More Telehealth Benefits Coming To Medicare Advantage Plans In 2020

Medicare Advantage plans can offer additional access to virtual doctors in their basic benefit packages under a new rule finalized by the Centers for Medicare

Dr. Minoti Parab, a telehealth staff physician with Online Care Group, is seen at her home office in Charlotte, N.C. on Friday, Sept. 11, 2015. Parab practices family medicine but sees no patients in person. All her 'telemedicine' patient consultants
 VIA GETTY IMAGES

Access to telehealth services for seniors got another boost Friday when the Centers for Medicare & Medicaid Services said it would allow private Medicare Advantage plans to offer additional access to virtual doctors in their basic benefit packages.

The so-called final rule will bring new benefits to seniors in 2020 as part of their Medicare Advantage plans. Such coverage is growing rapidly and expected to account for half of Medicare beneficiaries in the coming years, some analysts say.

“Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits,” the Centers for Medicare & Medicaid Services (CMS) said Friday. “But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.”

It could be a huge boon to companies like  American Well,  MDLive and  Teladoc and an array of startups getting into the business of offering access to physicians and patients via smartphone, tablet or computer. Employers and private insurers are already embracing the trend as a way to make health care visits convenient and avoid costly and unnecessary trips to the emergency room or a more expensive physician’s office.

CMS and some private insurers are expanding supplemental benefits into a collection of services that incentivize patient compliance as prevention to ensure keeping appointments or providing alternate remote clinic visits.

It will be interesting to visit the cost/benefit aspects of these benefits. Also to compare outcomes for those using these services.




More Telehealth Benefits Coming To Medicare Advantage Plans In 2020:

How 5G and IoT Can Enhance the Patient Care Paradigm |

Even though there are no smartphones or other devices that are on the market for 5G wireless communications, most cell carriers and smartphone manufacturers are hyping 5G and what it will do for all things, including climate change, and health.

Some are predicting a rollout by the end of 2019.  So what does 5G have to offer and how are vendors to begin offering the technology. More important are health systems ready and willing to pay the considerable price for an upgrade in wireless speeds?   Is there such a need?

The predictions (and promises) are manifold. The IOT (internet of things) is a leading use case.

What is the Internet of Things? for the non-geeks. 

A representation of the Internet of things (IoT).

We are already adopting the IOT for 'smart homes' smart hubs, thermostats, door locks, control of lights, window blinds, and just about anything that plugs into a wall outlet. Did I mention your oven, microwave, garage door opener, sprinkler system, or starting your automobile?  5G is predicted to facilitate autonomous automobiles allowing cars to communicate with each other. This potentially will eliminate road rage by humans.  It remains to be seen if 5G IOT will facilitate road rage by robots.

With 5G networks on the way and the Internet of Things expected to grow rapidly, the health industry appears to be on the cusp of a new system of care.

The commercial launch of standardized 5G mobile networks is expected by 2020, though some networks are expected to be live in select U.S. cities as soon as the end of 2018. Beyond simply providing faster connectivity than today’s 4G networks, 5G networks will be able to accommodate more connected devices and monitor data prioritization, keeping less vital downloads from occurring immediately.

Deloitte estimates the global market for IoT in healthcare — a vast collection of devices and sensors that generate and transmit data — will increase from $40 billion in 2018 to $158 billion in 2022. Growth will approach 250 percent in North America and exceed 350 percent in the Asia-Pacific region.

5G Offers a Path to Better Outpatient Management

While the combination of a better network and more connected devices will certainly improve care within the hospital, experts anticipate a bigger impact in other care settings — including the home.

“The vast majority of the impact of digital medicine is in outpatient management,” says Dr. Steven Steinhubl, director of digital medicine at the Scripps Research Translational Institute. “When you see a doctor, it’s sickness care, but what most people would like is to stay healthy.

When you see a doctor, it’s sickness care, but what most people would like is to stay healthy.”

Dr. Steven Steinhubl Director of Digital Medicine, Scripps Research Translational Institute

This type of care will come in many forms, ranging from passive monitoring of at-risk patients to more active monitoring of high-risk or high-acuity patients. Even patients who present as healthy will benefit, Steinhubl said, as monitoring will help identify conditions they may be developing, though they show no outward symptoms of illness.

