Movers & Shakers Interview with Jonathan Linkous, CEO of American Telemedicine Association

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As part of Frost & Sullivan’s on-going analysis of the latest trends impacting healthcare, future changes, and connected healthcare concepts, Daniel Ruppar, global program director – Connected Health, interviewed Jonathan Linkous, CEO of American Telemedicine Association, in May of 2014.

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Movers & Shakers Interview with Jonathan Linkous, CEO of American Telemedicine Association

  1. 1. MOV E R S SHAKE RS August 2014 “We Accelerate Growth” WE ARE IN AMAZING TIMES FOR TELEMEDICINE! A Conversation with Jonathan Linkous, CEO, American Telemedicine Association
  2. 2. MOVERS & SHAKERS 2 All rights reserved © 2014 Frost & Sullivan | www.frost.com Interviewed by Daniel Ruppar, Global Program Director– Connected Health, Frost & Sullivan Company Background The American Telemedicine Association (ATA) is the leading international resource and advocacy group promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into transformed healthcare systems that improve quality, equity and affordability of healthcare throughout the world. Introduction As part of Frost & Sullivan’s on-going analysis of the latest trends impacting healthcare, future changes, and connected healthcare concepts, Daniel Ruppar, global program director – Connected Health, interviewed Jonathan Linkous, CEO of American Telemedicine Association, in May of 2014. Linkous is the chief executive officer of the American Telemedicine Association (ATA), which is based in Washington, D.C. As the chief staff executive of ATA since its inception in 1993, Linkous has lectured and written extensively on healthcare modernization, technology issues, emerging applications and market trends in the US and around the world. He has served on a variety of national and international advisory bodies, including the Hurricane Katrina Advisory Panel, the HHS Chronic Care Workgroup, and the joint FCC-NTIA Advisory Committee on Communications Capabilities of Emergency Medical and Public Health Care Facilities. Linkous has 30 years of experience in public policy related to healthcare, telecommunications and aging in both the corporate and public sectors. In the private sector, he served as a senior telecommunications consultant at Issue Dynamics and provided consulting services to many of the nation’s leading telecommunications, technology and healthcare companies. Previously, he served as a national leader in aging services as the executive director of the National Association of Area Agencies on Aging and was a senior executive with the National Association of Regional Councils and the Appalachian Regional Commission. Linkous holds a Master’s Degree in Public Administration from the School of Government and Public Affairs at the American University in Washington, D.C., with additional postgraduate work at the LBJ School of Public Affairs in Austin, Texas. Movers & Shakers Interview with Jonathan Linkous, CEO of American Telemedicine Association
  3. 3. JONATHAN LINKOUS, AMERICAN TELEMEDICINE ASSOCIATION www.frost.com | All rights reserved © 2014 Frost & Sullivan 3 The interview discussed key trends in US healthcare relating to telehealth and the leveraging of information technology and platforms to improve delivery of care and outcomes. Key points covered in the interview included government policy related to telehealth, perspectives on tele-mental health and tele-pharmacy, the increasing interest in remote patient monitoring, the value of consumer-generated health data, the impact of better levels of telehealth and EMR technology integration, and telehealth perspectives for the remainder of 2014. Frost & Sullivan appreciates the opportunity to feature Linkous and the American Telemedicine Association as part of its Movers & Shakers series and expresses special thanks to Linkous for sharing his valuable perspectives on many important areas centric to transforming healthcare. Daniel Ruppar: There have been a lot of changes in the past year in the US healthcare marketplace. From the focus on readmissions, the growth and hype regarding wearable devices, continued discussions of regulatory issues for mHealth, and now the delay of ICD-10. Many of these factors are driving interests in use of different technologies and platforms to be a part of the enablement of improved delivery of care and outcomes. What are some of the key points in the past year of significance from ATA’s view regarding the direction of the healthcare marketplace? What is the impact on telehealth? Jonathan Linkous: Well, we’re in booming times, and that’s a good thing. The really amazing part is that, despite the fact that we have a lot of obstacles–you mentioned the delay of ICD-10, reimbursement issues, licensure issues, and others– there has been tremendous growth in telemedicine. We estimate somewhere around 10 million Americans last year were served by it. Not a huge figure in terms of where we’re going, but certainly a big leap forward from where we’ve been. Somewhere around 100,000 people who suffered stroke this last year were seen by a neurologist using telemedicine. Countless lives were saved. It is an amazing time that we live in. People talk about how, in the future, the delivery of care may change. I think that it has already changed. DR: What has been the impact in terms of people joining ATA as members? JL: The nice thing about being an association in boom times is that it’s good for the association as well. We are a fast-growing organization, in double- digit growth for our membership, budget