Transcript Slide 1

Opportunities in Broadband and
Telehealth for CA Providers
Focus on the Federal Stimulus and the California
Telehealth Network
Margaret Laws, California HealthCare Foundation
CAPH/SNI & CPCA Specialty Care Access Partnership
April 16, 2009
Outline

Stimulus opportunities in HIT, broadband and
telehealth

The California Telehealth Network – update

Overview of CHCF-funded projects

Diabetic Retinopathy Screening

Health Care Interpreter Network

California Center for Connected Health

UC/Safety Net Specialty Initiative
CALIFORNIA HEALTHCARE FOUNDATION
ARRA Overview
•
Significant opportunity for funding for health care
and broadband/telehealth
•
Extremely favorable federal match rates in many
programs
•
Strong focus on safety net providers and
programs
•
Some funds already released, others coming soon
•
Many programs still developing rules and proposal
processes
CALIFORNIA HEALTHCARE FOUNDATION
Funds for EHR Adoption
$34 Billion in Incentive Payments for
“Meaningful Use” of EHRs
Program
Medicare
Payment
Incentives
Medicaid
Payment
Incentives
Distribution
Agency*
Use of Funds
CMS
Incentive Payments
through Carriers
CMS
Incentive Payments
through State Agencies
and states
Recipients
Acute Care and
Children’s Hospitals
Physicians and
Dentists
Nurse Practitioners
and Midwives
Source: Manatt Health Solutions analysis of federal HITECH Act Legislation.
CMS isCenter for Medicare and Medicaid Services,
CALIFORNIA HEALTHCARE FOUNDATION
FQHC
Funding Flows – Appropriated Funds
$2 Billion in Competitive Grants
Program
Distribution
Agency
HIE Planning and
Development
ONC
EHR Adoption
Loan Program
ONC
Health IT
Extension Program
ONC
Workforce
Training Grants
HHS,
NSF
New Technology
Research and
Development Grants
NIST,
NSF
Recipients
Use of Funds
Planning Grants
State-designed
Entity
Implementation
Grants
States
Loans
Loan Funds
Health Care
Providers
Health IT Research
Center
Indian Tribes
Regional Extension
Centers
Medical Health
Informatics
Nonprofits
Services
EHR in Medical
School Curricula
Health Care Information
Enterprise Integration
Research Centers
Higher Education
Medical/Graduate Schools
Source: Manatt Health Solutions analysis of federal HITECH Act Legislation. ONC is Office of the National
Coordinator, HHS is Department of Health and Human Services, NSF in National Science Foundation, and
NIST is National Institute of Standards and Technology.
CALIFORNIA HEALTHCARE FOUNDATION
Least-advantaged
Providers
Federal
Government Labs
EHR Incentive Programs
Payment
Recipients
Medicare
Medicaid
Hospitals and physicians
Hospitals, physicians, NPs, dentists,
midwives, third-party entities
promoting EHR adoption
To qualify: 30% Medicaid case mix;
“Needy Individuals” test for FQHCs
Amounts for
Hospitals
$2 million base amount
Plus increases for annual
discharges, number of inpatient days
attributable to Medicare, and
charges attributable to Medicare
$2 million base amount
Plus increases calculated using similar
methodology as Medicare incentive
Amounts for
physicians &
others
Up to $44,000 per physician
Up to $64,000 per clinician
Over 5-year period
Over a 5-year period covering up to 85%
of eligible implementation costs
Timeframe
Incentive payments begin in 2011
Incentive payments begin in 2010, with
an advance of up to $22,000
Penalties begin in 2015
Eligible entities include Acute Care and
Children’s Hospitals
CALIFORNIA HEALTHCARE FOUNDATION
Estimate of California HITECH Funding
Federal
Allocation*
California
Estimate**
Medicare EHR Incentive Program
$20 billion
$2 billion
Medicaid EHR Incentive Program
$14 billion
$1.4 billion
Other Grant Programs
$2 billion
TBD
Program
* Congressional Budget Office estimate of outlays
** California’s proportionate share estimated at 10%
CALIFORNIA HEALTHCARE FOUNDATION
“Meaningful Use” of EHRs

