THE CHANGING FACE OF RURAL HEALTH CARE New Opportunities Amidst - - PowerPoint PPT Presentation

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New Opportunities Amidst Transition

November 14, 2018

THE CHANGING FACE OF RURAL HEALTH CARE

Eric Harkness Director of the Office of Health Policy

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Hospital Closings since January 2010 Affecting Tennessee

Since 2010, Tennessee has had the 2nd highest rural hospital closure rate in the nation and the highest rate of closures per capita.

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The Upshot: Access to Health Care is a Challenge for Many in Tennessee…

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…And the way we deliver health care—especially in rural areas—is changing, too.

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Today: Rural Health Care

Nursing Home Hospital:

• ED
• Lab
• Diagnostic
• ICU
• OB

Specialists: Ortho and Cardiac Health Department Primary Care FQHC Pharmacy General Surgeon

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Tomorrow: Rural Health Care

Emergency Department:

• Lab
• Diagnostic
• ICU

Health Department FQHC/ Primary Care Pharmacy Telemedicine to Anywhere

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An Inside Look at a Stand-Alone ED

Diagnostics Telemedicine to Anywhere Lab ICU/Observation Primary & Prenatal Care Rapid Transport

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Telemedicine to Anywhere: A [Large] Part of the Wave

• f Change

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What is Telemedicine, Legally Speaking?

Tennessee Code Annotated Definition (Title 56. Insurance § 56-7- 1002): (6) “Telehealth”:

(A) Means the use of real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

(i) Such provider is at a qualified site* other than the site where the patient is located; and (ii) The patient is at a qualified site or at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section; and

(B) Does not include:

(i) An audio-only conversation; (ii) An electronic mail message; or (iii) A facsimile transmission

*(4) “Qualified site” means the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity;

Two-Way Communication

Provider is at his/her clinic or Patient is at a school with nurses

Phone calls, emails, and faxes don’t count

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(b) Healthcare services provided through a telehealth encounter shall comply with state licensure requirements promulgated by the appropriate licensure boards. Telehealth providers shall be held to the same standard of care as healthcare services providers providing the same healthcare service through in-person encounters. (c) A telehealth provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity's network shall be subject to the same requirements and contractual terms as a healthcare services provider in the health insurance entity's network.

What is Telemedicine, Legally Speaking?

Selected Code (Title 56. Insurance § 56-7-1002):

“Delivery Style” Parity Regulatory Parity

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(e) A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service. (f) Nothing in this section shall require a health insurance entity to pay total reimbursement for a telehealth encounter, including the use of telehealth equipment, in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider in an in-person encounter. (g) Any provisions not stipulated by this section shall be governed by the terms and conditions of the health insurance contract.

What is Telemedicine, Legally Speaking?

Selected Code (Title 56. Insurance § 56-7-1002):

More Payment Parity Payment Parity Payor Discretion

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Regulatory Board Status of Telemedicine Rules

Rules Established:

• Medical Examiners

Drafts or conversations started:

• Dentistry
• Psychology
• Social Work and Licensed Professional

Counselor

• Nursing (very, very early conversations)

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Not quite the Wild West, but…

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…There is tremendous opportunity to take advantage of wide open spaces and new ways of doing things.

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When it comes to capitalizing our

• pportunities in Health Care,

Are we asking the right questions?

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Can the health care sector solve for health?

Can Health Care deliver the HEALTH we want?

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2017: The U.S. Ranks Last Among Peers

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Overall Health System Performance

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Equity of Health Systems

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Population Health Outcomes

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The U.S. Healthcare System Doesn’t Achieve Expected Value

• E. C. Schneider, D. O. Sarnak, D. Squires, A. Shah, and M. M. Doty, Mirror, Mirror: How the U.S. Health Care System Compares

Internationally at a Time of Radical Change, The Commonwealth Fund, July 2017.

AUS UK NETH NZ NOR SWE SWIZ GER CAN FRA US

Note: Health care spending as a percent of GDP. Source: Spending data are from OECD for the year 2014, and exclude spending on capital formation of health care providers.

Health Care System Performance Compared to Spending

Higher health system performance Lower health system performance Eleven-country average Higher health care spending Lower health care spending

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High Inequity in U.S. Healthcare Spending

(NIHCM 2012)

National Institute for Health Care Management

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Source: Bureau of Economic Analysis Health Care Satellite Account (Blended Account). Accessed January 25, 2016. Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Ill-defined conditions includes check-ups, follow-up appointments, preventive care, and treatment of minor conditions such as colds, flus, and allergies.

Chronic Diseases are Driving Most of U.S. Healthcare Spending

Total expenditures in $ billions by disease category, 2012

$39 $44 $67 $80 $93 $107 $113 $118 $124 $133 $138 $157 $186 $241 $247 $- $50 $100 $150 $200 $250 $300 Pregnancy and childbirth Dermatological Infectious diseases Mental illness Other Digestive Genitourinary Injury and poisoning Cancers and tumors Nervous system Endocrine Respiratory Musculoskeletal Circulatory Ill-defined conditions

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The Health Challenge of our Times

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The Big 4

Physical Inactivity Excessive Caloric Intake Tobacco & Nicotine Addiction Substance Use Disorders

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Our Brain’s Reward Center

Endorphins

(Endogenous Opiates)

THC Physical Activity Glucose Sex Nicotine

Yeah!

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Does this messenger know something about dopamine and our response to rewards?

https://www.youtube.com/watch?v=DRhlECBKvvo

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Health care is only a fraction of what determines our health.

Sources: McGinnis JM & Foege WH. Actual causes of death in the United States. JAMA 1993: 270(18):2207-12 (Nov 10) McGinnis JM, Williams-Russo P, & Knickman JR. The case for more active policy attention to health promotion. Health Affairs 2002; 21(2):78-93 (Mar).

Health Behaviors 40% Environment 5% Health Care 10% Social Factors 15% Genetics and Development 30%

Determinants of Health

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Our Present Health Reality

Prevention

Cure

Treatment

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Our Present Need

Prevention Cure Treatment

Treatment

Cure

Prevention

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A little late to change the oil?

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We Must Move Upstream…

…To create places and spaces where health is strengthened and fostered.

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So, What Creates Health? A Few Examples:

Meaningful work— including as a student Adequate Sleep Reimburse Health Care for Health Moderation in Everything Spaces & Places that Foster Health Social Inclusion Early Brain Development Our Human Biology Physical Activity Richness of Our Environment Nutritious, Balanced Diet Intentional Pregnancy

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When it comes to the outcomes of

• ur health care system,

where’s the disconnect to health?

Except, Filled Beds = $$$$ & Empty Beds = Health = No $

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As we take advantage of new technology and new ways of delivering health care, how do we rebuild our health system to deliver health, not just care?

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WHAT ARE WE DOING IN TN?

Tennessee’s State Health Plan

Are we creating or improving

• pportunities for
• ptimal health for

all? Are we moving upstream? Are we learning from or teaching

• thers?

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www.tn.gov/vitalsigns

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Real Change Stars at the Local Level

In 2019, 16 counties will conduct a pilot County Health Assessment that will inform their county in 3 key ways

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County Health Assessment Pilot Counties – Beginning Jan. 2019

Bradley, Chester, DeKalb, Fentress, Gibson, Giles, Hamblen, Hancock, Henry, Marshall, Meigs, Monroe, Stewart, Trousdale, Union, Washington

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Eliana Pearl

Born July, 2014 6 lbs. 12 oz. 20 inches

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What role can YOU play in protecting, promoting, and improving HEALTH?

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THANK YOU