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Road Map
Industry Overview
3
4
Industry Overview
Defining Telehealth
Industry Snapshots
Adoption Trends
Diagnosis and
Treatment
Real-time
Virtual Visits
Professional
Consultation
Remote Patient
Monitoring
Telephonic
Web-based
Mobile,
Smart Device
Kiosk
Monitoring and
Care Coordination
2016 The Advisory Board Company advisory.com
Asynchronous
Store-and-Forward
Bluetooth-Enabled
Peripheral Devices
Source: Market Innovation Center research and analysis.
Provider-to-Patient
Provider-to-Provider
Timing of Interaction
Common applications:
Synchronous
(real time)
Telestroke
TeleICU
Telepsychiatry
4
Common applications:
Asynchronous
(time lag)
Common applications:
Common applications:
Secure e-messaging
Teleradiology
Telepharmacy
Teledermatology
10
Strategic
Benefit
Enhanced rural
access
Improved patient
convenience
New patient
capture/retention of
existing patients
Popular
Vendors
Teladoc
American Well
MDLive
Doctor on Demand
Expanded PCP
capacity
Clinical Applications
Episodic
Primary Care
Urgent
Care
Chronic Disease
Management
Behavioral
Health
Source: Tahir D, Telehealth services surging despite questions about value, Modern
Healthcare, February 2015; Market Innovation Center research and analysis.
11
Strategic
Benefit
Improved access
in communities with
persistent provider
shortages
Popular
Vendors
Avizia
Vidyo
Improved patient
experience from
convenient
appointments
Vsee
Zoom
Reductions in
avoidable patient
transfers
Clinical Applications
Telepsychiatry
Telestroke
TeleICU
12
Asynchronous care
focuses the clinicians
interaction to the most
essential elements,
allowing batching of the
clinicians time to capture
scale economies.
Beckers Hospital Review
Strategic
Benefit
Extended hours of
specialist support
Popular
Vendors
AMD Global
Telemedicine
Expanded provider
capacity
GlobalMed
iClickCare
Improved patient
experience via
reduced wait in
access to care
Second Opinion
Telemedicine
Clinical Applications
Dermatology
Radiology
Retinopathy
Source: Carlin, P. and Regan, K. Telemedicine: A Growing Market, MD Buyline, August 2014.
http://www.mdbuyline.com/blog/telemedicine-growing-market/; Market Innovation Center research and analysis.
13
Strategic
Benefit
Enhanced patient
convenience
Popular
Vendors
Expanded patient
access to primary
care services
Streamlined
medication
management
EMR vendors
TigerText
Imprivata
Voalte
Doc Halo
Operational
efficiencies
Clinical Applications
Wellness
Coaching
Routine Patient
Follow-up
Chronic Disease
Management
Medication
Management
Source: Monegain, B. KLAS names top secure messaging tools, Healthcare IT News.
October 2015. http://www.healthcareitnews.com/news/tigertext-leads-messaging-marketnow; Market Innovation Center research and analysis.
14
$46B
Reduced ED
utilization, patient
readmissions
Popular
Vendors
Honeywell
HomMed
McKesson
Improved patient
management of
chronic, comorbid
conditions
Estimated RPM
market size in 2017
Cardiocom
Philips Healthcare
ScottCare
Reductions in patient
mortality
TouchPoint Care
Clinical Applications
Heart Failure
COPD
Diabetes
Source: Report: mHealth and Home Monitoring, Berg Insight. December 2015. http://www.berginsight.com/ReportPDF/ProductSheet/bi-mhealth7-ps.pdf;
Godfrey, J. et. Al., Report: State of the App Economy, 4th Edition, ACT | The App Association, January 2016. http://actonline.org/wpcontent/uploads/2016_State_of_App_Economy.pdf; Carlin, P. and Regan, K. Telemedicine: A Growing Market, MD Buyline, August 2014.
http://www.mdbuyline.com/blog/telemedicine-growing-market/; Market Innovation Center research and analysis.