Use of EHR in a meaningful manner, which
includes electronic prescribing (eRx)

Capable of electronic exchange of information to
improve the quality of health care

Electronic reporting on clinical quality measures

Other measures as determined by HHS Secretary
CALIFORNIA HEALTHCARE FOUNDATION
Health Information Exchange (HIE)

Require development of a state plan

Single state agency or state-designated entity to
carry it out

CA to Compete for planning or implementation
grants
State Designated Entity (SDE) Requirements

Nonprofit with representative governing structure

Defined technical plan and clinical use cases

Policy guidance for privacy and security
CALIFORNIA HEALTHCARE FOUNDATION
Broadband/Telehealth Funding
 Funding for health care in several provisions
throughout ARRA
 BBTH Funding concentrated in three programs:
o Broadband Technologies Opportunities Program (BTOP)
o Distance Learning, Telemedicine and Broadband Program
o Indian Health Service
CALIFORNIA HEALTHCARE FOUNDATION
Broadband Technologies Opportunities
Program
 $4.7B total funding
 Administered by Dept. of Commerce, NTIA, in
consultation with FCC
 Goals:
o Provide and improve broadband for consumers in
underserved areas
o Provide broadband awareness, training, access, equipment
and support to community organizations, including health
care providers
o Include access to and use of broadband by public safety
agencies
o Stimulate job creation and economic growth through greater
use of broadband services
CALIFORNIA HEALTHCARE FOUNDATION
BTOP, cont’d
 Funds must be distributed by Sept 2010
 First funding cycle releases funds in June 2009
 All funds are competitive (but at least one will be
awarded per state)
 Funding for innovative programs that promote
broadband sustainability
 “Call out” of availability of funding for federallyfunded programs (e.g. CTN)
 Requires 20% match
 Projects must be substantially completed within two
years of award
CALIFORNIA HEALTHCARE FOUNDATION
Health IT Regional Extension Centers
 HHS will create a new national entity – the “Health
Information Technology Research Center” within the
Office of the National Coordinator (ONC)
 Also establishes Regional Extension Centers to:
o Provide technical assistance
o Disseminate best practices
o Assist with implementation of EHRs by providers at the
local level
o Prioritize assistance to public, non-profit and critical access
hospitals; FQHCs; rural clinics and providers and others
who serve underserved populations; and individual and
small group practices
 Requires 50% match
 Funds distribution process and funding cycle TBD
CALIFORNIA HEALTHCARE FOUNDATION
Distance Learning, Telemedicine and
Broadband Program
 $2.5B through loans, loan guarantees and grants
 Administered by USDA Rural Utility Service
 Explicit focus on rural areas - 75% of project area
must be rural
 Matching requirement TBD
 Purpose being defined, but expected to be
broadband infrastructure
 Priority given to projects that:
o
o
o
o
Will begin promptly after approval
Will be fully funded if they receive aid
Offer a choice of multiple service providers
Have the highest proportion of residents who do not have
broadband access
CALIFORNIA HEALTHCARE FOUNDATION
Indian Health Service
 $85M for IT activities of the IHS
 Approx. 60% of funds to be obligated in FY 2009, 40
% in FY 2010
 Funds are for:
o Telehealth services and related infrastructure
o Improve quality and safety of health care for Native
American and Alaska Native populations
 Other funding information:
o Funds allocated at the discretion of the IHS Director
o About 20% of funds to be used on hardware purchases to
modernize infrastructure for security, networking, telecom
and health IT purposes
o A number of new purchases of software and software
development are anticipated
CALIFORNIA HEALTHCARE FOUNDATION
IHS, cont’d
 Funded activities anticipated to include:
o Resource and patient management system, EHR
modernization, personal health record enhancement,
acquisition of a practice management system and
architecture enhancements
o Telehealth infrastructure and developments
o Security enhancements and network upgrades
CALIFORNIA HEALTHCARE FOUNDATION
Funding for FQHCs

$1.5 billion for construction, renovation, equipment
and acquisition of health IT systems, including
telehealth

