OPERATIONAL EXCELLENCE TELEHEALTH IN ACTION


Lutheran Senior Services (LSS) in 2014 launched Project Wellness, a telehealth platform centered around telehealth kiosks.


• Kiosks are equipped with instruments that measure key health indicators, including blood pressure and glucose levels


• Program has triggered 3,800 interventions with 300 instances of seriously adverse health outcomes being prevented


• LSS communities in the project found an 11 percent reduction in move-outs to higher levels of care.


Source: Leavitt Partners


any telehealth service off ered by a Medicare Advantage plan must also be off ered in per- son (303.a.3).


The regulatory environment One key factor: Current legislation does not recognize senior living communities as qualifying originating sites for Medicare fee-for-service telehealth reimbursement. But this originating site requirement is not an issue for Medicare Advantage, which will expand telehealth coverage in 2020. The CHRONIC Care Act of 2018 spe-


• Senior living communities off ering in- novative solutions like telehealth can at- tract Medicare Advantage benefi ciaries


• Virtual care in senior living may help mitigate staffi ng shortages, especially in rural areas


• Remote health monitoring has great potential for chronic health conditions management.


Reimbursement trends are strengthening and beginning to favor the evolving land- scape. The Bipartisan Budget Act of 2018 grants Medicare Advantage plans broader fl exibility in covering telehealth services in plan year 2020. In 2016, the number of Medicare telehealth claims submitted increased 33 percent (372,518 to 496,396), and total payments increased 28 percent ($22.4 mil- lion to $28.7 million). This uptick in total payments is not attributable to fee schedule rate increases, but rather to more providers using telehealth services with their tradition- al Medicare fee-for-service benefi ciaries. Telehealth is becoming more ubiquitous and presents opportunity for senior living


TELEHEALTH SCORECARD


Leavitt Partners scored revenue streams for several factors on a scale of 1 to 5.


Less Attractive More Attractive Implementation Cost Timeline


Operational Complexity


Regulatory Exposure


Growth Potential Profi tability Market Opportunity


Overall Score


providers to off er virtual care services at their communities.


Challenges to telehealth use While use is increasing, it’s still far from common. Recent studies found only 12 per- cent of direct-to-consumer telehealth visits replaced a visit to another provider. This raises the question as to whether telehealth cuts or adds to net spending. Vendor and infrastructure investments


are another consideration. Electing to con- tract with a telehealth vendor to service vir- tual care services requires signifi cant capital. Telehealth systems off ered by vendors that include software, medical care devices, and mobile carts may cost upwards of $20,000 per community. While regulations are generally favorable,


some requirements can pose a challenge. These include managing strict confi denti- ality and patient access laws and monitoring which types of services must be in-person. Some services require an in-person visit before remote services can begin. The Bi- partisan Budget Act of 2018 stipulates that


cifi cally encourages the use of telehealth to better manage care for individuals with complex needs. It expands telehealth use for Medicare ACOs, extended broader telehealth benefi ts to Medicare Advantage plans, and expands use of virtual care for stroke and dialysis patients. In addition, the Centers for Medicare


and Medicaid Services has issued a new interpretation of how statutory require- ments apply to Medicare reimbursement for telehealth, in its 2019 Medicare Physician Fee Schedule (PFS). The new PFS provides broader reimbursement for certain virtual care services, such as virtual check-in, re- mote evaluation of pre-recorded patient information, and remote chronic care management.


Recommendations Moderate-growth-minded senior living providers should: • Explore potential opportunities to be- come an in-network provider of supple- mental benefi ts for Medicare Advantage plans.


• Explore potential opportunities to off er telehealth services in communities through a relationship with a health system.


32 SENIOR LIVING EXECUTIVE JULY/AUGUST 2019


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60