15
$7.2
2016
$11.0
2017
Popular Vendors
$41.3
2018
2019
2020
Fitbit
Apple HealthKit
Samsung S Health
Philips
GE Healthcare
Siemens
16
In millions of dollars
Millions of Visits
5-YR
Growth
20.0
$17.6
15.0
16.6
604% Growth
26.9
62%
21.5
48%
5.4
157%
14.5
10.0
2.1
2015
5.0
$2.5
0.0
2020
Total
PCP Visits
Specialty Consults
1) CMS data.
2) 2015 HIS Analytics report.
2016 The Advisory Board Company advisory.com
Sources: Herman B, Virtual reality: More insurers are embracing telehealth, Modern Healthcare, February 2016, available at:
http://www.modernhealthcare.com/article/20160220/MAGAZINE/302209980; Global Telemedicine Market Growth, Trends and Forecasts (20152020), Mordor Intelligence, http://www.mordorintelligence.com/industry-reports/global-telemedicine-market-industry, December 2015; Japsen,
Bruce, Doctors Virtual Consults with Patients to Double by 2020, Forbes, http://www.forbes.com/sites/brucejapsen/2015/08/09/as-telehealthbooms-doctor-video-consults-to-double-by-2020/#2d4da3675d66, August 2015; Market Innovation Center research and analysis.
17
Telehealth-Specific Role
4%
11%
IT Professionals
Clinical
Leaders
22%
63%
Strategic
Planners
35%
36%
Management of exploratory
process for new uses from grant
pursuit to pilot to scaling
Coordination with leaders across
strategic planning, clinical roles,
IT, and marketing in developing
new telehealth initiatives
18
n=141
n=141
Physician-toPhysician
16%
Direct-toPatient2
84%
Primary
Care
28%
CV
18%
eICU
16%
Stroke
11% Psychiatry
11% Pediatrics
9% Dermatology
4%
Women's
Health
1%
19
20
Consumers
Vendors
Adopters
Payers
Legislators
Shifting needs
& preferences
to favor virtual
care delivery
Developing and
promoting
technological
advancements
Providers,
employers
seeking
competitive
advantage
Determining
coverage terms
to manage cost
of care
Establishing
licensing and
regulatory
standards
21
#1. Consumers
20%
77%
85%
30%
Expected U.S.
population growth
among individuals 65+
between 2000 and 2030
Average increase in
cost per case for
individuals with two
chronic conditions
20%
19.5
55%
Percent of patients
receiving recommended
preventive care
Sources: Fox S & Duggan M, Part One: Who Lives with Chronic Conditions, Pew Research Center, November 2013. U.S. Department of Health and
Human Services Aging Administration. Aging Statistics, 2010, www.aoa.gov/AoARoot/Aging_Statistics/index.aspx HHS, Health Insurance
Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period, May 1, 2014; , Hospital Utilization, Costs, and Mortality for
Adults With Multiple Chronic Conditions, Nationwide Inpatient Sample, 2009, available at: /www.cdc.gov/pcd/issues/2013/pdf/12_0292.pdf; Merritt
Hawkins, Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates, 2014, accessed March 18, 2015, available at:
http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Surveys/mha2014waitsurvPDF.pdf; Market Innovation Center research and analysis.
22
Clinic location
near work
Clinic located
near errands
Emailing provider
with symptoms
Clinic located
near the home
54%
49%
53%
Of 18-29 yr olds
Of those making
>$71K per year
Of those working
>35 hours per week
Source: 2014 Primary Care Consumer Choice Survey, Market Innovation Center research and analysis.
23
72%
Consumers would see
a doctor via video
76%
Patients prioritize access to
care over need for human
interaction with providers
Then, Preference
67%
Patients prefer email
over webcam
70%
Patients prefer an online
visit to get prescriptions
Eventually, Shift
of total
20% Percentage
potential primary/
Key
Key Takeaways
Takeaways
Many patients arent looking for
the same type of intimate
doctor-patient relationship of old
Access to care is top concern
Currently, about 1 in 5
outpatient visits could be
done online
Millennial patients are
starting to actively choose
tech-savvy providers
Source: Pennic J, 72% of Consumers Are Willing to See a Doctor Via Telehealth Video Conferencing, HIT Consultant, December 11,
2013; American Hospital Association Trendwatch: The Promise of Telehealth for Hospitals, Health Systems and Their Communities,
January 2015; American Well, Telehealth Index: 2015 Consumer Survey, 2015; Market Innovation Center research and analysis.
