November 23, 2020

Please find below updates on how the health care system is leveraging telehealth and remote patient monitoring - including research, data, and polling on its current use in response to COVID-19.

Alliance News

PLEASE SIGN-ON to Consensus Principles on Telehealth Across State Lines

The Alliance for Connected Care seeks your support on an open letter to U.S. State and Federal Policymakers calling for care across state lines to support patients and empower healthcare professionals.

This high-level statement is intended to call attention to the need for telehealth care across state lines, through solutions that allow for mutual recognition of health professional licensure. Please sign here. Please also feel free to share this opportunity with others.

Read more about this statement featured in mHealthIntelligence.

WBEZ features Taskforce on Telehealth Policy: (11/17) – The Taskforce on Telehealth policy, a multi-stakeholder effort convened by the Alliance, NCQA and ATA was featured in a recent article in WBEZ. The article notes that the taskforce found there wasn’t a massive increase in overall health care utilization. Telehealth largely took the place of in-person care, instead of increasing the overall number of appointments. “It would have been a great indictment of telehealth or a confirmation of those fears if during COVID, when telehealth was unleashed, costs went through the roof,” Frank Micciche of NCQA said. “That would have been a death knell for telehealth. We absolutely did not see that.”

Babyscripts welcomes Alliance Executive Director Krista Drobac to Advisory Board: (11/17) – Babyscripts, a virtual care platform for managing obstetrics, welcomed Alliance for Connected Care Executive Director Krista Drobac to the Babyscripts Advisory Board.

Legislative Activity

We are tracking these and other bills on the Alliance website.

Expanded Telehealth Access Act: (11/16) – On November 16, Rep. Sherrill (D-NJ) and 13 bipartisan cosponsors introduced the Expanded Telehealth Access Act (H.R. 8755), which would expand the scope of practitioners eligible for payment for telehealth services under the Medicare program. View the press release and bill text.

Importantly, this bill allows for additional types of providers to serve as telehealth distant site providers after the end of the public health emergency. It specifically adds:

• audiologist;
• occupational therapist and occupational therapy assistant under the supervision of an occupational therapist
• physical therapist and physical therapist assistant under the supervision of a physical therapist;
• speech-language pathologist;
• specific facilities or additional providers that provide these services such as rehabilitation or home health agency.

Federal Updates

HHS: (11/20) – The Department of Health and Human Services issued a final rule on the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements. The Alliance for Connected Care focused on four priority areas for telehealth and remote patient monitoring in our comments on the proposed rule last December, which addressed:

• The possible exclusion of health technology companies from value-based safe harbors
• Implementation of the statutory exception for telehealth technologies for in-home dialysis as passed by Congress
• Possible arrangements involving telehealth and remote patient monitoring under the care coordination safe harbor
• Possible safe harbors for patient engagement and support that could include telehealth and remote patient monitoring services

View the press release and fact sheet. Analysis of the final regulation will be shared in the coming weeks.

HRSA Federal Office of Rural Health Policy: (11/19) – The Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORHP) provided updates on two licensure portability initiatives.

• The website for the Multi-Discipline Licensure Resource Project was created to support the pandemic response through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the FORHP-supported Licensure Portability Program. Created by the Association of State and Provincial Psychology Boards, the site provides up-to-date information on emergency regulation and licensing in each state for psychologists, occupational therapists, physician assistants, and social workers.
• ProviderBridge.org was created by the Federation of State Medical Boards through the CARES Act and the FORHP-supported Licensure Portability Program. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities.

State Telehealth News

WKOW: (11/17) – Wisconsin Governor Tony Evers announced a series of bills related to COVID-19 relief in the state. Under one proposal, insurers would be required to cover all telehealth services. Additionally, insurers would be required to reimburse providers for out-of-network care, to include telehealth, at 250 percent Medicare rates for care resulting from COVID-related disruptions.

The Buckeye Institution: (11/17) – This op-ed discusses the impact that telehealth expansion during COVID-19 has had in the state of Ohio in light of a recent telehealth bill that recently passed the State House of Representatives. As the bill moves to the State Senate, the author presents opportunities where the Senate can make improvements around telehealth cost-sharing considerations and services covered.

Medpage Today: (11/17) – A recent study based in Los Angeles found that telemedicine visits early on in the pandemic were linked to positive outcomes for inner-city children with asthma. The study found that routine asthma care delivered via telemedicine could improve disease control and increase appointment show rates.

KMA Land: (11/16) – In a recent interview, Iowa State Representative Ray ‘Bubba’ Sorenson said that expanding broadband capabilities in rural areas is a top priority during the 2021 legislative session. Sorenson said this is essential, as telehealth has continued to grow and it will positively impact the business economy in the state.

