The National Telehealth Webinar Series · Comprehensive Telemedicine: A Practical Approach...
Transcript of The National Telehealth Webinar Series · Comprehensive Telemedicine: A Practical Approach...
The National Telehealth Webinar Series
Presented byThe National Network of Telehealth
Resource Centers
Telehealth Resource Centershttp://www.TelehealthResourceCenters.org• California Telemedicine & eHealth Center (CTEC)• Great Plains Telehealth Resource & Assistance Center (GPTRAC)• Heartland Telehealth Resource Center (HTRC) • Mid Atlantic Telehealth Resource Center (MATRC)• National Telehealth Policy Resource Center (CCHP)• National Telehealth Technology Assessment Resource Center (TTAC)• Northeast Telehealth Resource Center (NETRC)• Northwest Regional Telehealth Resource Center (NRTRC)• Pacific Basin Telehealth Center (PBTRC)• South Central Telehealth Resource Center (SCTRC)• Southeastern Telehealth Resource Center (SETRC)• Southwest Telehealth Resource Center (SWTRC)• TexLa Telehealth Resource Center (TEXLA)• Upper Midwest Telehealth Resource Center (UMTRC)
Comprehensive Telemedicine: A Practical Approach
Thursday, October 16, 2014(8:00AM HST, 10:00AM AKDT, 11:00AM PDT, 12:00PM MDT, 1:00PM CDT, 2:00PM EDT)
Presented by: TexLa TRCSpeaker: Kim Dunn, M.D., Ph.D.
Your Doctor Program, L.P.Houston, Texas
Talk overview
» What are the standards of care today?
» Medical home
» Comprehensive telemedicine
» Leadership development for value based care
Current reality
FINANCIAL / REGULATORY PATIENT OWNERSHIP QUALITY MANAGEMENT AND SERVICE
Current reality cont.
Current information management
Clinical Documentation Patient Outcomes PaymentSubjective Objective Assessment Plan Variables
Doctors paid on
what document in
subjective and
objective, not
assessment, plan.
Current EMRs
follow the money
and also do not
incorporate
outcomes nor
telemedicine.
Disjointed
Used as a
surrogate
for quality
So the most
important
is…….
Not
automated
Not integrated
outside of
doctor office
Data
not easily
obtained
Not
actionable
Genetics
Social
Environ
Value based service
Quality
CostValue =
Quality Population health• Ambulatory: Age, sex, disease
specific PQRS/measures adjusted for social / clinical factors / adherence
• Inpatient: Required regulatory
Patient experience• Satisfaction / patient education• Improve access via telemedicine
Cost / Payment• Payment for telemedicine• Real time claims management• Point of service payment via
quality attestation
Quality attestation
Patient
KDunn and Associates, PAValue based contracting for patient centered,
telemedicine based care. We assure
The Physician Quality Standard TM is met via peer review and practice-based CME-CNE.
Schull Institute, a 501 C 3De-identified data analysis
Your Doctor Program, L.P.Training and support for telemedicine, medical home,
population management, and clinical integration.
PartnersCME: Texas Medical Association
CNE: Care Track, LLC, State of California
Value-based Care
StrategySave lives and money
through engaging
physicians in
telemedicine and quality
and patients in their care.
PayersPrimary: BusinessInsist on The Physician
Quality Standard TM
Secondary
• Payers: What does
The Physician Quality
Standard TM mean?
• Consumers: How we
assure your care is
coordinated, safe, and
effective if you do your
part.
