Telehealth Optimization Initiative

• Reports
• Overview
• Summary of Recommendations
• Action Steps for Achieving Broad Deployment
• Telehealth Optimization Initiative Collaborative Members

Reports

Overview

Given the magnitude of the healthcare crisis and the potential for telemedicine to substantially support solutions, the California Telemedicine & eHealth Center (CTEC) convened key stakeholders to collaboratively develop policy recommendations for the optimal deployment of telemedicine and telehealth. The Telehealth Optimization Initiative, a Collaborative formally chartered by CTEC, sought to engage the many telemedicine stakeholders; consumers, payers, advocates, funders, providers, healthcare systems and others, to identify needs, concerns, and opinions of the different groups, and to develop a unified perspective on policy and strategies necessary to overcome barriers to widespread adoption.

Major stakeholder groups representing different, broad-based constituencies with differing needs and concerns, participated in focus groups, structured reviews, and discussions of critical factors impacting telemedicine implementation. The findings from these efforts, along with independent research, were then reviewed by the Collaborative. The Collaborative identified a set of commonly agreed upon policy needs and outlined actions that legislators, funders, and other policy makers can enlist to advance and benefit from broader telemedicine deployment.

Optimizing Telehealth in California an Agenda for Today and Tomorrow: Major Findings ad Recommendations contains the result of the Collaborative's review and a blueprint for action. Links to this report, as well as to other documents developed as part of the Telehealth Optimization Initiative, are available by clicking on the report covers noted at the top of this page. These reports provide more detail on topics covered in the Major Findings and Recommendations Report.

Return to Top

Summary of Recommendations

Overarching Policy Recommendations for Broad Deployment of Telehealth

The Telehealth Optimization Initiative Collaborative members developed two overarching policy recommendations which form the foundation for expansion and optimization of California telemedicine. These recommendations promote and support telemedicine use whenever possible in all care settings.

• Telehealth and telemedicine services should be developed and implemented in every situation where patient care, access, provider availability, efficiency, or cost of service can be positively impacted.
• Telehealth and telemedicine should be a covered and reimbursable method for the delivery of services across the entire spectrum of healthcare services.

Return to Top

Action Steps for Achieving Broad Deployment

The Collaborative identified 37 actions that support California's broad deployment of telemedicine. The recommended actions address barriers to broad deployment and/or identify existing opportunities that can be leveraged. Action steps are organized into six major categories:

• Institutional Support and Incentives

• Consumer Demand

• Payer and Funder Support and Incentives

• Provider Availability

• Leadership, Expertise, and Coordination

• Research and Evaluation

Institutional Support and Incentives

1. Create a telehealth government task force comprised of various agencies and departments to assure that telehealth efforts are coordinated. Work with policy makers and key agencies, including control agencies, to create a better understanding of the potential for telemedicine to improve healthcare access to underserved populations and to promote its use.
2. Ensure that state agencies identify possible applications and develop feasibility studies on the expanded use of telehealth for cost reduction and service efficiency.
3. Ensure that local agencies receiving state General Funds identify possible applications for telehealth and develop feasibility studies on the expanded use of telehealth.
4. Encourage the University of California Medical Schools to develop one all-campus pool of telemedicine providers.
5. Encourage the federal Receiver for the California Department of Corrections and Rehabilitation to fully optimize the use of telemedicine in the delivery of patient care to the inmate population.
6. Encourage the Department of Corrections and Rehabilitation and the federal Receiver to form partnerships with rural and underserved communities to maximize the use of available medical and behavioral health providers.
7. Work with County Mental Health Plans to include support of telemedicine services and programs as part of their use of Mental Health Services Act funds, and to support county and primary care.
8. Encourage California Public Employee Retirement System to investigate the potential for telemedicine services to reduce healthcare premiums, particularly where services are known to reduce healthcare costs, such as health education, in intensive care units, and home monitoring.
9. Convene state regulators and other stakeholders to consider what statutes and regulations could be changed to positively support the expanded use of telehealth. Identify where policies need to be changed through legislative action and pursue such legislative changes.
10. Ensure that California tax code allows telemedicine sites to be treated in the same manner as other employer provided medical benefits.
11. Encourage health insurers to provide discounts for employers who:
    • Support preventive medicine through telehealth services.
    • Utilize providers offering telemedicine services known to reduce healthcare costs, such as health education, in intensive care units and home monitoring.

