This document summarizes a presentation given at the Florida TeleHealth Summit in Winter Park, Florida on December 5, 2014. The presentation discusses the promise and progress of telehealth, including examples of successful telehealth programs that have reduced costs and hospital readmissions. It also analyzes Florida's efforts and needs regarding telehealth policy, noting the state lags behind others in coverage and reimbursement. The document outlines 42 policy decision points regarding telehealth and emphasizes the importance of telehealth in building a sustainable healthcare system and laying the cornerstone for critical connections to care.

1. Time for Telehealth:
Critical Connection &
Foundational Cornerstone
Tamara Y. Demko, JD, MPH, ABD
Director, Florida TaxWatch Center for Health & Aging
Florida TeleHealth Summit
Winter Park, Florida
December 5, 2014

2. The Promise of Telehealth
• Successfully used worldwide to deliver a full
spectrum of health care services
From pediatric endocrinology to emergency
management
“Anything ending in –ology”
• Access to safe, appropriate health care when
needed and before more costly interventions
are needed
Reduction in emergency department
utilization
Rural and non-ambulatory access
Specialist consult as needed

3. The Progress of Telehealth
• World Health Organization – 25% responding countries
have national telehealth policy/strategy
Many more have telehealth programs (Mongolia,
Norway)
Or use for specific topics (28+ countries use for
cardiology)
• United States
21 states + Washington, D.C. legislatively mandate
private coverage
12 states + Washington, D.C. legislatively mandate
Medicaid coverage
43 states + Washington D.C. provide some level of
Medicaid reimbursement

4. Case-by-Case Building of ROI
Convincing, But Fragmented
State System Telehealth Delivery
Patient
Condition(s) Metric 1
ROI Impact on
Metric 1 Metric 2
ROI Impact on
Metric 2
CO
Centura Health at
Home (CHAH)
integrated home telehealth
services with remote
monitoring and a clinical
call center
Congestive heart
failure, chronic
obstructive
pulmonary disease,
and diabetes Cost savings
$1000 and $1,500
per patient
Thirty-day
readmission rates
Reduced by 62
%
FL
Baptist Health South
Florida
eICU LifeGuard remote 24/7
physician monitoring Varied
Total Savings in 1
Year Snapshot
$15 million
($1,800/day)
Length-of-Stay (7 year
period)
Reduced 29%
ICU stay;
reduced 33%
hospital stay
FL
University of
Florida/UF Health
Florida Initiative in
Telehealth and Education
(FITE), videoconferercing
rural areas to UF specialists Diabetes (pediatric)
Total program
savings per year
(excluding
transportation
savings) $27,860
Hospitalizations of
children with diabetes
per year
Decreased
from 13 to 3.5
MA
Partners HealthCare
along with the
Center for
Connected Health
(CCH)
Connected Cardiac Care
Program (CCCP)
telemonitoring Heart failure Net savings $8,155 per patient
Heart failure hospital
readmissions
Reduced by 50
%
TX
CHRISTUS Health
System
Videoconferencing, home
monitoring (Remote Patient
Monitoring Solution (RPMS)
Pilot) Heart failure Cost of care
Decreased from
$12,937 to $1,231 Average admissions
Decreased
from 1.43 to
0.20

5. Florida Needs Telehealth
• Potential cost-savings = $1 billion with 1% reduction
in charges across costly hospitalizations and
emergency room visits (2012-13 AHCA data) –
Critical Connections to Care
• Rapid population growth
• Geographic disparities across 67 counties
• Aging & disabilities populations
• Public health preparedness
• Emergency management access

6. Florida’s Efforts to Move
Telehealth Forward
• Years of introduced legislation
• 2014 Legislative Session
• Board of Medicine
• Industry conferences and discussions
• Florida TeleHealth Workgroup

7. GAUGING FLORIDA’S STATE OF HEALTH
Population, Economy, Physical Well-being

8. Florida Compared: Demographics,
Health, Business
FL CA GA NY TN TX VA
Population (7/2013) 19,552,680 38,332,521 9,992,167 19,651,127 6,495,978 24,448,193 8,260,405
Population Rank 4 1 8 3 17 2 12
% State Population 65+
(7/2013) 3,647,617 4,791,731 1,195,955 2,832,481 952,376 2,966,167 1,105,381
# Medicaid Enrolled in
Thousands (6/2013 KFF - pre
open enrollment data) 3,290.00 7967.7 1,536.30 5,141.70 1,305.60 3,644.20 851.4
Geographic Disparity (2012
report) 48 42 37 14 17 39 40
Disparity in Health Status
(2013 report) 41 48 18 24 11 46 37
Chief Executive Ranking Best
States for Business 2 50 10 49 3 1 11
CNBC Ranking Best States for
Business 20 32 1 40 14 2 8
ALEC Ranking Best State
Economic Outlook 16 47 9 50 19 13 11
Tax Foundation Ranking
Business Tax Environment 5 48 32 50 15 11 26

9. Florida Lags Behind
American
Telemedicine
Association
Grades
Coverage and Reimbursement
(C grade)
COVERAGE &
REIMBURSEMENT
FL
# States
Higher Grade
# States Lower
Grade
# States Equal
Grade
# States N/A
*Overall Grade C 28 + D.C. 3 18
Parity Topics
Private Insurance F 21+DC 0 28
Medicaid C 24+DC 8 17
Medicaid Service Coverage & Conditions of Payment
Patient Setting F 38+DC 0 11
Eligible
Technologies
F 22 0 26+DC
Eligible Providers F 26+DC 0 23
Informed Consent F 34+DC 0 12 3
Telepresenter C 36+DC 0 10 3

