Did your state get a good grade? Thanks to the American Telemedicine Association, you can now find out. The ATA is out with a new report that awards “grades” in its “50 State Telemedicine Gaps Analysis.” In recent days, Gov.
On Monday, the American Telemedicine Association released two state policy reports on telemedicine that identify shortfalls in practices nationwide, FierceHealthIT reports.
States were assigned letter grades -- A through F -- based on their telemedicine policies.
Details of Coverage, Reimbursement Report
One report analyzed coverage and reimbursement standards (Dvorak, FierceHealthIT, 9/9).
Overall, seven states scored an A for payment and service delivery policies that support adoption of telemedicine:
Virginia (Pedulli, Clinical Innovation & Technology, 9/10).
Connecticut, Iowa and Rhode Island had the most significant barriers to advancing telehealth and scored the lowest in the report (FierceHealthIT, 9/9).
The report found that 21 states have telehealth parity laws for private insurance, but 29 states received a failing grade for having no such law in place.
Meanwhile, the report found that 47 state Medicaid programs at least partly covered telemedicine (ATA report , 9/8).
Details of Physician Practice Standards, Licensure Report
The second report analyzed and compared physician practice standards and licensure regulations for telemedicine.
The report found that for practice standards:
23 states received an A; and
1 state -- North Dakota -- received a failing grade (FierceHealthIT, 9/9).
The report noted that the results indicate "telemedicine utilization had been met with a mix of strides and stagnation in state-based policy" (ATA report , 9/8).
Meanwhile, no state received an A for interstate licensure policies for telemedicine, likely because of other restrictive policies that hinder practicing medicine across state lines, according toFierceHealthIT (FierceHealthIT, 9/9).
In a release, ATA CEO Jonathan Linkous said, "We hope these reports serve a dual purpose: to showcase the states that are doing an excellent job when it comes to telemedicine and to serve as a wake-up call to those who are failing to extend quality and affordable care to the residents of their state."
He added, "We hope that states will respond by streamlining policies to improve medical practice rules, licensure, health care quality and reduce costs through accelerated telemedicine adoption"
The Coastal Carolina Neuropsychiatric Center began offering telemedicine and telepsychiatry services in 2010, according to JDNews. It’s a type of two-way video conference over a secure line where a doctor can assess a patient from a remote location.
Africa presents a unique opportunity for those who wish to pioneer mHealth or mobile technology healthcare solutions on the continent.
Mobile cellular subscribersAfrica presents an interesting opportunity for mobile health. PHOTO: TechHealth Perspectives
This is according to Doctor Harry Greenspun, a director at the Deloitte Center for Health Solutions, who believes that healthcare in Africa could follow suit behind the continent’s unique adaptation to telecommunications technology.
(READ MORE: The changing face of Africa's healthcare sector)
“Africa presents a really interesting opportunity for mobile health which is different from other parts of the world. If you look at some of the more developed countries in the world, the opportunity in Africa is really around using mHealth as the basis for healthcare infrastructure,” Greenspun told CNBCafrica.com.
“In healthcare, as countries develop more sophisticated healthcare delivery systems, they’re not going to model it on the old-fashioned bricks and mortar type-of healthcare system. They’re going to be using technology in order to provide better access, better quality, better safety at a lower cost.”
Greenspun also stated that an increased use of mobile healthcare solutions would be able to service those who live in inaccessible areas.
“If you think about the way healthcare’s traditionally delivered, you need facilities, you need trained people, as opposed to a lot of the ways healthcare is delivered in Africa, where it is often delivered in the homes and in the community,” he said.
“The spread and adoption of mobile devices opens the door to use these as the healthcare infrastructure, to bring better information to individuals, provide specialist care, remote monitoring to do remote diagnosis. [By] connecting people via phones, you can create infrastructure.”
SAFETY AND SECURITY
He added that as a result of this need, there is a lot of innovation in the use of mobile and other devices to provide a higher level of care and emphasised the need to provide healthcare solutions in the safest and most secure way possible.
(WATCH VIDEO: Trends that create variance to healthcare in Africa)
“There’s always a concern about privacy and security so establishing trust is going to be very important. It has to be done in a safe way with the right safeguards or training. You have to match the level of care with the ability for the people on the other end to be able to take advantage of it,” he explained.
“There is a lot of interest in mobile health in Africa because people recognise that it’s going to be important for public health. The important thing for people to understand is there are differences between how mobile gets deployed in the industrialised world versus the opportunity to improve healthcare in the developing world.”
According to a new market report published by Transparency Market Research “Telemedicine Market [Specialty (Cardiology, Dermatology, Neurology, Orthopedics, Emergency Care, Internal Medicine, Gynecology, and Others) and Services (Tele-Consultation, Tele-Monitoring, Tele-Education, Tele-Training, Tele-Care, and Tele-Surgery)] – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2014 – 2020,” the global telemedicine market was valued at USD 14.3 billion in 2013 and is expected to grow at a CAGR of 14.3% in the forecast period from 2014 to 2020, to reach an estimated value of USD 36.3 billion in 2020.
