Telehealth

1. Telehealth Dan Schwartzer Deputy Commissioner Wisconsin Office of the Commissioner of Insurance

2. State of the Market • ACA – Year 2 • Transitional Policies • Network Adequacy • Self-Funded • 2017 Waiver

3. Wingspread Conference: Better Health at Lower Cost • 2013 NGA/IOM meeting at Wingspread had 40 attendees, including Gov. Walker, over 2.5 days. • Major points of agreement, healthcare system needs: • Provider payment reform • Better focus on primary care and coordination of care (including wellness programs) • Governor is state official best suited to drive real change: • Influence over state employees, Medicaid • Can convene stakeholders and drive agenda better than any other official

4. Wingspread: Task Development • Group offered competing opinions on how to make provider payment reform and increased focus on primary care happen. • Developed five tasks: • Statewide review of healthcare manpower requirements; • Dept. of Health Services (DHS) to develop package of Medicaid reforms for near and long-term program savings; • OCI and DHS to develop package of changes to state laws and regulations to facilitate and enhance the use of telemedicine in rural WI. • State agencies and stakeholders to identify best practices for health benefits and services for small businesses. • Wisconsin’s health care data groups will develop opportunities to provide consumers transparency in health care quality and costs.

5. Telehealth Task • OCI and DHS tasked with developing package of changes to state laws and regulations necessary to facilitate and enhance the use of Telemedicine in rural WI. • Gov. Walker gave permission to expand task to all of Wisconsin, as issue is far more than rural. • OCI uses term “Telehealth” to capture all remote health care clinical services using telecommunications technology.

6. Industry Adoption • Although still in early stages, many insurers are adopting Telehealth solutions • Insurers recognize that Telehealth can support integrated health care • Can be more economical than in-person care in appropriate settings • Models include: • Video conference (Skype) only • Integrated video conference and kiosk unit • Video conference in conjunction with PA or LPN • May be adaptable for mobile clinics and more economical than near-site facilities

7. Current Regulatory Environment • Practice of medicine • Telehealth provider must operate within scope of license • Generally, is considered to be practicing medicine in the state in which doctor resides • Must be licensed by the patient’s state of residence • Medicaid definition • Medicaid defines which services should be covered by telehealth • Private Insurance • Widely covered by private insurance • Limited Regulation • No real definition • No impact on network adequacy

8. Importance of Statutory Definition • No statutory limits allow providers and insurers to innovate and adapt new technology as it becomes available • But complete lack of statutory definition makes limits of playing field uncertain – What is permissible? • Inhibits speed to market as insurers do not know whether regulator will approve

9. Recommendations • Broad statutory definition would define limits of playing field without stifling innovation • “Telehealth” means health care delivery, diagnosis, consultation, treatment, transfer of medical data or exchange of medical education information through the use of interactive audio, video or other electronic media, provided that services delivered through audio only telephones, electronic mail messages or facsimile transitions are not included.”

10. Recommendations • Patient Compensation Fund structure already accommodates Telehealth • Practitioners in other states who see a small number of WI patients via Telehealth may obtain an exemption; • Practitioners who see a greater number of WI patients will pay a varying percentage of the PCF contribution depending on the number of hours they devote to WI patients • Licensure: • Other states have implemented Expedited or Special Purpose license; Compacts; Universal Licensure Application. • DSPS Moving towards Universal Licensure (Already being proposed by FSMB)

11. Recommendations • For State Government: • ETF’s GIB recently approved full use in state employee plan; further state employee use may be desirable • Department of Corrections uses Telehealth for behavioral health patients, but continuity of care is hampered by absence of electronic medical record • Current statute limits Telehealth use in Medicaid; Can it be expanded without expanding state budget?

12. Other Considerations • Basically government needs to stay out of the way • Let medical community determine appropriate use, just as it does today.