Digital Medicine Pathway to Clinical Adoption: Comparative Clinical - - PowerPoint PPT Presentation

Digital Medicine Pathway to Clinical Adoption:

Comparative Clinical Evidence Essential Along Pathway Continuum

Sylvia J. Trujillo

Senior Washington Counsel November 1, 2018

#PCORI2018

2 • November 1, 2018

Sylvia J. Trujillo

• Has nothing to disclose.

3 • November 1, 2018

How is comparative effectiveness research in digital medicine necessary to facilitate clinical adoption?

• What is AMA’s and physician interest in digital medicine tools

(including telehealth, remote patient monitoring, and other modalities)?

• What are the major barriers to physician adoption of digital

medicine interventions like the ones discussed?

• What additional information is needed to change practice?

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Why is digital medicine needed?

No Ordinary Future Trends

• Baby Boom size
• Longevity
• Lower birth rates
• Strain on safety net program
• Growing shortages of clinicians and

caregivers

Current Challenge

• Incidence of chronic disease and

prevention /chronic care management challenges

• Cost of health care
• Fragmentation of care and

duplication of care and administration

• Geographic mismatch between

specialists and patients

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2016 AMA Digital Health Study

AMA commissioned survey

• f physicians

Digital Health Study Overarching finding:

• physicians are optimistic that

digital medicine tools will improve medical practice and patient care

Investigate physician

• motivations
• current usage
• expectations for integrating digital

health tools into their practice

Physicians Adopt

clinical efficacy demonstrated (as compared to in-person care) standard liability insurance coverage available data privacy/security is assured by experts workflow integration with electronic health record (EHR) systems coverage and payment

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AMA Digital Health Initiatives: Innovation to Clinical Integration

Physician Questions:

• 1. Is it clinically valid?
• 2. Will I get paid?
• 3. Will I get sued?
• 4. Does it work in my practice?

Discovery / Clinical Validation Regulatory / QA Coding Pricing Coverage Liability / Med- Mal, PI, HIPAA Interoperability Infrastructure Training / Workforce AMA Initiatives:

PHYSICIAN INNOVATION NETWORK

XCERTIA INDUSTRY GUIDELINES

DIGITAL MEDICINE PAYMENT ADVISORY GROUP

PHYSICIAN INNOVATION NETWORK / DIGITAL PLAYBOOK EDUCATION CENTER

ADVOCACY & POLICY INITIATIVES

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Digital Medicine Payment Advisory Group

Enterprise solution

Innovation Regulation Coding Pricing Coverage Liability Inter-operability Training Aggregate evidence base Gaps in coding Fair and accurate valuation Widespread coverage Program Integrity risks risks unique to digital medicine

Will I get paid?

2017

Will I get sued?

2018 High Touch: 14 advisors with a staffer assigned to each advisor Mix of established players (such as Cleveland Clinical), national innovators, CPT Panel and RUC members

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DMPAG Objectives

Establishment of a clear pathway to clinical integration of digital medicine in order to ensure access to high quality and safe clinical care for patients and their physicians that promote improved health outcomes. The Advisory Group will address:

Creation and/or dissemination of data/evidence supporting the use of digital medicine technologies and services in clinical practice. Existing code sets (with an emphasis on CPT and HCPCS) and the level to which they appropriately capture these services and technologies. Factors that impact the fair and accurate valuation for services delivered via telehealth. Widespread coverage of digital medicine (including telemedicine and remote patient monitoring), including greater transparency of services covered by payers and advocacy for enforcement of parity coverage laws. Program integrity concerns of payers including, but not limited to, appropriate code use, and other perceived risks unique to digital medicine.

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DMPAG

Remote patient monitoring codes Internet interprofessional consultation codes

DMPAG Environmental Survey of Clinical Literature

• In-depth Interviews of

early adopters

• Consultations with

clinical experts DMPAG Code Applications submitted to CPT Editorial Panel

• CPT Editorial

Panel Adopts Codes CMS Proposes Coverage FY 2019

• Final Rule will

be issued in November

AMA

Digital Health Implementation Playbook Physician Innovation Network Education Center Xcertia

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Evidence Base Needed to Expand Integration

• Does digital medicine promote the quadruple aim?
• Enhancing patient experience
• Improving population health
• Promoting value
• Improving the work life of health care providers, including clinicians and staff
• Does digital medicine modality provide care in less restrictive / less institutionalized

sites of care in a clinically efficacious manner? (Care closer to patient)

• Does digital medicine tool promote prevention (or delay onset of disease or

mitigate impact)?

• Does digital medicine modality promote care coordination or continuity of care?

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Learn More

• www.ama-assn.org

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Thank You!

Sylvia Trujillo

Senior Washington Counsel November 1st, 2018