and for our attendance at the annual meeting. (Note: ATA currently has around 8,000 active members). But, it’s not just our numbers that are growing. It’s also growth in the attention that is being paid to telehealth by leaders of the senate, leaders of the house, members of the administration, and in practically every state in the country. There are somewhere around 32 states that have introduced legislation this year (as of May 2014), expanding the use of telemedicine in their states. It’s an amazing time. It’s not just in the growth of what has happened for ATA. We’re very much a mission-driven organization. We survived to push telemedicine. So the fact that telemedicine is growing and that so many people are coming to us but also coming to look at legislation and at new ways of doing things–it’s just a wonderful time. DR: What issue regarding government policy and telehealth is most top of mind to you right now? JL: Government policies are a huge array of things, anything from the United Nations international policy down to a local government. If you look at some of the most important ones, on the federal level, certainly looking at the Medicare program, which is the largest payer of healthcare in the country, it is not truly aligned with everything that’s going on with technology. We are still very much set with a group of laws and with regulations that were good for the 20th century, but now we’ve been in the 21st century for 14 years. So there needs to be some work. It used to be that we were really pushing for reimbursement for every CPT code in telemedicine. Now, more and more, we are saying to Medicare and to other government programs, just get out of the way and let the doctors and the patients in the health systems
  4. 4. MOVERS & SHAKERS 4 All rights reserved © 2014 Frost & Sullivan | www.frost.com do what’s needed to be done to improve quality, to expand access to care, and use the technology where it’s important. You have a lot of the change under health reform. The nice non-partisan part of health reform is that both sides are saying we’ve got a huge demand and we’ve got to meet it. Both sides are saying that we need to use technology, that we need to change our payment system from fee-for-service to capitated accountable care organizations or managed care. All of that managed care and capitated care – that’s like the end of the rainbow for telemedicine, because those organizations now have the incentive of using technology. If you can [provide technology that can] bring down costs, if you can expand care, and if you can improve your quality indicators, then they’re going to use it. Well, that’s what telemedicine does. So with government policy, we’re poised to really leap forward. But a lot of regulations are still in place back where they were two decades ago. That’s a big issue in the federal level. In the states we’ve got Medicaid, licensure, and on and on. I could go on forever. DR: For the past two years, respondents to our telehealth market trends survey have identified home health/ disease management remote patient monitoring as the leading transformative healthcare technology. This also aligns with our view of the top business opportunities in the telehealth market as well as deal activity where a lot of medical technology companies are less focused on the hospital and more focused on the expanding continuum of care. What does this trend mean for the broader landscape of telehealth? JL: We are in an interesting time in terms of remote monitoring because we have a confluence of things that are happening. With the aging of the population and the increase in people with chronic conditions like COPD, congestive heart failure (CHF), advanced diabetes, complications from diabetes and a host of other issues, we have people who are becoming the “frequent flyers,” the people who are using healthcare emergency rooms (ERs) and hospitals at an enormous level, and that is growing. There is a great need to do whatever we can to keep these people out of hospitals and out of ERs and in their homes, and as healthy and as comfortable as they want to be and as we want them to be. Remote monitoring is a key to that. It’s not the total solution, but it is an incredible key to that. At the same time, with mobile health and other applications going in, the interest of consumers in using technology has increased. We have all of these things that are kind of coming into one. It’s no wonder that we have this interest. In some systems, they’re even leaping ahead. For example, in the Veteran’s Administration (VA)– that’s a large healthcare system with capitated care where you are providing care for veterans for the rest of their lives. There is a lot of incentive for the VA to use remote monitoring. The VA has 100,000 people who are now getting remote monitoring in their own homes and is seeing amazing results in terms of the decreased utilization of hospitals and huge savings. I was just visiting yesterday with someone who runs a very large telemedicine program in Canada. They have had the exact same experience – reductions in utilization of double-digits and costs-savings that are huge. We are aligning to say that this is the right time. We still have old regulations that need to be resolved, as I said, and Medicare doesn’t pay for remote monitoring at this point. There are a few hurdles to be jumped over, but the stars are aligning. DR: We’ve seen interest from both providers and vendors looking to understand more about opportunities for telemental health, as well as telepharmacy. What are your perspectives on these areas? JL: Let’s take them separately. In mental health, we estimate that somewhere around 300,000 people see a therapist remotely using telecommunications annually. Sometimes [the telehealth encounter] is in an institution; sometimes hospitals do a screening for patients who come into the hospital and then they use telehealth to access a psychiatrist or a psychologist who couldn’t get there otherwise; or sometimes the encounter is just an individual therapy session where patients are using some form of telecommunications to talk to the therapist. In many ways, this has been around