Papers, Surveys, and Studies

Check out the Alliance for Connected Care studies and polling website for more resources.  

COVID-19 Healthcare Coalition: (11/19) – The COVID-19 Healthcare Coalition released its Telehealth Impact Study, which includes a claims data analysis and physician survey. A patient survey is expected to be released by the end of the year. Key highlights include:

• Total telehealth claims – Prior to March 2020, telehealth claims in the United States grew at a very slow rate. With the onset of the COVID-19 pandemic, there was  an abrupt spike in telehealth claims in spring 2020 with a gradual decline in the summertime.
• How telehealth services are being used – Diagnosis codes have been organized into clinically relevant grouping and body systems. Mental health disorders were the leading diagnosis for telehealth claims before and during the pandemic.
• Telehealth across state lines – Patients and providers are most commonly in the same state during telehealth visits but not all the time. Prior to March 2020, the majority of telehealth claims were delivered out-of-state. While a large share of telehealth claims are still delivered out-of-state, the majority are provided by in-state providers.

Massachusetts Health Policy Commission: (11/18) – The Massachusetts Health Policy Commission released data finding that, although some typically larger providers could use telehealth to increase access, many found it difficult to use or clinically inadequate, and patient volumes declined, in part due to technological barriers.

American Psychological Association: (11/17) – The APA released a COVID‐19 Telehealth Practitioner survey finding that the vast majority of psychologists are treating their patients virtually via telehealth. Additionally, a third of psychologists were treating patients living in a different state from where they practice.

Patient-Centered Outcomes Research Institute (PCORI): (11/17) – PCORI Board of Governors approved nearly $10 million to explore how telehealth can be used to improve outcomes for women. The newly approved awards related to digital health include:

• $6 million for a University of Washington study that will be the first national randomized trial on improving outcomes for African-American women with endometrial cancer. African-American women with endometrial cancer have higher mortality rates due to factors including social isolation during treatment, which can affect whether they complete treatment. This trial will compare how well two virtual interventions, group-based and one-on-one peer support, reduce social isolation and if they improve treatment completion as well as patients’ experiences.
• $3.7 million for a University of Pittsburgh Medical Center study looking at whether different strategies for maternity case management (MCM) can improve the mental health of low-income pregnant and postpartum women with anxiety and/or depression. The project will compare a traditional MCM program to MCM supplemented with a digital behavioral health tool, as well as MCM plus the digital behavioral health tool combined with coaching from health/wellness coaches.

Anthem Public Policy Institute: (11/17) – A new report by Anthem’s Public Policy Institute highlights the use of virtual healthcare by individuals enrolled in Anthem’s affiliated Medicare Advantage (MA) plans during the early months of the COVID-19 pandemic compared to earlier time periods. Virtual care among Medicare Advantage (MA) enrollees grew exponentially in the early months of the COVID-19 pandemic, though use was uneven across demographic groups. Most notably, older individuals used a smaller share of virtual services than would be expected based on their 2019 in-person utilization. View the press release and full report.

Psychiatry & Behavioral Health Learning Network: (11/17) – A program incorporated at the Montefiore–Einstein Center for the Aging Brain (CAB) in Yonkers, New York, during the COVID-19 pandemic demonstrates that telehealth can be used to stay connected to older adults with cognitive impairment during public health emergencies, researchers reported. “Caregivers reported that the televisits adequately addressed all concerns that they had at the time of the visit,” the authors of the report wrote.

mHealthIntelligence: (11/17) – Research presented at the American Heart Association's Scientific Sessions 2020 found that atrial fibrillation (AF), an irregular heartbeat that can increase the chance of stroke, was detected up to ten times more frequently in high-risk patients who wore a continuous cardiac monitor for a month after heart surgery compared to patients who had standard follow-up care

College of Healthcare Information Management Executives (CHIME): (11/16) – According to an analysis of 2020 data from the CHIME Digital Health Most Wired survey, the usage and adoption of telehealth more than doubled between 2019 and 2020. Telehealth adoption in most care settings rose by approximately 40 percentage points. View the press release and survey.

Telehealth News and Market Developments

mHealthIntelligence: (11/20) – Stanford Children’s Health launched a new chronic disease prevention virtual care program that utilizes telehealth strategies to provide comprehensive HIV-prevention services to patients up to the age of 25 in California. “Virtual care allows us to meet youth where they are, even during transition to college or other moves, and offers an added layer of confidentiality, as it allows providers to communicate with patients one-on-one, without involving a parent or other guardian if that is the patient's preference,” said Geoff Hart-Cooper, MD, founder and medical director of the Virtual PrEP Program.

