Download Schwartzer AHI Telehealth Presentation 0914 – jrl edits[2]

Dan Schwartzer
Deputy Commissioner
Wisconsin Office of the Commissioner of Insurance

ACA – Year 2
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Transitional Policies

Network Adequacy
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Self-Funded
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2017 Waiver
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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
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Group offered competing opinions on how to
make provider payment reform and increased
focus on primary care happen.
Developed five tasks:
1.
2.
3.
4.
5.
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.
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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.

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
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Models include:

May be adaptable for mobile clinics and more
economical than near-site facilities
◦ Video conference (Skype) only
◦ Integrated video conference and kiosk unit
◦ Video conference in conjunction with PA or LPN

Practice of medicine
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Medicaid definition
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Private Insurance

No impact on network adequacy
◦ 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 defines which services should be covered by
telehealth
◦ Widely covered by private insurance
◦ Limited Regulation
 No real definition
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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

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.”

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)
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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?
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Basically government needs to stay out of the
way
Let medical community determine
appropriate use, just as it does today.