Quality
Service Cost
Patient
» Saved lives with two pilots in
high risk populations (dual
eligible) and homeless (1.5%
mortality reduction
» Established program for quality
that overcomes physician
barriers for engagement
» Eliminate ED visits
for primary care
» Reduced
readmissions 75%
» Comprehensive
reimbursable
telemedicine model
» Feedback from
patients to improve
service and
decrease liability
Accomplishments since commercialization
• Defined CME / CNE Program
• Defined market for employer community
Our value summary
KDunn and Associates, Standards for Value Based Care
Quality attestation for point of service payment for Value
Based Care
Total quality management
Use of The Physician Quality
Standard TM by practitioners
meeting standards
Patient centered, telemedicine based
service delivery
Your Doctor Program for
Accountable Communications
Service Products
Healthcare in Your Hands
Medical Home in a Box
Accountable Care in a Box
Technical integration to standards
BenefitsProviders
Leadership development for quality, service, and effectiveness
Paid for telemedicine
Paid faster via quality attestation model
Save money via medmal reductions
Board Re-Certification
Patients / Payers
Save money
Care is coordinated, safe, and effective
Engagement for prevention and disease management
Improved access and save time / money via
telemedicine
* KDunn and Associates, P.A., dba HealthQuilt, is a practice association for value based care contracting. We use a patented
process for total quality management via peer reviewed program for standards of practice for a patient centered, telemedicine based
care delivery model.
Value improvement via total quality management
Ongoing value improvement
» Quarterly value improvement peer comparison reports» Population health: Top five clinical quality adjusted for patient
adherence and patient social / clinical risk factors.
» Patient experience: Service and patient engagement
» Cost: Total cost with emphasis on devices, total costs, readmissions
» Annual value improvement» Population health: Top five clinical quality metrics adjusted for patient
adherence and patient social / clinical risk factors.
» Patient experience: Service and patient engagement
» Cost: Total cost with emphasis on devices, total costs, readmissions
HEALTH HOME
Medical home
Consumer Centered Model
Encounter Type Key actions Billing Event
In Person
Sign MH / Info mgt agreements X
Credit card on file X
Training on tool / download application X
Establish pt's doctor network X
Establish / update care plan /allergies X
Select one prevention goal: Need Smoking Cessation / Weight
Reduction? xxxx: Prevention X
Disease specific goals / contracts xxxx: Patient teaching X
Health Risk Assessment xxxx: HRA X
Update living will / mpoa X
Preparedness plan given X
Patient card sent X
Upload encounter note / labs / imaging xxxx: Encounter note
Patient Take Care plan, doctor instructions, and card to
annual visit. Request care plan update and encounter data
faxed / uploaded
Define tasks X
Send encounter survey X
Trip claim X
Update care plan
Upload encounter note / labs / imaging xxxx: Encounter note
Patient Take Care plan, doctor instructions, and card to
visit. Request care plan update and encounter data faxed /
uploaded
Define tasks X
Send encounter survey X
Trip claim X
Care plan updated and all patient records updated X
Messaage / fax referral request X
Order X
Patient take care plan with them with request X
Care plan recommendations updated X
Note / data uploaded vs. faxed back to medical home xxxx: PMPM or PCO
Patient Take Care plan, doctor instructions, and card to
visit. Request care plan update and encounter data faxed /
uploaded
Care plan updated X
Define tasks X
Send encounter survey X
Trip claim X
Care plan updated
Message / fax referral request
Patient take care plan / card with them xxxx: DME/Pharmacy
Patient Take Care plan, instructions, and card to visit.
Request care plan update and encounter data faxed /
uploaded
Define tasks X
Send encounter survey X
Patient take care plan / card with them
Note /data uploaded vs. faxed back to medical home xxxx: PMPM or PCO
Care plan updated
Patient Take Care plan, instructions, and card to visit.
Request care plan update and encounter data faxed /
uploaded
Define tasks X
Send encounter survey X
Hospital / Nursing facility based
Patient take care plan / card with them / Care plan managed by
nurse as inpatient and attending physician assumes medical
home care oversight role
1. Attending / staff
Note / data uploaded vs. faxed back to medical home xxxx: PMPM or PCO
Patient Take Care plan, instructions, and card to visit.
