Medicare

True Innovation in Telehealth Requires Addressing All the Opportunities and Challenges. Can We Deliver on the Promise?

mthomp7 — Wed, 28 Apr 2021 18:51:56 +0000

True Innovation in Telehealth Requires Addressing All the Opportunities and Challenges. Can We Deliver on the Promise? mthomp7 Wed, 04/28/2021 - 14:51

In This Story

Alison Evans Cuellar, PhD, MBA

Mason faculty outlines what is required to develop a coherent telehealth strategy that increases access, addresses disparities, and improves care.

Telehealth as a channel for delivering care has boomed in the past few years in response to the growing need for more flexible opioid treatment options and limitations to in-person care during the COVID-19 pandemic. But for states, payers, and providers to deliver on the long-term promise of telehealth, areas such as funding, infrastructure, policy, access points, and coverage must also evolve.

A recent issue brief, Steps Toward a Coherent Telehealth Policy, by Alison Cuellar, PhD, Professor in the Department of Health Administration and Policy at ��AV, provides a comprehensive overview of the opportunities to innovate telehealth policy to drive adoption, expand coverage, and improve care. The brief, co-written with Anton Arbatov, adjunct faculty and vice president at SOC Telehealth, and Constance Owens, PhD student in the Health Services Research program, explores the complexities of licensure, payment policy, and policies for safety net providers.

While many of us equate innovation and telehealth with virtual visits with a doctor, this form of telehealth makes up less than 40% of revenues. Cuellar explains that there are actually three major segments of the telehealth sector: virtual visits (whether between patient and provider or two providers), remote monitoring services, and store-and- forward services for sharing digital images and video between providers. Cuellar examines the three models as well as their unique policy, delivery, and cost-structuring challenges—helping readers navigate the complexities and considerations.

“The true innovation related to telehealth is not just the technology – it is the behind the scenes work to foster wide-spread and equitable adoption. This will require creative and flexible ways of thinking about who can provide telehealth services, what kind of services will be covered, where the patient can receive care, and who will pay for it. There is too much at stake not to innovate,” says Cuellar.

Cuellar’s Policy Brief addresses some of the unknowns and obstacles associated with telehealth- such as whether increased convenience will lead to more appointments and higher costs, but with marginal benefits– and the challenges associated with conducting a physical exam remotely. The brief focuses on policy issues such as reimbursement policies and how they differ across payers and activities. For example, she illustrates differences in Medicare coverage depending on the “originating site of care”, the nature of the service provided, and how the service is delivered. Cuellar also authored an opinion piece in The Hill on March 20, which further explored a “post-COVID reimagining of telehealth in Medicare.”

An expert in health policy and health systems, Cuellar points to amazing innovations whereby dentists deliver care, children receive care at school, and psychiatrists see patients in emergency rooms – all remotely. States are also expanding the list of eligible providers who can be paid for their remote care to include dentists, speech or physical therapists, for example. Allowing more providers to deliver care across state lines though licensure changes is also key to expanding telehealth. The Brief underscores the need for further innovation in these areas to reach the full potential for addressing disparities and reaching underserved populations.

The Brief outlines many opportunities for innovation. For example, Cuellar sees behavioral health and counseling services as areas where telehealth can help address growing demand and provider shortages. She encourages payers to consider the types of care that are possible via remote video, how to expand access and improve care, and the types of care that could originate in a patient’s home.

In some instances, regulation has not been able to keep pace with changes in state laws creating a dynamic environment. Cuellar foresees that definitions of telehealth modalities, cross-state licensure, patient consent, and online prescribing as “active areas of policy development.”

While telehealth innovation was originally driven by the opioid crisis and COVID-19, all three segments of telehealth hold great potential for improving access and quality of care. Advancements in the areas of federal and state investment, coverage, licensure, and payment policy can further promote innovative care and reduce disparities.

For questions about telehealth policy or other matters related the health policy, contact Alison Cuellar at aevanscu@gmu.edu.