Funds available to FQHCs and FQHC controlled
networks

Competitive award process

HRSA plans to announce the program in mid-May

Matching funds requirement TBD
CALIFORNIA HEALTHCARE FOUNDATION
The California Telehealth Network
CALIFORNIA HEALTHCARE FOUNDATION
The FCC’s Universal Service Fund, Rural
Health Care Division
 Purpose: To ensure that rural health providers pay
no more than their urban counterparts for
telecommunications
 $400 million authorized each year for the program
since 1997
o Distributes less than 10% in any year
 Few eligible health care providers take advantage of
the program
CALIFORNIA HEALTHCARE FOUNDATION
FCC Rural Health Care Pilot Program
 Announced Fall 2006 - Up to $417 million
available over three years
 Purpose: “to facilitate the creation of a nationwide
broadband network dedicated to health care,
connecting public and private non-profit health
care providers in rural and urban locations”
 Pays flat 85% of telecommunication-related
expenses
o
o
o
o
Capital
Connection
Installation
Network Consulting/Design
 Encourages regional broadband health care
networks with connections to national backbones,
e.g., National Lambda Rail (NLR), Internet2 (I2)
CALIFORNIA HEALTHCARE FOUNDATION
California’s Proposal to the FCC Background
 Fall 2006: Consortium formed by Governor’s Office –
includes broad coalition of CA stakeholders
 May 2007: Single California proposal submitted
 University of California Office of the President and
UC Davis Health System selected as managing
partners
 November 2007: FCC awards California up to $22.1
million to create the California Telehealth Network
 Winter 2007: matching funds granted by California
Emerging Technology Fund, and
UnitedHealth/PacifiCare
CALIFORNIA HEALTHCARE FOUNDATION
California’s Proposal - Goals
 Goal 1: Create statewide broadband network
dedicated to health care
 Goal 2: Link the California Telehealth Network
(CTN) to a national backbone
 Goal 3: Leverage and build upon recent investments
in telehealth
 Goal 4: Utilize CTN for ongoing disaster
preparedness training
 Goal 5: Report back to the FCC on the pilot program
and suggested revisions to the FCC’s current rural
health rules
CALIFORNIA HEALTHCARE FOUNDATION
CTN Technical Highlights

Persistent, IP-Based connection (no dial-up)

Dedicated End-to-End Connection
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Explicit Quality of Service (QOS)
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Bandwidth exceed current needs (expandable)
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“Interoperable,” peer-to-peer (Any-to-Any)
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24 x 7 x 365 Monitoring
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Secure, Private Network
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Access to UC’s, CSU’s, K-12, CalREN2

Access to National Lamda Rail and Internet
CALIFORNIA HEALTHCARE FOUNDATION
Site interested in
participating in CTN
CALIFORNIA HEALTHCARE FOUNDATION
CTN Statistics
 Total number of sites: 940
 Number of towns represented: 345
 Total number of organizations: 221
 RUCA Rurality designations 2 and above: 401
CALIFORNIA HEALTHCARE FOUNDATION
Breakdown of Potential Sites
Hospitals Clinics
Public
Health
Mental Indian
Health Health
Rural
57
255
21
25
40
Urban
27
373
42
60
6
CALIFORNIA HEALTHCARE FOUNDATION
Counties Represented
CALIFORNIA HEALTHCARE FOUNDATION
CTN Timeline: 2008-2009
 Extensive Statewide Survey Jan. – June 2008
 Collect 900+ LOA’s: July - September 2008
o we will continue to collect LOA’s!
 Submit RFP, LOA’s, USAC Forms: Nov. 2008
 Evaluate RFP Bidder Responses: April/May 2009
 Select Vendor(s): May/June 2009
 Select initial Participants: June/July 2009
 Begin Implementation: August/September 2009
CALIFORNIA HEALTHCARE FOUNDATION
Requirements for a successful
statewide telehealth network
 Broadband connectivity
o
o
o
o
Reliability
Quality of Service (QOS)
Security
Privacy
 Telemedicine Equipment
o At specialty and remote sites
 Training and technical support
CALIFORNIA HEALTHCARE FOUNDATION
FCC Non-Reimbursable Expenses