Return to Categories

Consumer Demand

1. Ensure that all California payers provide information on telemedicine benefits to all enrollees in their Explanation of Coverage documents.
2. Ensure the development and distribution of a variety of educational materials, including public service announcements, aimed at informing consumers, providers, and insurers of the benefits and availability.
3. Develop incentives to encourage consumers to purchase home monitoring equipment, and participate in chronic disease monitoring and management programs.
4. Ensure that all California payers have clearly articulated telemedicine payment policies that are regularly updated and easily available to providers.
5. All entities covered under the Telemedicine Services Act of 1996 should require a designated officer to answer questions regarding coverage and payments.
6. The Department of Managed Health Care should include telemedicine services and benefits information in publications regarding health plan selection.

Return to Categories

Payer and Funder Support and Incentives

1. Healthcare leaders should identify and target financial support for telehealth programs, including provisions in grant programs that encourage private and public partnerships and increase the availability of services. Use similar incentives to emphasize the development of profitable and socially responsible programs, such as those that reduce the carbon footprint and create improved access to care.
2. Investigate and implement investment strategies necessary to provide capital funding for program start-up across the spectrum of healthcare services. Leverage savings to support investment today that can be repaid from future savings.
3. Support incentives that encourage corporations to undertake the business of telehealth. Specifically focus on engaging the venture capital community as a potential new fund source.
4. Leverage savings achieved through telemedicine programs to provide investment capital for new telemedicine efforts.

Return to Categories

Provider Availability

1. Request the Medical Board of California consider the need for telemedicine supportive policies and regulations including the need for expeditious processing of licensure applications. The Medical Board should recommended policy and regulatory changes to support telemedicine expansion in California.
2. Request the Department of Health Care Services review all Medi-Cal provider rules and regulations and make amendments where necessary to support the practice of telemedicine in California.
3. Funders should encourage the development of services that assist provider and patient sites in coordinating service need with provider availability, including assistance with program development and technical support.
4. Industry professional associations and accreditation bodies should encourage the adoption of a standardized credentialing form (by facility type) that can be used by telemedicine providers to apply for privileging.
5. The federally designated Telehealth Resource Center Web site should include a web-based portal that identifies existing, licensed telemedicine providers.
6. Medical schools and other education training bodies should develop training and education programs to target and educate primary care and specialty providers interested in developing telemedicine practices.
7. Payers should identify changes in practice patterns associated with telemedicine and develop new reimbursement models that clearly support differences in telemedicine service delivery.
8. Government leaders should explore expanding federal and state loan repayment programs as a mechanism for encouraging providers to participate in telemedicine.

Return to Categories

Leadership, Expertise, and Coordination

1. Adequately fund the federally designated Telehealth Resource Center to continue and expand the operation of the centralized neutral source for information and program development support.
2. Designate a state agency level office to be responsible for the development of a coordinated strategic plan for the telemedicine components of publicly-funded health programs.

Return to Categories

Research and Evaluation

1. Conduct a statewide service needs analysis and assessment of capacity of telemedicine delivery to identify unmet provider service needs and location of need.
2. Establish standardized data collection tools and encourage telemedicine funders to adopt the tools and require its use by all funded programs.
3. Develop and capture utilization data on telemedicine services from all patient and provider sites in California regardless of payment or funding source. Report this information annually in the Federal Telehealth Resource Center Annual Report on the Status of Telemedicine in California.
4. Funders should hold telemedicine to the same standards as traditional healthcare modalities when evaluating ways to enhance utilization.
5. The Little Hoover Commission, or similar independent body, should undertake a formal review and evaluation of the Telemedicine Services Act of 1996.
6. Contingent on funding, CTEC should conduct a baseline survey of California insurers and managed care organizations to understand how they decide whether or not to reimburse for telemedicine.

Return to Categories

Telehealth Optimization Initiative Collaborative Members

The California Telemedicine and eHealth Center would like to acknowledge the participation of the many telehealth experts involved in this effort, and thank them for their commitment and support of this collaborative initiative.

Return to Top