differs among these types** 7

8. Hospital and Specialty Care 8

9. Three Domains of Telehealth Hospitals & Specialties Specialists see and manage patients remotely Integrated Primary Care Mental health and other specialists work in primary care settings (e.g., PCMH’s, ACO’s) Transitions & Monitoring Patients access care (or care follows patients) where and when it is needed to avoid complications and more costly levels of care **Value proposition differs among these types** 9

10. Integrated Primary Care 10

11. Hub and Spoke Telemedicine HUB Spoke pt Spoke pt Spoke pt Spoke pt MD PhD DO NP Spoke pt Spoke pt

12. Peer-to-Peer Telemedicine CHC pt MD CSW NP DO PhD NP pt MD

13. Peer-to-Peer Telemedicine – Peer-to-Peer Model Clinicians anywhere Patients anywhere Patient site bills, receives payment Clinician gets paid by patient site (as an employee or contractor) Clinicians anywhere Patients anywhere Patient site bills, receives payment Clinician gets paid by patient site (as an employee/contractor) “Telecommuting” (IN & IL)

14. Three Domains of Telehealth Hospitals & Specialties Specialists see and manage patients remotely Integrated Primary Care Mental health and other specialists work in primary care settings (e.g., PCMH’s, ACO’s) Transitions & Monitoring Patients access care (or care follows patients) where and when it is needed to avoid complications and more costly levels of care **Value proposition differs among these types** 14

15. Transitions and Monitoring 15

16. P2P Network(s) 3 CMHC 1 RHC 2 FQHC 1 LTC (plus MD/NP site) 2 CAH 1 Admin (Grantee)

17. P2P – Putting Rural in Charge Rather than connecting with a large health system, rural CHCs can hire/contract directly with the clinicians/services they need – CHC drives the project – CHC chooses clinicians/services/format – CHC bills for services – CHC pays clinician CHC maintains ownership/control 17

18. Telemedicine Policy & Payment Regulations: Professionals are regulated at the state level (doctors, nurses, counselors, etc.) Medicare: Pays for certain outpatient professional services (CPT codes) for patients accessing care in rural counties and HPSAs in rural census tracts. *No regs; only conditions of payment. Medicaid: Telemedicine is “a cost-effective alternative to the more traditional face-to-face way of providing medical care…that states can choose to cover.”

19. Triple Aim - Volume vs. Value Still early in the “Transition to Value” – Only 11% of dollars linked to value today Volume still drives most of sustainability Keeping patients healthy and out of the ED is a key goal of primary care Main strategy: Driving utilization… 19

20. Driving Utilization Drive from high cost to high effectiveness – Away from ED (to Primary Care) – Away from No Care (to Primary Care) – Common element: To Primary Care Strategies: 1.Actively find patients 2.Reduce gaps, dropouts, lost to follow up 20

21. ED Mental Health Evaluations Minimize impact of adverse utilization Improving efficiency of ED – Reduced “boarding” – Reduced lost costs for self-pay patients Routing the adverse utilizer into more appropriate services ** Improved Integration will be Essential! ** 21

22. Other Potential Integrations LTC/SNF Integration – Geriatric Primary Care & Monitoring – Geropsychiatry Community Paramedicine and Mobile Integrated Health (MIH) – Urgent Care/ED replacement – Providers plan care if patients can’t 22

23. Telehealth Connects the Pieces Innovation at the Bottom: Innovation at the Top: New and better treatments New and better delivery Better outcomes for the whole population

24. Key Factors That Drive Success Clear Vision (with a sustainable model) Technological Openness Among Staff – “Can we meet by video?” Good Information (regs, billing, etc.) Solid Partners & Partnerships Efficient Execution, with Frequent and Scheduled Testing and Rehearsal 24

25. CONTACT Jonathan Neufeld, PhD, HSPP Clinical Director Upper Midwest Telehealth Resource Center jneufeld@umtrc.org (574) 606-5038 25