As a group, about 35 percent of baby boomers were interested in using their smartphone to learn about and better manage their own health, according to results from a survey conducted by academic researchers in late 2010. The survey, which consisted of responses from 469 consumers, 258 of which are baby boomers, only published its findings this month.
Looking over the year’s telemedicine deals, it seems like investors are hedging their bets. Although tools supported by employer plans have dominated, direct to consumer models are proving attractive too, as have more specialized business to business services. I spoke with a handful of investors to get their perspectives.
Based on their feedback, the consensus is with business to business to consumer solutions demonstrated by companies like TelaDoc and MD Live. Telemedicine provided through employer wellness funds makes sense to investors. It offers a way for employers to save money on unnecessary emergency room visits. Staff can access these video consults either through kiosks àla HealthSpot or from a smartphone or computer without missing work. But it’s the future that’s intriguing.
Some factors that could swing the balance in the coming years rest on the physicians’ comfort level with this technology. Along with the ability to attract and keep more board certified physicians or successfully get reimbursement, how does the physician come across to the patient on the other side of the computer, mobile device, etc? Are they smiling? Are they comfortable with the technology? How effective are they at directing patients or another medical professional with the patient in using bluetooth devices to get specific readings? How is data from the session integrated into the patient’s EHR?
There have also been some barriers impeding growth. Ezra Mehlman of Health Enterprise Partners pointed out that the inability to grow small businesses has historically posed a big barrier to entry in the market. “Regulations that impede interstate consults have made it very complicated for small businesses to grow, although the regulatory environment has been changing. Also, it’s hard for companies to pay physicians enough to take video calls from home and a lack of a compelling revenue models to interest physicians.”
Here is an overview of some of the telemedicine models and services that investors highlighted
“B2b models such as Teladoc and MD Live have rightly attracted considerable attention. However, the increasingly “retailization” of the market via high deductible plans, HSAs, defined contribution, and generational shifts, should increasingly change this dynamic and we will see more individuals optimizing for convenience and access outside of the context of their insurance provider’s network as a means to moderate costs.”
Health Enterprise Partners, Ezra Mehlman, vice president
“The data we have seen suggests that when a company plan, self-insured employer or hospital is picking up the bill, utilization [of telemedicine] is higher…I think there is a higher willingness for patients to use the service when it is no skin off their back.”
Direct to consumer
Skip Fleshman, Asset Management Ventures partner supports this model as a backer of HealthTap. Factors like the caliber of doctors it has been able to attract is a significant point going in its favor, said Fleshman. “Where the rubber meets the road is what kind of physicians will you attract? That is where models like HealthTap make more sense.”
And yet, he wonders how much consumers will be willing to pay from their own pocket. Although some companies have focused on providing second opinions for diagnoses that require surgery or a complex treatment regimen like cancer, Fleshman says most people trust their doctors.
Coppedge: “In the long run as attitudes shift and individuals become more accountable for their own health (the analogy would be a car owner being responsible for their own maintenance) we think we will see some big winners emerge in the D to C space, at least for primary and urgent care. This trend may be accelerated in places like New York City, San Francisco, Los Angeles, Seattle, and Portland but it may take five to 15 years for most of the country,” he said. “The winners when the D to C opportunity really emerges may not be the high-profile venture-backed companies making headlines today but rather the folks who already have strong consumer healthcare brands like Walgreens, CVS, Walmart, WebMd, J&J and the some of the leading and well-regarded health systems.”
Mehlman said the direct to consumer space makes sense as part of a concierge service for primary care and may prove an attractive option as consumers face higher deductables. On the other hand, it depends on how they value the perceived benefit from this service. Would they prefer to spend their money on healthcare or allocate it on sexier options?
Telepsychiatry and teledermatology are a couple of examples of telemedicine specialties that have gained more acceptance. These companies are split between services offered to and through providers and direct to consumers. 1DocWay provides its telepsychiatry service through psychiatric hospitals supported by physician networks and works within the reimbursement parameters of Medicare and Medicaid. Teledermatology companies such as Iagnosis’ Dermatologists on Call have relied more on the direct to consumer market. In addition to the convenience factor, embarrassment is a strong motivator for this care delivery approach, particularly when it involves a rash associated with a sexually transmitted disease.
Another area where telemedicine is provided through a hospital is interpretation services for non-English speakers. Mehlman pointed to InDemand Interpreting, a company backed by Health Enterprise Partners. Interpreters work from video call centers and offer services in more than 13 languages and signing for deaf patients.
Provider based solutions Hospitals and health systems such as University of Pittsburgh Medical Center and Mayo Clinic are offering video consults with patients. Although the consensus is that it’s early days to determine how successful this approach will be, it raises some interesting questions about the directions it will take, such as specialty areas. Several institutions are already providing telemedicine services to other hospitals through teleICU and telestroke. It also will be interesting to see whether patients put more trust in services originating from hospitals, rather than a vendor in the longterm.
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