Request care plan update and encounter data faxed /
uploaded
2. Consultant / staff Care plan updated X
3. DME / Meds Define tasks X
Send encounter survey
Home HealthPatient care plan managed by home health with oversight from
medical home xxxx: PCO
Messaging Part of care plan for administrative purposes
Update care plan
Document telemed encounter note / labs / imaging xxxx: Encounter note
Define tasks
Send encounter survey
Trip claim or credit card payment
Update care plan
Document telemed encounter note / labs / imaging xxxx: Encounter note
Define tasks
Send encounter survey
Trip claim or credit card payment
Update care plan
Message request
Phone conversation
Specialist document encounter recommendation xxxx: Encounter note
MH Update care plan xxxx: PMPM or PCO
Define tasks
Send encounter survey
Trip claim or credit card payment
Update care plan
Message request
Video call in system
Specialist documentation encounter in system xxxx: Encounter note
MH Update care plan xxxx: PMPM or PCO
Define tasks
Send encounter survey
Trip claim or credit card payment
If patient does not have FOR A, gets daily message to enter their
data per the disease protocol
If can get FORA
Training on tool
Sync with mobile app
Uploads daily
Threshold established for patient
Above threshold triggers alert to clinical support to call the
patient xxxx: PMPM or PCO
Care plan updated
Define tasks
Send encounter survey
If not already PMPM, trip claim for PCO
Done inside the Care Plan Management, documentation,
billing at the point of service delivery completion or per
contract
Biomonitoring: Patient-Medical Home
LIV: Patient-MH or Specialist
In Person
Clinical Centered Model
Med Home: In person / episodic
In Person External Referral Specialist /
Lab
Med Home: Telephone during Office
Hours
Telemedicine
Curbside: Med Home-Specialist
Referral for DME / Pharmacy
Emergency / Urgent Care
Med Home: Telephone after Office
Hours / Oncall
Annual visit with medical home
Annual /
Population
healthdata
Ongoing:
Eight
in
person
Ongoing:
Six telemed
in care plan
* documentation
inside the care
plan
Point of
Service
Payment /
via Quality
Attestation
1. Care
Plan /
Tasks
2. Upload
data
3. Send
Survey
4. Ongoing
CME/
CNE
Trip claim to
rendering
physician
* Patent pnd
Healthcare in Your Hands TM
Patient centered care automation
Comprehensive telemedicine
» Care plan (all records available and translated into an integrated care plan)
» Messaging for administrative tasks(prescription refills, schedule appointments, call center support)
» Biomonitoring for patient engagement
» HTN: Blood pressure, weight
» Diabetes: Glucose, exercise, diet
» Weight loss
» Smoking cessation
» Telephonic / live interactive visits » Medical home / primary care
» Specialists
Medical home / specialists for clinical integration
Physician Care Oversight
Outpatient: Medical Home
Inpatient: Attending as
“Temporary Med Home”
Specialists
Outpatient : Defined by medical home
Inpatient: Defined by attending physician
Methodology• Base standard• CME / CNE to customize
treatment preferences• Primary care manage
care plan including risk factors and patient tasks
• Curbside from specialist to primary / attending
• Population health via Annual Health Risk Assessment
• Defines patient engagement tasks
• Quarterly feedback
What it means for a patient
» One phone call
» 24 / 7 access to a doctor via telemedicine
» Care coordinated via care plan and telemedicine, working with home health
» Care transitions eliminated
» Service follow up all encounters
» Care coordinated, safe, and effective
Telemed: care plan / messaging
Population health
» Prevention Visit: Annual age, sex, disease specific health risk assessment that attributes physician ownership / risk adjustment
» Disease management tracking
Health risk assessment
Disease Tracking / Biomonitoring
Patient agreementPatient tracking, many devices
for electronic tracking
Telephonic / Live interactive
» Primary care: $50 if established care
» Specialist “curbsides”: $75, applies to deductible if need in-person, part of clinical integration program
» Live interactive
» Per doctor for second opinion
» Hospital care transitions using care plan management process and home visits for telemedicine via physician care oversight
Encounter Documentation
» 15 encounter type templates
» Linked to CPT / transaction codes
» Survey follow up 3 days after service delivery with provider attribution
YDP card and Secure online access