24
#2. Vendors
Telemedicine Equipment
25
#3. Adopters
Retailers
18.4%
Projected growth
through 2020 in
global market for
telehealth
technologies1
Employers
& Payers
+2K
Retail clinic sites
in 43 states and
the District of
Columbia2
Providers
74%
Employers
expecting to offer
telehealth in
20163
1) FierceHealthIT, Rapid Growth Projected for Global Telemedicine Market, May 2015
2) A&M, Retail Healthcare: Growing Trend for Healthcare Service Delivery
3) Emerman, E. Health Care Benefits Cost Increases to Hold Steady in 2016, National
Business Group on Health Survey Finds, National Business Group on Health. August
2015.
4) American Well, Telehealth Index: 2015 Physician Survey Insights
2016 The Advisory Board Company advisory.com
Direct-to-Consumer
Service Offerings
57%
Physicians willing
to see patients
via video4
26
Liability
Doctor-Patient Relationship
Usefulness of Data
Source: Friedberg, M et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems,
and Health Policy, RAND/AMA 2013 Physician Satisfaction Study, http://www.rand.org/pubs/research_reports/RR439.html; Sullivan, M.
Guess What? Doctors Dont Care About Your FitBit Data, Venture Beat, August 2014, http://venturebeat.com/2014/08/15/guess-whatdoctors-dont-care-about-your-fitbit-data/; Chen, P. Are Doctors Ready for Virtual Visits? The New York Times, January, 2010,
http://www.nytimes.com/2010/01/07/health/07chen.html?_r=0; Market Innovation Center research and analysis.
27
#4. Payers
Source: Center for Connected Health Policy, http://cchpca.org/telehealth-policy; American Action Forum, http://americanactionforum.org/insights/curbingthe-provider-shortage-more-coverage-for-telehealth-services; Market Innovation Center research and analysis.
28
Geographic Location
of Originating Site
Must be provided to an
eligible beneficiary in an
eligible site
Site must be located in:
1. A Health Professional
Shortage Area outside
of a Metropolitan
Statistical Area
Type of Health
Provider at Distant Site
Physician
Nurse practitioner
Physician assistant
Nurse midwife
Clinical nurse specialist
Clinical psychologist and
clinical social worker
3. A county outside of
an MSA
Registered dietitian or
nutrition professional
Type of Institution
for Originating Site
Office of a physician or
practitioner
Hospital
Critical access hospitals
Rural health clinic
Federally Qualified Health
Centers (FQHCs)
Skilled nursing facility
Sources: Medicare Telehealth Payment Eligibility Analyzer, U.S. Department of Health and Human Resources,
http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx; Market Innovation Center research and analysis.
