Telehealth under the Ryan White Program in Maryland Ashley Wu - PowerPoint PPT Presentation

Telehealth under the Ryan White Program in Maryland Ashley Wu Prevention and Health Promotion Administration Center for HIV Prevention and Health Services May 8 2020

Prevention and Health Promotion Administration MISSION AND VISION MISSION The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community-based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations. VISION The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well- being. 2

Key Terms and Definitions Introduction

What’s the difference between Telehealth and Telemedicine? • Telehealth is a broader scope of remote health care services that includes non-clinical services • Telemedicine refers specifically to remote clinical services 4

Types of Telehealth 5

Providing Sites • Distant site: a site at which the licensed distant site provider is located at the time the service is provided via technology-assisted communication. • Originating site: location of an eligible Medicaid participant at the time the service being furnished via technology-assisted communication occurs. 6

Telehealth in Maryland

Background • First telehealth laws passed in 2012 • Interstate Medical Licensure Compact (IMLC): allow physicians to practice in multiple states, connect with patients in underserved and rural areas • Several bills have been passed to support insurance coverage of telemedicine services (Senate Bill 781, 789, 496, 198) 8

Provider Registration • Providers need to register as telehealth providers, and enrol in the Maryland Medical Assistance program (MMAP) • Credentialing: verify provider education, insurance, standard of practice • Hospitals can contract providers from other states • Exception: VA health care providers can provide telehealth services within their scope to VA beneficiaries, irrespective of State or location. 9

Licensing Process • Licensing: securing authority to practice medicine within a state • For telehealth, licensing process can be expedited by leveraging existing provider information • Providers then choose number of states they desire to practice in (no additional fee charged) 10

Medicaid Coverage • People receive Medicaid first before assistance from RW Program • Medicaid covers inpatient and specialty medical care coverage • “Hub and spoke” model 11

Eligible Sites • University health office • Local health dept • Hospital • Nursing facility • Private practice office • Outpatient mental health center • Residential service site • Community based substance use provider 12

Eligible Providers • Nurse practitioner • Nurse midwife • Physician • Physician assistant • Community based substance use disorder provider • Opioid treatment program facilitator • Outpatient mental health centers • Federally qualified health centers 13

Case Studies

Success stories from other states • VA Affairs (rural Illinois and Iowa) • LaPHIE (Louisiana): public health info exchange network • TelePrEP (Iowa): deliver PrEP medication to growing rural population at high risk for HIV • Illinois prison telehealth program: first time incarcerated patients 15

Patient Outcome • Indicators • Reduce total medical expenditure • Improved retention rate in care • Improvements in viral suppression rate • Increase patient satisfaction 16

Federally Qualified Vendors • Qualifications • Secure • Mobile access • Customer support • Potential vendors • AmericaWell • MDLive • Tytocare (under Epic Systems, work with Johns Hopkins Hospital) • eVisits 17

Addressing Infrastructural Barriers • Connectivity considerations • Internet speed • Funding for improving service in rural area • Focus on services independent of internet • Access to providing sites • 71% of patients live >60 minutes away from HIV clinics, 27.4% could save travel time by utilizing telehealth 18

Next Steps

• Contacting UMD STAR TRACK pediatric HIV clinic, Chase Brexton on launching pilot partnerships, and expand to various county helath departments in the near future • Accelerate telehealth for HIV care in light of COVID- 19 pandemic 20

References • American Association of Family Physicians (2018, November 12). What's the difference between telemedicine and telehealth? Retrieved from https://www.aafp.org/media-center/kits/telemedicine-and-telehealth.html. • Telepresenters. (n.d.). Retrieved from https://www.ortelehealth.org/content/telepresenters. • Telehealth Use in Rural Healthcare. (2019, December). Retrieved from https://www.ruralhealthinfo.org/topics/telehealth/project-examples. • Telehealth Use in Rural Healthcare. (2019, December). Retrieved from https://www.ruralhealthinfo.org/topics/telehealth/project-examples. • Telemedicine in Maryland: State Regulations, Laws & Policies. (2019, October). Retrieved from https://evisit.com/state- telemedicine-policy/maryland/. • Interstate Medical Licensure Compact. (2019). Retrieved from https://imlcc.org/. • Interstate Medical Licensure Compact. (2019). Retrieved from https://imlcc.org/. • MD Medicaid Telehealth Program. Telehealth Provider Manual • Title 10 Maryland Department of Health: Medical Care Programs Telehealth Services. (2019, October). Retrieved from https://mmcp.health.maryland.gov/SiteAssets/SitePages/Telehealth/10.09.49 October 2019.pdf. • Salzman, S. (2018, November 20). Telehealth May Improve HIV Viral Suppression for People in Prison. Retrieved from https://www.thebodypro.com/article/telehealth-may-improve-hiv-viral-suppression-for-p. • Murphy, K. (2015, February 5). Which Federal Agencies Are Involved in Mobile Health Policy? Retrieved from https://mhealthintelligence.com/news/which-federal-agencies-are-involved-in-mobile-health-policy. • Wicklund, E. (2017, March 29). VA Tests Telemedicine-based Collaborative Care for Rural Vets. Retrieved from https://mhealthintelligence.com/news/va-tests-telemedicine-based-collaborative-care-for-rural-vets. 21

Prevention and Health Promotion Administration https://phpa.health.Maryland.gov 22