American Medical Association Telehealth Resolution: (11/18) - The American Medical Association resolved to continue advocating for telehealth after the COVID-19 pandemic, particularly among underserved communities. The agreed-upon policy resolution, included in the AMA's preliminary report released Wednesday, charged the AMA with continuing to advocate "for the widespread adoption of telehealth services in the practice of medicine for physicians and physician-led teams post SARS-COV-2."

The resolution also tasks the AMA with the following steps:

• “Continue to advocate for the widespread adoption of telehealth services in the practice of medicine for physicians and physician-led teams” after the pandemic;
• Advocate that the federal and state governments and agencies and the payer industry “adopt clear and uniform laws, rules, regulations, and policies relating to telehealth services that provide equitable coverage that allows patients to access telehealth services wherever they are located (and) provide for the use of accessible devices and technologies, with appropriate privacy and security protections, for connecting physicians and patients;”
• “Advocate for equitable access to telehealth services, especially for at-risk and under-resourced patient populations and communities, including but not limited to supporting increased funding and planning for telehealth infrastructure such as broadband and internet-connected devices for both physician practices and patients;” and
• “Support the use of telehealth to reduce health disparities and promote access to health care.”

Healthcare IT News: (11/18) – Earlier this year, Geisinger deployed an iPad with the Caregility app to each room of the step-down units. At the touch of a button on the app, the nurse in the room with the patient could access an experienced critical care nurse or provider. “In the units supported by eICU, patients appreciate that there always is somebody in the background helping us make sure they’re not having any problems,” Tracey Kopenhaver, RN, eICU and cardiac ICU operations manager at Geisinger noted. “The bedside nursing and provider staff appreciate the additional support from the eICU staff.”

Fierce Healthcare: (11/16) – During a Fierce Health IT event, experts from Doctor On Demand and Amwell discussed the future of health care and said that among the biggest changes that could come out of the massive shift in telehealth use during the pandemic is that payers will increasingly encourage "virtual first" healthcare.

Home Health Care News: (11/16) – Colorado-based TRU Community Care began providing palliative care through telehealth at the end of 2019. Prior to adding virtual visits, nurses entering patients’ homes were able to complete a maximum of five visits daily, which jumped to nine patients daily after adding virtual visits. The new process also allowed TRU Community Care to more easily track and trend patients’ disease progression over time.

mHealthIntelligence: (11/16) – Cris Ross, the Mayo Clinic’s chief information officer, says the COVID-19 crisis forced the health system to adapt at a rapid rate, moving from about 4 percent of virtual visits before the pandemic to 85 percent during the roughest days of late spring and early summer. As the coronavirus continues its course and the healthcare industry looks to adapt to a new health environment, Ross says health systems like the Mayo Clinic – which is now seeing more than a million users on its app – have to modernize the back end to meet the front end.

Ithaca Journal: (11/15) – Cayuga Health expanded telehealth services to meet patient needs in response to COVID-19. “Telehealth is emerging as an effective and sustainable solution for precaution, prevention and treatment to stop the spread of COVID-19,” states Martin Stallone, President & CEO of Cayuga Health. “This technology bridges the gap between our patients and providers so everyone – especially symptomatic patients – can remain at home and see their physicians for an appointment.

Upcoming Events

November 25, Aledade, “Making Telehealth and In-Person Care Work for Primary Care Long-Term.”

December 2, mHealthIntelligence, “Webcast: The New Health Care Imperative: Optimizing Access Across Business Lines.”

December 8, CDC, ”The Impact of Telehealth on Health Equity from the Perspective of Large Healthcare Systems during the COVID-19 Pandemic.

December 11, AHIP, “Digital Engagement through Digital Communications.”

Past Events

HIMSS TV, “How telehealth helps prevent burnout among nurses.” In this new video, Laura Jonsson, NP from Matrix Medical Network shares how telemedicine technology and the difference care paradigm it enables help nurses minimize stress and the burnout it can cause.

HIMSS TV, “Telehealth bridging the gap for behavioral health patients.” The fourth episode of the HIMSS telehealth miniseries featured PARITY Health Information and Technology Founder and Chief Innovator Iris Frye interviewing Dr. Danielle Hairston, psychiatry residency training director at Howard University College of Medicine.

Managed Healthcare Executive, “MHE Talks: Improving Patient Access.” In the first episode of the MHE Talks podcast, John Henderson, president and CEO of the Texas Organization of Rural and Community Hospitals, spoke about COVID-19, telehealth, emergency care, and Medicaid expansion.

Please subscribe to this newsletter and send any news or events to crystal.wallace@connectwithcare.org for inclusion.