  5. 5. JONATHAN LINKOUS, AMERICAN TELEMEDICINE ASSOCIATION www.frost.com | All rights reserved © 2014 Frost & Sullivan 5 for a long time. People always talk about telemedicine as this brand new type of thing. Doctors have been using telephones for over 100 years. So it’s really not new. And in mental health therapy, it’s not new at all. The founding president of ATA 21 years ago was a psychiatrist and was very actively involved in this area. Tele-mental health makes a lot of sense and most of the major insurers are looking at this. We have guidelines that we have developed on video conferencing using tele-mental health which we have had out for a long time. The American Psychiatric, American Psychological, and Social Workers societies are looking at this and endorsing these various approaches to using tele-mental health practices. Tele-mental health is one of the top four applications of telemedicine we are seeing today. In terms of tele-pharmacy, that is being used particularly in rural hospitals where they can’t afford a full-time pharmacist and in some rural areas, for refills for consumers. It is a very interesting technology that they’re using right now. But it is also a tricky thing because now we are not just talking about medical practice laws, but we are talking about laws dealing with pharmacy. Again, it’s the regulatory maze that you have to go through. However, the shortage of health providers with the increased needs for tele-pharmacy, complications of medications, and complicated laws of pharmacy, again, all of those are coming together today. I expect to see tele-pharmacy be one of the faster-growing applications in telemedicine in the next five years because the time is right, and the technology is out there. We are still going to have pharmacists; they are going to be seeing and overseeing this maybe from a distance, and it just makes sense. DR: Consumer wearables (activity trackers /form factors such as from Fitbit, Jawbone, Misfit Wearables) are actively being integrated with EHRs and remote monitoring applications as a data set to be used as part of overall patient data for healthcare decision-making. The Apps from these sensor-driven devices, as well as other consumer mHealth Apps, also contain data that is entered by the consumer/patient manually. What is your view on the value of consumer-generated data as part of the overall data set (integrated with enterprise healthcare data from providers) for use in patient care? How do you see that continuing to progress? JL: It is an interesting area, fascinating to me just to look at the potential in the applications that are out there. Wearable devices are the newest and hippest thing that everyone is trying to get. It’s a little bit more hype than reality at the moment. There’s so much out there. You can measure anything you want, and wear it wherever you want–become your own Inspector Gadget as you are walking down the street. How much of that is going to really take off? We have yet to see. The important part when we look at that is consumer acceptance. Will they look at it, not just download the app for the next week, but will they be using it and will it make a difference a year or two years from now? That’s an important part. The second part is how does [these data] integrate into the existing healthcare system? Remember, most healthcare costs are not paid by the consumer. They are paid by a health insurer or by some other mechanism such as the government. The individual will pay the health insurance premiums, but it’s the insurers and the payers in healthcare that really have a lot to do with consumer applications. So you can’t just go around them. It has to be integrated into the system. That’s what ATA does is a lot of work to try to get these latest applications, not just say that it is a neat thing, but get the insurers and the hospitals to integrate them into their system. Now, when it comes to consumer applications and consumer-generated data, of course that has been around for a long time. People, when they have a child, they take the child’s temperature. That’s been around for 100 years as consumer-generated data. Now we’re talking about examples such as, let’s say, I have high blood pressure and I use the iPad and take my blood-pressure readings on a daily basis. This data goes into my own unit and doesn’t necessarily get transmitted to a doctor. Doctors love the fact that consumers will look at this consumer-generated data and take care of themselves. But that doesn’t necessarily mean that they want every patient to send them their blood
