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Intel-GE Care Innovations' Randy Swanson talks about 'Paying for Telemedicine'

Randy Swanson, vice president of business operations for Intel-GE Care Innovations, will take part in an industry executive panel on "Paying for Telemedicine" from 10:45-11:45 a.m. Monday. He recently answered some questions from ATA 2012 Show Dailies Editor Eric Wicklund.

Reimbursement seems to be the No. 1 issue among physicians who have been slow to adopt telehealth. What are the key factors holding up reimbursement?
Although reimbursement would certainly speed adoption of this important technology, especially in the provider and small practice settings, we don't think the industry can or should wait. There is no guarantee when – or whether – reimbursement for telehealth will become the norm. That said, probably the key factor holding up a formalized reimbursement is acceptance of the status quo.  

Hopefully, we're seeing that change a bit now. There is a major trend toward paying for outcomes and rewarding coordinated care, both of which have the potential to bring telehealth to the forefront of care. Physicians, payers and employers all have an interest in improving outcomes and many opportunities exist today that make sense financially and are in support of the patient.

How can (will) payers shape the dialogue? Should they be assuming a more active role in designing reimbursement methods for physicians?
Payers are a great example of an at-risk entity that benefits from providing care recipients a better overall solution. They have the chance to both speak for their members through their offerings and provide employers greater choices to where they serve as benefits administrators.

We're already working with groups such as Humana to help them lead this transformation. Humana, for example, is very active in innovative care models that use telehealth for population-based care. These types of programs will become more and more common as the cohort of chronically ill continues to grow.

How can independent physicians or those in small practices use telehealth to improve their practices? Are physicians beginning to see this as a viable business plan?
Small practice physicians may be challenged to provide all the elements of a great telehealth plan. They can benefit from working in concert with a full solution provider – one who is focused not just on devices and incorporates full end-to-end services that the physician can easily access. They may also seek to work directly with motivated payers looking to provide cost-effective solutions to a specific patient population.

Should large hospitals and provider networks follow a different business plan? What would work for them? What wouldn't?
Large hospitals and provider networks have a clearer vision into the benefit of telehealth, especially as they begin to face penalties for readmissions within 30 days of discharge. For them, telehealth can offer the greatest benefit in short-term use, instead of multi-year chronic disease management programs. They also have an opportunity to develop a reward system with the health plans that they work with, using telehealth where all parties can share in the savings from more proactive and coordinated care. Lastly, there are an increasing number of new models of telehealth implementation that could work for large hospitals and provider networks, such as post-transplant care management.

Are there certain types of telehealth that offer a better ROI?
Telehealth is innovating and expanding at an incredible rate, so healthcare organizations have a range of options that could offer solid ROI. For smaller and more straightforward disease management needs, first-generation telehealth solutions that just use vital signs monitoring will often work well. However, the profiles of chronically ill patients are becoming increasingly complex; we're seeing a major uptick in organizations that want population health management, which often requires next-generation telehealth systems with video conferencing and true patient engagement to impact behavior change.  

Ultimately, hospitals and providers of all sizes must look first and foremost at the needs of their population. Since telehealth isn't a "one size fits all" answer, different entities may tailor their offerings to impact short-term readmissions or long-term chronic diseases, and ROI can't be achieved without first going through a clear assessment process. Long-term disease states need long-term implementations. Complex disease states may need a higher emphasis on clinician interaction. We've found the upfront identification of a population must match the changes in the business processes to deliver a robust solution that meets its ROI goals.

Do rural telehealth programs face the same financial issues as urban programs?
Rural programs have both significant challenges and significant drivers to adopt telehealth. In terms of challenges, broadband availability to realize the full potential of patient interaction could be uneven, adding additional cost requirements into the program. But on the other hand, managing a highly dispersed patient population through telehealth could reduce the burden on nurses, enabling them to "visit" more than a dozen patients in a day via telehealth instead of just two or three in person. This would put a greater focus on getting the best possible information to the clinicians every day. We think a flexible approach that takes advantage of broadband where it's available and still provides appropriate levels of information where it is not are a good balance.

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