ipi

1. www.ipi.org

2. The Institute for Policy Innovation (IPI) is a non-profit, non-partisan public policy "think tank" based in Lewisville, Texas and founded in 1987 to research, develop and promote innovative and non-partisan solutions to today's public policy challenges. • IPI's focus is on approaches to governing that harness the strengths of individual liberty, limited government, and free markets. • IPI emphasizes getting its studies into the hands of the press and policy makers so that the ideas they contain can be applied to the challenges facing us today. • IPI is engaged in an extensive publication program of policy studies, issue briefs, newsletters and books on public policy issues, all of which are available in electronic form. • IPI is a non-partisan organization, but we approach policy issues from a consistent philosophical viewpoint of individual liberty and responsibility, free markets, and limited government. • IPI is a public foundation, supported by contributions from individuals, businesses, and other non-profit foundations. To maintain its independence, IPI neither solicits nor accepts contributions from any government agency.

3. Houston's HIT landscape and challenges for 2013 What I will address today: States and “grassroots” are leading the way We need more policy maker “heros” Developments and developing… Texas Medicaid Federal developments What is to come? Barriers The government role

4. States ahead of the federal government • Reform is happening rapidly and the federal government is largely oblivious – some activity at FDA, FCC and FTC • The states are largely the primary regulators anyway, including: • Pharmacies • Hospitals/clinics • Physicians and nurses • Medicaid • State Children’s Health Insurance Program (SCHIP) • Nursing homes/assisted living

5. States ahead continued… • Several states have been moving forward in telehealth/mheath/remote care for years including Texas. • 16 states have mandated that all private payers in the state reimburse for telemedicine services if such services would be reimbursed through an in-person visit. • In Texas, Sens. Kirk Watson, John Corona and Rep. Armando Martinex • US Rep. Dr. Burgess

6. In 2013 so far (not a complete listing) • DC - legislation filed that would require private health insurers and Medicaid to cover healthcare services via telemedicine, which is defined as "the delivery of healthcare services through the use of interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment." • CT - bill filed that would require health insurers to cover services provider through "telecommunications technology." • FL - bill introduced to require insurers, including Medicaid, to provider coverage for telemedicine, extend Medicaid coverage for telemedicine to homecare services, provide coverage under the state plan or a waiver for home health services provided to eligible people with chronic conditions, and create a framework to allow for consults with practitioners and professionals in other states. • MS - bill introduced to require insurers to cover telemedicine services if they are the same as a person would get through an in-person visit; the bill would also authorize healthcare providers licensed in the state to provide treatment recommendations to a patient after a telemedicine consult.

7. Continued… • NM – Two bills filed bills requiring insurers to cover healthcare services provided via telemedicine. • SC - bill filed to require individual or group health maintenance organizations to cover telemedicine services. • IN - bill filed seeking to require Medicaid to reimburse certified home health agencies, federally qualified health centers and rural health clinics for telehealth services. • CA – Telehealth Promotion Act introduced • NB – • bill filed that would authorize telehealth services for public school students. • bill filed to require health insurers to cover the screening, diagnosis and treatment of autism in those under 21 years of age, as well as authorizing behavioral health treatment through telehealth. • bill filed to create a Telehealth Behavioral Services Program for youths involved in juvenile justice programs

8. Industry(supply and demand), the grassroots, are leading the way A Mercer, survey reports that 15% of major employers offer some form of telemedicine, while an additional 39% are considering the option. Wilde Mathews, Wall Street Journal, 12/20 Remote physician consultations typically cost about $40 to $45, significantly less than visits to an emergency department or urgent care center, as well as most in-person doctor visits. More Health Plans, Employers Begin To Pay for Telehealth Services

9. Industry leading continued… Health care providers increasingly are adopting telehealth technology as more insurers and employers begin to pay for such services, the Wall Street Journal reports. WellPoint offers in its employer and individual plans remote consultations with physicians using laptop webcams or video-enabled smartphones and tablets. The company will include its new LiveHealth Online program in employer plans in California and Ohio next year and aims to expand the service to commercial plans by late 2014. Other insurers -- including Aetna and UnitedHealth Group – following similar paths

10. Simply put…. We need more policy maker health technology heroes – at the very least to not mess up the good and maybe to even consider the benefits!

11. Developments and developing…Texas Medicaid Texas Medicaid, is mandated by Texas law to provide for coverage and reimbursement for certain telemedicine services. Covered services include: • Medication management • Psychotherapy • Physician consultations Mental health services likely the most rapid growth Various proposals about patient site locations for coverage

12. Developments and developing…Other Activity • New rules issued by the Federal Communications Commission regarding the rural health program • Impending regulations from the Food and Drug Administration governing mobile medical devices, for certain software/apps that act like medical devices • FTC action? • Session in Austin? • Off of Capitol Hill?

13. Barriers • leading barriers to the deployment of telemedicine in the U.S. have almost all involved government policy. • reimbursement by Medicare and Medicaid • state-based standards of care and professional licensing • device regulation • telecommunications policy • Industry challenges • Security/privacy • Interoperability • Acceptance

14. The government role? • Legislation enabling tele-health, removing regulatory barriers • Encouraging health insurers to begin to pay for tele-health • CMS using more technology such as text4baby to help pregnant Medicaid patients (again, states could make an effort to embrace) • Encourage “personal pharmacies” e.g. DayaMed • Encourage use of EHRs, individually kept EHRs • Do not tax that which should be encouraged

15. Developments and developing…What is to come? ?

16. The take home Changes in the public policy landscape are much much slower than innovation. The challenge is to educate policy makers so they are not causing roadblocks to success.

17. www.ipi.org Bartlett D. Cleland Bcleland@IPI.org (d) 972 874 5140 (m) 703 626 8478