  6. 6. MOVERS & SHAKERS 6 All rights reserved © 2014 Frost & Sullivan | www.frost.com pressure, glucose, weight, and temperature every day. Doctors are going to be hit with a tsunami of data. They just can’t do it. So the question is, as we get more and more consumer-generated data– and consumers do want to do this and it does help–how do you integrate [these data] into the EHR? How do you get this automatically uploaded and put in? That’s the real $60 or maybe $60 billion question that we have before us. DR: We are seeing that EHRs and other clinical IT systems now have better levels of telehealth technology integration. What does this trend mean for the practice of telehealth and for the vendors involved? JL: Well, you’re absolutely right. We are looking at a change in the way that electronic health records and a lot of the health IT companies are looking at telemedicine. It used to be that telemedicine existed separately from the whole work of hospitals. You’ve got to remember that most electronic medical record systems are within a hospital. Most people’s lives are not within a hospital, it is in the community and with a number of different doctors and specialists, some of which may be affiliated with a hospital, and some may not. So their electronic records have to be more than something that a hospital adopts. It has to be something broader than that. Telemedicine by its definition breaks the walls of hospitals and breaks down into wherever the patient may be. We are now on the cusp of having electronic records that accept video, accept pictures, and that may start to look at the integration of consumer-generated data. So EHRs have to go outside of the walls of a hospital and into where the patients are and let the patients control it, and let them be the ones to access their own data. That is where you are going to really have huge returns. DR: In Q4 2013, ATA announced its partnership with the Qualcomm Tricorder XPRISE and Nokia Sensing XCHALLENGE. How important are these types of initiatives in supporting different pathways for innovation in the marketplace? What is the goal of ATA in becoming involved in these competitions? JL: Well, besides being a lot of fun, it is great that both of these companies have put a lot of money to encourage this innovation. If you look at what is coming down the path, we are in amazing times. The Tricorder XPRISE is supporting development of products that will do an instant diagnosis of a number of different diseases. Or the Nokia prize, which is looking at sensors of different types of human interactions, human functions that can be done automatically. You don’t have to go to the doctor to get your blood pressure. You don’t have to even necessarily go in to get a strep test in the future. This could be all done automatically. The challenge for telemedicine, once again, is that the technology and the ability to provide healthcare is out in front of our ability to regulate it and to understand how it is paid for. So I think that our role is to encourage this technology and to be on the front tier of science as far as we can push it, and then look at the backend and say, “OK, we now have this device that can instantly diagnose you, how are we going to pay for that?” Or how does that integrate the next time you have to have an appendix out? That’s the real challenge. That is ATA’s piece. That is why we are really strongly supportive of these types of programs that use these technologies, and then work with these companies to try to get them integrated into where healthcare is going. DR: What is one key item you would like to see come to fruition by the end of the year (2014), be it from policy, technology or other factors that can have a positive impact on telehealth? JL: In terms of policy, we have pushed any number of things. There are so many new ways of providing healthcare through accountable care organizations, through managed-care programs, through the medical home. We still have some very specific regulations that can be easily waived by the administration to look at allowing these new companies, these new organizations, and these frameworks to use telemedicine. Sometimes they are still limited to rural areas. We need to get that waived. It is a very simple thing to do. It doesn’t cost money. As a matter of fact, it will save money. So that’s a very simple thing. We would like to have Congress do that. In terms
  7. 7. JONATHAN LINKOUS, AMERICAN TELEMEDICINE ASSOCIATION www.frost.com | All rights reserved © 2014 Frost & Sullivan 7 of states, again, the move by states to open up Medicare regulations is important. Some states are considering looking at reciprocal arrangements in terms of licensure. Those are the types of things where we are really making progress. So all of that we would like to see. We are going to be having a very heavy issue of that at ATA’s annual conference this year (in May). We will have 4,000 or 5,000 people gathered in Baltimore to talk about this specific issue. I am really hoping that coming out of that meeting we are going to really move forward and get this changed this year. And then, next year, even more things to conquer. DR: Thank you so much for taking the time to do this interview, Jonathan, as a part of our Movers & Shakers series. JL: Thank you for the opportunity.
  8. 8. DANIEL RUPPAR Global Program Director - Connected Health 210.348.1000 daniel.ruppar@frost.com ABOUT FROST & SULLIVAN Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants. For more than 50 years, we have been developing growth strategies for the Global 1000, emerging businesses, the public sector and the investment community. Is your organization prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies? Contact Us: Start the Discussion For information regarding permission, write: Frost & Sullivan 331 E. Evelyn Ave. Suite 100 Mountain View, CA 94041 SILICON VALLEY 331 E. Evelyn Ave. Suite 100 Mountain View, CA 94041 Tel 650.475.4500 Fax 650.475.1570 SAN ANTONIO 7550 West Interstate 10, Suite 400, San Antonio, Texas 78229-5616 Tel 210.348.1000 Fax 210.348.1003 LONDON 4 Grosvenor Gardens London SW1W 0DH Tel +44 (0)20 7343 8383 Fax +44 (0)20 7730 3343

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