Telemedicine Equipment

Associated clinical devices

Telemedicine Training

Operational Expenses
o
o
Project management
Technical support teams
CALIFORNIA HEALTHCARE FOUNDATION
Opportunities for Providers
 Application for funds as part of CTN – for sites
qualified to be connected beginning fall 2009
o Funding opportunities in BTOP, DLTB and IHS programs
for provider-level implementation, training, equipment and
support
o Potential funds for operations/implementation of CTN
o Potential for additional CTN sites (beyond initial 730
qualified sites)
 Applications for funds by organizations and networks
across the state – broad opportunities depending on
site/provider characteristics
 Participation in HIE/EHR programs
CALIFORNIA HEALTHCARE FOUNDATION
CHCF-Funded Projects
 Diabetic retinopathy screening project
o Remote screening of retinal scans for diabetic patients in
primary care clinics
o Cameras in 47 clinics across the state
o About 15,000 screens done to date
o UC Berkeley team available to read scans for nominal fee;
or clinics can send scans to providers in their own
community
o Program is gaining momentum, but working to increase
number of screens for active clinics and recruiting new sites
o Cameras will be moved from some sites where program did
not get up and running
CALIFORNIA HEALTHCARE FOUNDATION
DRS, cont’d
 Characteristics of successful programs:
o Support of top clinic leadership for program
o Providers and care/case managers buy in – refer patients
for screening
o Screening process is integrated into primary care (versus a
one day diabetes day or screening event)
o Staff are designated to work on program and understand
their roles and responsibilities
o Participating staff are well trained and supported when technical
problems come up
o Management helps staff trouble-shoot when barriers come up at
the clinic
o Clinic team shares information , challenges and ideas with other
clinics in the program
o Feedback and recognition programs – photographers and staff get
kudos for screening
CALIFORNIA HEALTHCARE FOUNDATION
Health Care Interpreter Network
 Real-time voice/video interpretation – collaboration
among CA safety net hospitals ;15 languages
 Active members:
o
o
o
o
o
o
o
o
o
Community RMC (Fresno)
Harbor-UCLA
Kern
LAC+USC
Olive View –UCLA
Rancho Los Amigos
Riverside County
San Joaquin General
San Mateo
 Continuing to recruit safety net hospital members – two
more pending
 Projects being developed to expand into new areas
o Interpretation for Medi-Cal providers
o Behavioral health/mental health consultation
CALIFORNIA HEALTHCARE FOUNDATION
California Center for Connected Health
 Strategy and planning organization for telehealth in
California, launched January 2009
 Mission: Promote a shared vision for telehealth
adoption and integration in the health care delivery
system
o Work to ensure that California is a national model of telehealth
integration;
o Identify and promote practice patterns, policies, regulations, and
statutory changes that will maximize the ability of telehealth to
improve health outcomes and care delivery; and
o Manage a specialty care pilot project for UC campuses and
community-based clinics to develop a sustainable model for
telehealth services.
 First project – Issue Brief on ARRA opportunities on
broadband/telehealth opportunities
CALIFORNIA HEALTHCARE FOUNDATION
UC Safety Net Specialty Initiative
 Project designed to leverage the CTN and UC’s
Prop 1D funding for telemedicine
 Goals:
o Provide additional access to UC specialists in telehealthamenable specialties for safety net patients
o Systematically evaluate costs and new practice models
o Develop sustainable program
 All five UC campuses with Prop 1D funds will
participate
o Areas of specialty being determined, but correspond to
needs documented in clinic surveys
 Participating clinics to be selected via RFP process
later in 2009
CALIFORNIA HEALTHCARE FOUNDATION
Resources
 ARRA issue briefs:
www.chcf.org – search on ARRA
www.connectedhealthca.org
 CTN:
www.caltelehealth.org
 HCIN:
www.hcin.org
CHCF Web Site: www.chcf.org
CALIFORNIA HEALTHCARE FOUNDATION