Topics

Telehealth

Health Policy

Medicare

Centers for Medicare & Medicaid Services (CMS)

faculty spotlight

CHHS News

Mason Momentum

Examining Virginia’s Behavioral Health Care Transformation – A Layered Approach

mthomp7 — Fri, 02 Apr 2021 19:28:16 +0000

Examining Virginia’s Behavioral Health Care Transformation – A Layered Approach mthomp7 Fri, 04/02/2021 - 15:28

In This Story

Alison Evans Cuellar, PhD, MBA

In a column on state policy, Alison Cuellar and William Hazel examined the transformation of behavioral health care in Virginia.

Cuellar and Hazel examine how Virginia transformed the state’s behavioral health and substance use treatment landscape over the past five years.

In a column on state policy, Dr. Alison Cuellar, professor in the Department of Health Administration and Policy at ��AV and Dr. William Hazel, former Virginia secretary of health and human resources, examined the transformation of behavioral health care in Virginia resulting from a “layered approach” that included policy changes in procedures, outreach, eligibility and coverage, workforce, and payment. Changes resulted in an increase in the number of substance use providers and in the number of patients treated and laid a foundation to address social determinants of health and disparities.

The article published in Psychiatric Services, examined the ways in which Virginia transformed the state’s behavioral health and substance use treatment landscape over the past five years through policy mechanisms to shift funding, the workforce, and delivery of care and to enhance access.

Virginia’s efforts to increase access to behavioral health and substance use services were driven by the high cost of institutional care which was often shifted from the community to the state level, inadequate jail and crisis services, and the opioid epidemic. Cuellar and Hazel cite a layered approach to key areas of policy change that made expanding access to care possible: procedure, outreach and coordination, eligibility and coverage, workforce, and payment.

The article detailed Virginia’s policy changes of note, such as a federal Medicaid waiver to expand coverage for outpatient primary care visits, specialty behavioral health care, medication for uninsured individuals with severe mental illness who were treated by local community service boards as well as for those at incomes 60% of the federal poverty level. The state also emphasized fostering outpatient, office-based treatment and focused on recruiting providers to deliver medication-assisted therapy, particularly with multidisciplinary teams.

Workforce policy changes included expanding nurse practitioners’ (NP) scope of practice and increasing the number of licensed NPs. NPs now represent 25% of the buprenorphine-waived providers. The state has increased its waivered provider rate faster than the national average and increased the number of licensed mental health professionals per capita by 30% in rural counties – faster than the national average of 22% for rural counties.

“The collective impact of the changes Virginia has implemented over the past five years has laid the foundation for the transformation of behavioral health care,” says Cuellar. “This approach may inform other states’ approach to addressing the opioid epidemic and meeting the growing demand for behavioral health services.”

About ��AV

��AV is Virginia's largest and most diverse public research university. Located near Washington, D.C., Mason enrolls 39,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity and commitment to accessibility. For more information, visit https://www2.gmu.edu/.

About the College of Health and Human Services

��AV's College of Health and Human Services prepares students to become leaders and shape the public's health through academic excellence, research of consequence, community outreach, and interprofessional clinical practice. George Mason is the fastest-growing Research I institution in the country. The College enrolls more than 1,900 undergraduate and 1,370 graduate students in its nationally-recognized offerings, including: 5 undergraduate degrees, 13 graduate degrees, and 7 certificate programs. The college is transitioning to a college of public health in the near future. For more information, visit https://chhs.gmu.edu/.

Topics

The Hill: Dr. Alison E. Cuellar writes opinion piece about reimagining post-COVID telehealth in medicine.

Anonymous — Wed, 24 Mar 2021 18:36:29 +0000

The Hill: Dr. Alison E. Cuellar writes opinion piece about reimagining post-COVID telehealth in medicine. Anonymous (not verified) Wed, 03/24/2021 - 14:36

In This Story

Alison Evans Cuellar, PhD, MBA

A post-COVID reimagining of telehealth in Medicare

Topics

Telehealth

Medicare

CHHS in the Media

College of Health and Human Services

College of Health and Human Services Department of Health Administration and Policy

New York Times: Research from Dr. Priyanka Anand from ��AV cited in article related to Medicare and mental health coverage.