Front of card» Identifies your primary doctor
contact for information
» Access for your doctors to your care plan through the Quick Response (QR) code
» HIPAA compliant QR reader
Back of card» Your name
» Instructions to your doctors to follow information management standards
» Financial strip
Smartphone Application
Personal QR reader
takes you and a doctor
to your care plan
Supports communication
and biomonitoring
Medical Home in a Box TM
Train the trainer model
» Teach medical home, telemedicine, clinical integration
» Policies / procedures
» Training manuals
» Online training
» Patient contract reviews
» Branded card printing
» License of Healthcare in Your Hands integrated into care delivery
» Marketing plan for The Physician Quality Standard TM
90 Day Team for Value Based Contracting to The Physician Quality Standard TM
» Kim Dunn, MD, Ph.D.: Physician leadership development, telemedicine, medical home, preparedness and disaster response
» Sandra Petersen, DNP, Ph.D.: Nurse leadership development, patient engagement for self management, hospice, policies/ procedures
» Karen Garmin: Policies / procedures
» Jay Stowers: Liability management
» Justice Kennedy: Financial management
» Kevin Dunn: Marketing with The Physician Quality Standard TM
» Adi Kadapa, MD, MS: Technical integration lead
90 day initiation
Month 1
» Initiate physician leadership / business plan
» Policies and procedures for value based contracting to The Physician Quality Standard TM
» Network / Leadership Development
» Video production for specialist “baseline protocols” for primary care / patient education
» Primary care / Emergency / Hospital physician agreements for Peer Review with KDA
» Co-branding / Marketing plan for cards / employers / MCOs
» Initiate technical integration roadmap via YDP care plan framework
» Initiate FTC Letter of Determination for Clinical Integration based on policies and procedures
Month 2
» Medical Home in a Box TM: Physician Care Oversight for Patient Centered Care / Quality
» Outpatient
» 2 day onsite consulting, workflows, tasks, go-live with HIYH Info Kiosks, NCQA application / 90 day reporting period
» Inpatient (Temporary medical home)
» 2 day onsite consulting, workflows, tasks, go-live with HIYH Info Kiosks, clinical integration
» Initiate employer marketing campaign
Month 3
» Finalize technical integration
» Initiate peer comparison report program
» Expand employer marketing campaign
Initiation
PHYSICIAN LEADERSHIP DEVELOPMENT
» Content» Standards for information management
» Clinical integration / Accountable care
» Medical home
» Telemedicine
» Liability reduction
» Patient engagement
» Care plan / regulatory management
» Care transitions
» Activities onsite with nursing staff» Practice assessment- clinical, business
» Document treatment preferences
» Telemedicine training
» Takehomes» Clinical quality improvement plan
» Secure IT / Risk infrastructure
» Quarterly reviews
» Annual PDCA
STAFF TRAINING
» Content» Policies / procedures
» Workflows / tasks
» Communication / telemed standards
» Preparedness
» Activities» Workflows / tasks
» Takehomes» Checklists for workflows / task lists
» Policies / procedures
» Ready for reporting
» Satisfaction / Education improvement plan
90 day timeline
Wk1 Wk 2 Wk 3 Wk 4 Wk1 Wk 2 Wk 3 Wk 4 Wk1 Wk 2 Wk 3 Wk 4
Telespecialists Agreements Film, edit
Peer review agreements
with all doctors in pilot
Online customized CME /
CNE training program
XXX Physician
/ Nursing
Leadership
Training
Rapid medical home to
NCQA Level 3 / FTC Clin Int
Assessment, evaluate Proposed changes Complete customized policies
Technical integration planTechnical
assessment
Co-branding / marketing
program
Marketing to SIE
Financial/ regulatory modelsCodes defined
Staff Leadership Policies TrainingTechnical
assessmentBranding
Marketing to
Employers
Financial /
regulatoryHours
Dr. Kim Dunn ** * * * * * 480
Dr. Sandi Petersen * * ** 130
Jay Stowers * * ** 120
Kevin Dunn * * * * ** * * 480
Justice Kennedy ** * 480
Sean Harkins * * 480
Karen Garmin ** * 150
Dr. Adi Kadapa * ** 480
Total for Initiation 2800 hours
Consulting Team for 3 Month Clinical Integration / Licensing Initiation
Proposed changesPhase 1 implementation: Data
submission / presentation layer
Ongoing Support: Card field
printers, patient application
ReviewMaterials developed:
website, card, printed
Co-marketing to SIE/ Business communityID Targets
FTC Clinical Integration
Letter / Value based care
DeliverablesMonth One Month Two Month Three
