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1
IMPACT OF HEALTH INSURANCE AND
GOVERNMENT REIMBURSEMENT EXPANSION
ON VIRTUAL VISIT TELEMEDICINE MARKET,
THE USA PERSPECT...
2
Key Stakeholders for Scalable and Sustainable Telehealth Program
3
Wellness and
Prevention Care
Chronic Disease
End Of Life Care
Acute and
Sub-Acute Care
TPM Goal
Improve
Overall Health
a...
1. Federal Government – Medicare
• Traditional Medicare
• Managed Medicare
• DoD/VA
2. State Governments – Medicaid
• Trad...
1. Traditional Fee for Service
2. Capitated/Negotiated Rates
• ACO
• PCMH
• Bundle Payment
• Episode of Care
3. Employer W...
6
PAYERS: Reimbursement Models
7
PAYERS: Latest Reimbursement News
Aetna Enters Into Agreement to Provide Value-Based Care
Cigna Telehealth Connection Ex...
8
QUESTIONS
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Reimbursement for Teleconsultation by health insurance companies : A story from the USA - By Dr. Pramod K Gaur,

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Reimbursement for Teleconsultation by health insurance companies : A story from the USA By Dr. Pramod K Gaur, Formerly VP, United Health Insurance Adjunct Professor, Seidenberg School of CS & IS, Pace University, USA

Published in: Healthcare
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Reimbursement for Teleconsultation by health insurance companies : A story from the USA - By Dr. Pramod K Gaur,

  1. 1. 1 IMPACT OF HEALTH INSURANCE AND GOVERNMENT REIMBURSEMENT EXPANSION ON VIRTUAL VISIT TELEMEDICINE MARKET, THE USA PERSPECTIVE Pramod K. Gaur Ph.D. Adjunct Professor, Pace University Chair, mHealth SIG, American Telemedicine Association
  2. 2. 2 Key Stakeholders for Scalable and Sustainable Telehealth Program
  3. 3. 3 Wellness and Prevention Care Chronic Disease End Of Life Care Acute and Sub-Acute Care TPM Goal Improve Overall Health and Wellbeing Stay Healthy Get Healthy Living with Illness Mobile Health Apps Evidence Based Telemedicine Remote Patient Monitoring 75% 20% 5% Reimbursement for TPM Services
  4. 4. 1. Federal Government – Medicare • Traditional Medicare • Managed Medicare • DoD/VA 2. State Governments – Medicaid • Traditional Medicaid • Managed Medicare • Medicaid - Medicare Dual Eligible 3. Large Employers – Self Insured • Over 90% plans have Telehealth Coverage Now 4. Insurance Companies • Risk Based Policies for Individuals and Small Businesses Provide Telehealth Coverage 5. Self Pay – Consumers can get a Teleconsult for $49 Telehealth Reimbursement: PAYERS 4
  5. 5. 1. Traditional Fee for Service 2. Capitated/Negotiated Rates • ACO • PCMH • Bundle Payment • Episode of Care 3. Employer Wellness/Prevention Incentives 4. Pre-Tax Spending Accounts • Health Savings Account • Flexible Savings Account 5. Self Pay - High Deductible Plans PAYERS: Reimbursement Models
  6. 6. 6 PAYERS: Reimbursement Models
  7. 7. 7 PAYERS: Latest Reimbursement News Aetna Enters Into Agreement to Provide Value-Based Care Cigna Telehealth Connection Expands Access and Choice to Millions Including Adding Access to Behavioral Health Consults United Healthcare Offers Compelling Medicare Products for 2017 Aetna to Transform Members’ Consumer Health Experience Using iPhone, iPad and Apple Watch Telehealth Visits covered by 29 Blue Cross Blue Shield Plans UPMC launches telehealth startup to keep nursing home patients out of the hospital More Than Half of Kaiser Permanente's Patient Visits Are Done Virtually
  8. 8. 8 QUESTIONS

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