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Telehealth helps patients get the care they need where and when they need it. In this era of healthcare reform, the efficiencies created by telehealth are increasingly valued. A recent study from business information provider IHS predicts that the U.S. telehealth market will grow from $240 million in revenue today to nearly $2 billion in 2018—that’s an annual growth rate of 56 percent. But along with the clear advantages that come with extending capabilities and patient interactions beyond the traditional office setting, telehealth programs also involve risk. So before developing a telehealth program, provider organizations should consider four key steps to ensure their program is a scalable, financially viable enterprise solution.
Before jumping into a telehealth program, be sure you fully understand growth opportunities, economic return, and execution risk. Consider macro trends including market size, competition, and reimbursement rates. Take into account available telehealth solutions and supporting technologies, integration capabilities, and security parameters. Consider patient and provider demographics and disease and geographic trends. Continuously ask if telehealth is an investment that makes sense for your organization.
Define what telehealth success means to your organization by conducting a needs assessment to identify and prioritize potential telehealth activities that will match gaps in services in your community. Identify how your telehealth program will provide solutions to current challenges. And don’t forget organizational alignment. Assess how your telehealth program aligns with the overall mission, vision, values, and culture of your organization.
Design Your Program
Leverage the input of a multidisciplinary group of stakeholders to detail all dimensions of your telehealth program, including the following.
Governance. Establish a governance structure that outlines where clinical and operational oversight resides and who is accountable for telehealth financial performance.
Revenue model. Define the payment type, reimbursement level, and value proposition. Determine which services are reimbursable through Medicare, Medicaid, and private insurance. Consider other potential funding sources, such as government grants, foundations, and vendors or developers willing to fund telehealth expansion. Plan for long-term financial sustainability.
Human resources. Determine the number and type of staff (and support staff) needed to deliver telehealth services.
Processes and policies. Develop standardized processes and policies that facilitate high-quality, efficient care. As much as possible, incorporate telehealth into current standards to encourage easier adoption.
Technology. Determine the features of telehealth technology that will meet your clinical needs and business plan. Develop technology specifications, and consider:
Training. Develop a plan for training, licensing, and credentialing. Training should include direct users of telehealth technology as well as administrators and referring providers.
Measurement. Identify performance metrics and the performance reporting capabilities needed to effectively gauge program success.
Partnerships. Identify potential collaborators and partners to alleviate costs, accelerate program implementation, drive innovation, and manage risk. Consider partnering with vendors, payers, other providers, and major employers in your region.
Be sure your implementation timeline allows enough time to secure executive and clinician support. Order, install and troubleshoot equipment. Train staff and ensure required credentialing. Then roll the program out in phases. Use a small pilot program to fully test care and technology plans and quantify your return on investment by measuring clinical results and evaluating patient and provider satisfaction. And finally, strive to continuously improve. The most successful telehealth programs constantly integrate changes based on consumer and provider feedback.
Bill Fera, MD, is Principal in Ernst & Young LLP’s Advisory Health Care practice and is based in Pittsburgh. Follow Bill on Twitter: @BillFeraEY
The views expressed herein are those of the authors and do not necessarily reflect the views of Ernst & Young LLP.
This material has been prepared for general information only and is not intended to be relied upon as accounting, tax or other professional advice. Please refer to your advisors for specific advice.
Publication Date: Friday, March 14, 2014
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Copyright 2016, Healthcare Financial Management Association.
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