29
#5. Legislators
CRITERIA
Good to Excellent
Average
Fair to Poor
Medicaid
Commercial
Geographic &
Reimbursement Reimbursement Patient Setting
Requirements
Licensure
& Eligible
Practitioners
Patient Informed
Consent &
Telepresenter
Prescribing
& Practice
Standards
Care
Innovation
30
Eligible
Technologies
Setting
Requirements
Type of setting
and location of
patient at time of
encounter
The most
supportive states
have no
geographic
requirements for
reimbursement
Some states
cover remote
patient monitoring
or home health,
usually for specific
conditions like
CHF, COPD, or
end-stage renal
disease
Type of
Service
Some states limit
the services for
which they offer
reimbursement to
chronic disease or
behavioral/mental
health
Many states limit
reimbursement to
teleradiology or
emergency
services
Most states limit
the types of
providers that are
eligible to conduct
specific services
Commercial
Parity Laws
The majority of
states have
commercial
parity legislation
in place
State statute
requiring
commercial
payers to
reimburse for
eligible
telehealth
services at the
same rate as inperson services
Payer-Led
Programs
Individual payers
may choose to
include telehealth
services in
benefit packages
regardless of
state laws
Some payers
offer their own
telehealth
services or
partner with
vendors (e.g.,
United
HealthCare &
MDLive)
31
Licensure Requirements
Practice Standards
32
ACO Struggles
Source: Lacktman, Nate. 2016 Will be the Year of Telemedicine and ACOs, Health Data Management, December 21, 2015,
http://www.healthdatamanagement.com/news/2016-will-be-the-year-of-telemedicine-and-ACOs-51741-1.html; Wicklund, Eric. Telemedicine
a Key Component of Next-Generation ACOs, mHealth Intelligence, January 13, 2016, http://mhealthintelligence.com/news/telemedicine-akey-component-of-next-generation-acos. Market Innovation Center research and analysis.
33
2016 Updates
Type of Interaction
Source: Center for Medicare and Medicaid Services CY2015 Physician Fee Schedule
Proposed Rule, 42 CFR 410; Market Innovation Center research and analysis.
34
Legislation to Watch
State Bills
8 of the 18 states that do not currently have parity laws are considering
them for the 2016 session; other states will work to remove restrictions
on practice and patient setting
Licensure
Compacts
Congressional
Bills
MedPAC
QuasiRegulatory
35
Metric Selection
Value Proposition
Prioritization Exercise
36
Metric Selection
FINANCIAL METRICS
Direct revenue
Indirect revenue
Operational efficiencies
from reimbursements
by payers, self-pay,
and contract value
Cost avoidance
from replacing in-person
encounters and avoiding
unnecessary care
VALUE METRICS
Clinical quality
Provider satisfaction
Competitive advantage
improvements from
sustained connections
with patients, more
timely preventive care
as a result of enhanced
access to specialist
expertise, improved
workflow tools
37
38
60%
Stanford Medicine
launched virtual visits
at PCP clinic
160
155
Minutes saved
for each virtual
appointment1
Hours of physician
time saved (across
2.2 doctors)
Cost Savings
30-40%
Rationale: More
convenient access to
PCPs and wellness
coaches for lowutilizing ACO
population
Savings may reflect
lower acuity of virtual
visits
Savings on cost-per
appointment
39
Office Visit
46%
Urgent Care
ER
Patients Served
New
Patients
50%
Current
Patients
50%
35%
12%
Other
6%
No Care
1.4%
40-60%
Of new patients lack a current
primary care physician
MultiCare
partnered with
vendor to provide
on-demand visits
Volume: 200-800
virtual visits/month
Rationale:
Add PCP capacity by
decanting low-acuity
visits; exclusive vendor
relationship aided
patient retention,
downstream
care capture
40
40%
80%
Source: Pai, A. Wyoming Medicaid Taps Wildflower for Pregnancy Tracker App, Mobihealth
News, February 12, 2014; Source: Market Innovation Center research and analysis.
41
Flow
Sheets
Chart Review
0-3%
$1M
300
Number of patients in
program, of 2,200 total
heart failure patients
42
Primary Care
OP Care
Improve primary
care coverage
Extend clinic
coverage from
specialists
Cut inappropriate
admissions and
transfers
Improve availability
or access to
specialist expertise
Bridge gaps in
availability or access
to specialist expertise
Streamline
information transfer
between care
settings
Increase
interoperability
between
hospital/post-acute
care provider EMRs
Improve patient
compliance with
post-discharge care
pathway
ED
IP Care
Address causes of
frequent treatment
complications
Avoid readmission
rates/penalties
PAC
Support seamless
care transitions
43
Pediatric Applications
Telehealth Reimbursement
TeleICU
Telestroke
Teleoncology
Wearables
Telebariatrics
44
Your
needs
How we
can help
Scope of
Telehealth
Content
45
In Closing
advisory.com