And for all patients, ongoing data collection can monitor everyday activities closely linked to health and wellness. “How does exercise help or hurt sleep? How does alcohol affect stress? There’s an impact, but it’s always measured in the doctor’s office, which is an artificial setting,” Steinhubl says.

However, the practice of medicine is increasingly designed to support team-based care complemented by technology, Kvedar says. “We’ll get to a point where we have layers of different activity,” he says. “Chatbots, person-to-person messaging, IoT device data transmissions, phone calls, and video calls.”

There will still be a lot of interaction in an office and a lot of face-to-face healthcare, but also a lot of asynchronous activity, 

Much of the hype and drive toward a medical IOT is being driven by wireless carriers themselves (build it and they will come). From previous experience, this will follow the usual curve of exponential growth

AT&T (white paper) focuses on the use of IOT . 

Examples of IoMT include remote patient monitoring of people with chronic or long-term conditions; tracking patient medication orders and the location of patients admitted to hospitals; and patients' wearable mHealth devices, which can send information to caregivers. Infusion pumps that connect to analytics dashboards and hospital beds rigged with sensors that measure patients' vital signs are medical devices that can be converted to or deployed as IoMT technology.

As is the case with the larger Internet of Things (IoT), there are now more possible applications of IoMT than before because many consumer mobile devices are built with Near Field Communication (NFC) radio frequency identification (RFID) tags that allow the devices to share information with IT systems. RFID tags can also be placed on medical equipment and supplies so that hospital staff can remain aware of the quantities they have in stock.

It becomes readily apparent there is and will be a confluence of numerous wireless technology for real-time management of data involving patient care.  5G may afford better communication without telephone, IM or electronic health records, it may eliminate chats as well.  Multiple people and entities will be able to monitor in real time and allow operating room, ICU, recovery room, respiratory therapy nurse, physician, pharmacist, admitting and discharge personnel to be simultaneously aware of what is going on with the patient, where they are and know what vital signs are at in real time.

One can only wonder if this will result in information overload and have a paradoxical effect on patient care.

Medical Internet of Things and Big Data in Healthcare

How 5G and IoT Can Enhance the Patient Care Paradigm | HealthTech Magazine: A combination of new networks and connected devices will shift care to better meet patients on their terms.

Here Are California's New Laws To Address The State's Opioid Crisis

About 2,000 Californians die from opioid overdose annually, according to the California Department of Public Health. This week in Chico, one person died and 12 were taken to the hospital after a suspected overdose on a powerful opiate called fentanyl.

The California Legislature looked at more than 20 bills last year designed to address the ongoing opioid crisis, passing 14. The laws cover a few approaches to bringing opioid death numbers down, including stemming over-prescribing practices, improving medication assisted treatment and saving people in the throes of overdose with an antidote called naloxone.

Here’s a roundup of what former Gov. Jerry Brown signed to tackle the problem.

Curbing Painkiller Prescriptions

In an effort to reduce fraud, AB 2789 will require doctors to write electronic prescriptions starting in 2022. Supporters argue this will make it easier for doctors to record prescriptions in the state’s CURES opioid database. Some physician groups say that the electronic system is too costly for doctors with small practices.

AB 1753 authorizes the Department of Justice to reduce the number of printer vendors making prescription pads and requires pads be marked with a serialized number starting this year. It’s part of a wider effort to standardize and label all prescription pads, which could help law enforcement track down lost, stolen and counterfeit prescription pads.

There’s currently a mismatch between California’s controlled substance schedules and the federal government’s. AB 2783 aims to fix it by reclassifying some drugs as Schedule II controlled substances.

SB 1109 aims to better educate doctors about opioid addiction risk. Physicians and surgeons are already required to take continuing education courses on pain management. Starting in 2019, the course must also address the risks of addiction associated with the use of Schedule II drugs. The law makes a similar change to mandatory courses for dentists, nurses, osteopathic physicians and physician assistants.  

Also on the topic of education, AB 2487 authorizes physicians and surgeons to complete a one-time continuing education course on opiate-dependent patient treatment and management, instead of the mandatory continuing education course on pain management.