Physician leadership development for clinical integration, medical home, telemedicine
YDP baseline protocols
customized to XXXX
Disease management /
telemedicine established
Train the
Trainer Medical
Home Program
for 90 day
reporting
period
Ongoing Practice based CME /
CNE
Peer review agreements
Customize training platform / content with XXXX
Customized to XXXX
Policies and Procedures: Clinical integration, medical home, telemedicine, quality, risk management
Transition
Training and Support Manuals for patients, doctors, staff, specialists, nursing
Example business proforma
• $2.8 M annual revenue
• 6 physicians
• Active patients: 34750
• Average pts / doctor / day: 18
Daily Monthly
Annual
visits
not
covered
Comprehensive
Annual YDP new
wellness / disease
management /
preparedness
model for service
delivery model
with increase of
$100
Physician care
plan oversight:
Info / Quality
management /
Biomonitoring:
2.5/5/12.5 PMPM
Telephone visit
payment during
day 2/ doctor
plus on call 4,
total daily is 16 /
day $30
Clinically
Integrated
Specialists:
$50
Average per day per doctor 18
Number of doctors 6
Total Visits 108 2160 8830
Acuity Level of patients
INCREASED
ANNUAL
Level 1 26,461 2.5 883000 2646100 793830 793830
Level 2 6289 5 628900 377340 188670
Level 3 2000 12.5 200000 300000 60000
P4P 883,000 3,475,000 1,471,170 1,042,500 6,871,670
Current
model
YDP
model
Annual 200 300
1 visit 100 100
Telemedicine
2 telephonic / day / practitioner
/ 5 oncall 0 60
PCO/ QM / Biomonitoring
(50/50 split) 0 60
NP extender for annual visits home
/ office
Phone calls
and wellness
visits
300 520
Actual New Revenue by Population Health / Value Based Contracting
Definition of a computer
One who computes…….
The patient……
And their doctors…
Lifelong patient ownership 365 / 24, all situations
Self management• Education • Accountability• Wellness• Biomonitoring• Social support• Disaster
preparedness
Engaging physicians in quality
Framework transition
YDP model
» Model: Quality based, patient centered, data integration
» Communication: Care plan, telemedicine
» Documentation: Care plan, outcomes, tasks
» Payment: Paid for telemedicine / point of service completion
Current model
» Model: Episode based, financial based, not patient accountable
» Communication: Fax, voice mail, no follow up
» Documentation: Review of Systems / Exam
» Payment: Episode of care with challenges of denials, lack data
How we work with employers» Insist on
» standards for information and quality management
» Telemedicine
» point of service payment via quality attestation
» Meetings with all contracted insurers / managed care
» Define target populations
» Pre-adjudicate claims
» Pay for comprehensive telemedicine / in person
» Pre-post impact on quality, service, cost for shared savings programs
BenefitsProviders: Physicians / Hospitals / Nurses
» Rapid clinical integration
» Rapid medical home
» Payment at point of service completion via quality attestation starting with telemedicine
» Get in charge of quality, service, and efficiency for all required CME / CNE and Board Re-certification
» Clinical integration
» Hospitals: Reduce 30 day readmissions, regulatory information management, liability
» Ambulatory: Pay for wellness, telemedicine, improve revenue cycle management, reduce regulatory information management, liability, all P4P
» Technical integration to support current technology
Employees / Consumers / Patients
» Improve access via telemedicine
» Remove hassles for administrative requests
» Frustration of duplication of data to different doctors
» Improve safety of healthcare system
» Ownership of their wellness and care
» Emergency management service and travel medicine support
Employers Save 3-7 % on healthcare costs with no new cost outlays
» Patient knowledge of their responsibilities to own care
» Practitioner ownership of quality and cost reductions
» Emergency workers have access to core patient data
» Decreased costs via telemedicine
» Improved worker compensation
» Eliminate fraud
Next steps
» Enroll in “Train the trainer” program for leadership development
» Identify physician, nursing, pharma, IT, financial, marketing leaders for initiation
» Approve project plan
» Initiate 90 day project to value based contracting via medical home, comprehensive telemedicine and total quality management
Contact
» Kim Dunn, MD, Ph.D.
» 713-981-6125 (o)
» 832-752-1635 (c)
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