Anonymous — Thu, 07 Jan 2021 17:42:17 +0000

New York Times: Research from Dr. Priyanka Anand from ��AV cited in article related to Medicare and mental health coverage. Anonymous (not verified) Thu, 01/07/2021 - 12:42

In This Story

Priyanka Anand, PhD

You're Not Too Old to Talk to Someone

Topics

CHHS in the Media

Medicare

Mental Health

Jack Hadley, PhD

admin_alpha — Tue, 20 Oct 2015 23:27:01 +0000

Jack Hadley, PhD admin_alpha Tue, 10/20/2015 - 19:27

HAP Research Faculty, HAP

Biography

Jack Hadley's current research focuses primarily on issues related to costs and efficiency in the Medicare program. One study is investigating the sources of variations in Medicare and total medical care spending per Medicare beneficiary, and whether there are subsequent effects on changes in beneficiaries' health. Two other projects link data from national surveys of physicians and insurance claims from their Medicare patients to study the relationships between Medicare fees and the supplies of physicians' services and, more broadly, the effects of physicians' financial incentives on the cost, quality, and efficiency of care provided to their Medicare patients. Another study in conjunction with the National Cancer Institute will investigate methodological issues in using observational data to evaluate the outcomes of alternative cancer treatments for elderly patients.

Building on this research, he plans to focus his teaching activities around policy and research issues in the Medicare and Medicaid programs. Possible future studies include the effects of practice and market characteristic son the cost of care received by high-cost Medicare patients, who account for a substantial share of Medicare's total spending, and the effects of physicians' financial incentives on treatments and outcomes of Medicare patients with back/spine disorders.

Dr. Hadley's past research has emphasized empirical analysis of various issues in health care organization and financing. He has conducted studies of the financing and costs of care used by the uninsured, the determinants of health insurance coverage, the consequences of being uninsured, access to care, physician and hospital payment, medical education financing, hospital efficiency, assessment of the outcomes of medical treatment, and the effects of managed care on health care delivery systems. Much of his work has analyzed large data bases such as national household and physician surveys, Medicare claims and national hospital data in order to understand patient, provider, and system responses to policy changes.

Dr. Hadley co-authored the report, "New Forms of Primary Care Practice Organization and the Care of Cancer Survivors," with Dr. John Cantiello, Department of Health Administration and Policy. Jack Hadley, PhD was supported by a Research Scholar Grant - Insurance, RSGI-13-150-01- CPHPS from the American Cancer Society.

Read the report (pdf) and appendix (pdf).

Research

Research Interests

Health services research and policy
Costs and efficiency in the Medicare program

Degrees

PhD, Economics, Yale University
MPhil, Economics, Yale University
BA, Economics, Brandeis University

Medicare

True Innovation in Telehealth Requires Addressing All the Opportunities and Challenges. Can We Deliver on the Promise?

In This Story

Mason faculty outlines what is required to develop a coherent telehealth strategy that increases access, addresses disparities, and improves care.

Topics

Examining Virginia’s Behavioral Health Care Transformation – A Layered Approach

In This Story

Cuellar and Hazel examine how Virginia transformed the state’s behavioral health and substance use treatment landscape over the past five years.

Topics

The Hill: Dr. Alison E. Cuellar writes opinion piece about reimagining post-COVID telehealth in medicine.

In This Story

Topics

New York Times: Research from Dr. Priyanka Anand from ����AV cited in article related to Medicare and mental health coverage.

In This Story

Topics

Jack Hadley, PhD

Biography

Research

Research Interests

Degrees

New York Times: Research from Dr. Priyanka Anand from ��AV cited in article related to Medicare and mental health coverage.