Expanding Treatment

Starting July 2020, AB 349 requires the Department of Health Care Services to adopt new regulations and update reimbursement rates for the Drug Medi-Cal Treatment Program

Naloxone Access

AB 2256 is designed to make it easier for pharmacists to give naloxone, an overdose antidote, to law enforcement officers who have completed special training. An individual pharmacist can already give the drug to a law enforcement officer, but wholesalers cannot. If law enforcement agencies want to acquire large amounts of naloxone, they must go through a local health department. Police departments and other agencies argue this process makes it unnecessarily difficult to get the life-saving drug. The U.S. Surgeon General said earlier this year that all people at risk for overdose, and community members who interact with them, should know how to use naloxone and keep it within reach at all times.

Patients at high-risk of overdose should have wider access to naloxone in doctor’s offices this year under AB 2760. The law requires doctors prescribing opioids to also offer patients for the overdose antidote, and educate patients and their loved ones on how to use it.

Prescription Database Could Help Prevent Opioid Abuse, But State System Still Lags

Here Are California's New Laws To Address The State's Opioid Crisis - : About two-thirds of last year’s big pile of bills designed to tackle the opioid crisis became law. Here’s what they do.

10 Reasons Why Digital Health Start-Ups Go Bust | LinkedIn

While the digital health market is expanding rapidly, ninety percent of start-ups will probably die within two to five years from their inception. That’s an awfully high number, so we looked around what could possibly go wrong with digital health start-ups to avoid the undeserving fate of falling into the abyss.

Until relatively recently there was a divide between electronic information and clinical healthcare. Neither camp knew much about the other.  Neither industry had use for each other.

Growing from a small effort of individual clinics the use of electronic health records to a large software-medical industry the progress has been unrelenting but steady due to federal subsidies.

An offshoot has developed to harness the technology which augments the use of the EHR as a central repository for remote data, 

Dreamers are visualizing a health care system dominated by information technology, while clinicians are in a conundrum about loss of personal contact and automation.


The theoretical and Reality

This progress is not much different for any startup, not just in healthcare. The valleys are different for each industry.  In healthcare they are:

 No scientific validation

The “break things and move fast” attitude can lead to the lack of appropriate scientific evidence for a solution. If start-uppers cannot wait enough to scientifically back up their product or service – marketing their product without enough scientific evidence or conducting clinical trials on small sample sizes, short duration of the study and other internal biases - they should not even consider starting their business in the first place – or they end up as Elizabeth Holmes and Theranos.

Everyone knows the story. The most successful female entrepreneur in medicine, the youngest inventor in healthcare and her promise: one drop of blood – and the patient will know more about their illnesses than in their whole life before. Theranos promised to also dramatically cut costs, to be flexible, easily portable and above all – reliable. Unfortunately, most claims proved to be false, and there’s not even evidence that the technology ever worked.

Forgetting patients and diversity

Although the goal of most healthcare products and services is the improvement of patient outcomes, the most painfully common mistake a digital health company can do is forgetting patients. Yet, having a leadership team that is a mix of healthcare, technology, consumer and design improves the odds of success. Without understanding patients’ preferences and needs, it is impossible to create valuable solutions. Moreover, they should be included in the entire process – from the idea to solve a specific problem through design, product development, launch, and follow-up.

2) Not taking into account care providers

Healthcare is a tricky business. In many cases, start-ups create a service or product for better patient experience, but they actually sell it to care providers: doctors, hospitals, pharmacies, paramedical staff, pharmaceutical companies, insurance companies, etc. And even if they don’t directly come in contact with all the different stakeholders, they might feel their presence.

Even such a giant tech company as Amazon had to take a different path than it planned when it came to pharma. Jeff Bezos’ company decided to give itself a head start in the pharmacy business by purchasing PillPack, a mail-order pharmacy company for 1 billion dollars in June 2018. The reason for the purchase was actually that Amazon had to abandon its original plans of selling pharmaceutical drugs through its Amazon Business marketplace, although it would have been the obvious choice. Why? Partly because it has not been able to convince big hospitals to change their traditional purchasing process, which typically involves a high number of middlemen and loyal relationships.

(29) 10 Reasons Why Digital Health Start-Ups Go Bust | LinkedIn