10. 42+ Policy Decision Points
Spectrum of Options
Coverage, Cost, & Parity
• Medicaid
• Medicaid-Medicare dual eligibles
• Patient costs
• Private insurance coverage mandate
• Private insurance parity vs. different
rates not comparable to face-to-face
services
• State employee health plan coverage
Definitions, Locations, & Transmissions
• Telehealth/telemedicine definition
• Services defined
• Distance/geography Restrictions
• Originating site (e.g., clinician office,
home)
• Distant Site
• Live videoconferencing
• Remote monitoring
• Store and forward
• Other permitted transmissions
• Excluded transmissions

11. Policy Decision Points -
Continued
Provider Related
• Other health care practitioners
• Out-of-state practitioners
• Physicians/practitioners
• Practice of medicine (what crosses into
practice)
• Practitioner registration/telehealth registry
• Practitioner sanctioning
• Practitioner training
• Prescriptions – Controlled
Substances/Legend Drugs
• Prior relationship with patient
• Professional Liability Coverage
• Standard of care & quality of care
• Supervision requirements
• Telepresenter requirements
Technology, Privacy, Recordkeeping, Other
• Equipment/technology requirements
• Fiscal impact monitoring
• HIPAA compliance/privacy
• Informed consent
• Interstate compact
• Medical/health records
• National licensure
• Population Uses/Rules (e.g., prison
population)
• Rulemaking Authority
• Specialty Rules (e.g., eye care, mental
health)
• State reporting (e.g., legislative, state
agency)
• Statewide network
• Venue/jurisdiction

12. Laying the Cornerstone
• Telehealth as foundational in health care
delivery that works
• Long-term, sustainable health care system
Ability of licensed practitioners to deliver care
Ability of Floridians to get needed, timely care

13. TELEHEALTH CORNERSTONE
CONFERENCE
 What do policymakers need to know?
 On what policy decision points can we achieve
consensus?
 What is needed to keep the discussion going while
Florida refines decisions?
 What barriers currently exist and how can we
overcome them?

15. STATE OF THE NATION
American Telemedicine Association
Latoya Thomas
Florida TeleHealth Workgroup
Southeastern Telehealth Resource Center/
Florida State University
Rena Brewer & Mike Smith
STATE OF THE STATE

16. 3 Workshops – 3 Lenses
Different Angles for a Clearer Picture
• Lens 1, Subject Matter: Child health,
aging & disability, access to care,
chronic disease management/
emergent issues
• Lens 2 – Industry: Providers,
practitioners, payers,
business/innovation
• Lens 3 – Consensus-Building: Out-of-
state providers, scope, financials,
technology & innovation

17. Lunch Panel – How to Build Telehealth
Policy Discussion Highlights
Speaker Pro Tempore Matt Hudson
State Representative John Wood
Mike Smith – Florida TeleHealth Workgroup
Phillis Oeters – Baptist Health South Florida
Justin Senior – Agency for Health Care Administration
Dr. Mark Stavros – Florida State University
Tom Feeney – Associated Industries of Florida

18. KEY POLICY MESSAGES
• Not every issue requires legislation,
• There will not be consensus on all issues
• Top policy priorities going into the 2015
Legislative Session:
– defining telehealth/telemedicine and what
telehealth success entails
– examining avenues for funding incentives
and reimbursement
– revisiting logical and safe licensure options
– writing legislation to be technology neutral

19. KEY TAKE-HOME POLICY MESSAGES
– making it easier for practitioners who engage in
telehealth
– leveraging existing technology (e.g., electronic
health records)
• Legislation should
– seek to make telehealth more available
– avoid language that imposes arbitrary
restrictions
– not detract from the current successful
provision of telehealth occurring across the
state (First do no harm)
– consider the convening of an continuous
advisory body while preliminary legislation goes
forward
– Lay the cornerstone by moving on policy issues
for which there is clearer consensus

20. NEXT STEPS: MOVING FROM
CONFERENCES TO CORNERSTONE
It’s Time for Telehealth

21. Building Tools
Right Tool Depends on Job
• Policymakers
– ROI data
– Information & decision tools
– Real people/constituents (bringing the message
home)
• Patients
– Social marketing push/market demand
– Safety & awareness
• Practitioners
– Assurance of standards of practice within
specialty
– Clear guidelines, including reimbursement

22. Building Tools
• Providers
– Better understanding of costs (up front and
long-term) & ROI
– Negotiating contracts & options
• Payers
– ROI financial and outcome based
– Patient demand; contract demand;
alternative business models
• Businesses & Innovators
– Understanding of cost pass-through ESI,
utilization, & employee productivity
– Telecom successes, ROI potential
– Grant partners & contracts

23. Building Tools
• Telehealth Champions (Everyone in this
room!)
– Share your successes
– Inventory & data collection
– Find creative collaborations
– Realistic policy expectations
• Walking before running
• Getting creative
• Avoid polarized silos
• All-or-nothing bets
– Framing telehealth as win-win
• Health care generally is zero sum
• Telehealth can be uniquely different

24. Florida TaxWatch
Tamara Y. Demko, JD, MPH, ABD
tdemko@floridataxwatch.org
Telehealth reports and conference materials are available at
floridataxwatch.org