CHICAGO – Lisa Schmitz Mazur believes that reimbursement for and regulation of digital health will continue to evolve as patients and providers embrace its role in the delivery of health care.
An attorney who specializes in digital health topics, Mazur will present a session on the reimbursement and regulatory landscape at the 2017 Home Health Technology Summit March 26-28 in New Orleans. She took some time to talk with us recently about her experience navigating reimbursement and regulations, and the race to capture patient engagement.
HHTN: How have you seen provider clients approach the issue of reimbursement?
Mazur: The reimbursement environment is changing for the better. There is a growing recognition that digital health tools are imperative for a transition from payment based on volume to payment based on value that is evaluated in terms of measurable improvements in care delivery and population health. For example, digital health tools are being used in countless ways by physicians, hospitals and other health care providers to deliver higher quality, lower cost care, under alternative payment schemes or quality-based reimbursement models. Prominent among the many examples is the use of digital health tools by accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). Under the MSSP, ACOs receive incentive rewards if they are able to improve the quality of care provided to Medicare beneficiaries, and decrease or control health care costs. ACOs use digital health tools to better coordinate and deliver higher quality and more cost-efficient care to maximize their financial rewards under MSSP.
HHTN: How do you see the reimbursement landscape improving?
Mazur: The opportunities for digital health tools to assist providers to improve the quality of care and decrease expenses are impressive. While direct reimbursement is largely limited to telemedicine services, the shift toward alternative and value-based payment models will certainly incentivize the further adoption of digital health tools by health care providers, as these tools are critical to complying with new payment schemes. We will likely see enhanced reimbursement of telemedicine services in the coming years. But just as (or even more) importantly, we will see enhanced use of digital health tools to enable strong performance under value-based payment models.
HHTN: In your experience helping provider clients develop digital health programs, how did you help them navigate the regulatory challenges?
Mazur: Health care providers face both immense opportunities and daunting challenges when developing and implementing these programs. One key challenge relates to compliance with the often-complex state and federal laws and regulations adopted by the numerous regulatory bodies responsible for overseeing different aspects of telemedicine. Because innovation is moving faster than the law in this area, in-house counsel and compliance officers must pay careful attention to legal and regulatory developments and be prepared to identify and develop strategies to address the many potential compliance and liability risk considerations arising from the use of telemedicine and other digital health tools. In addition to understanding and monitoring, and developing responsive compliance strategies for these legal and regulatory requirements, health care providers, patients and consumers must approach telemedicine and other digital health tools with a reasonable degree of caution. Providers must perform sufficient “due diligence” to determine whether the digital health tool is capable of effectively meeting their specific clinical and business needs, as well as the needs of their patients.
HHTN: Because this market is still evolving, how do you see it shaking out over the next five to 10 years?
Mazur: Digital health is in the early stage of its evolution, but growth even in the short term will be exponential. I anticipate that we will continue to see patient/consumer engagement through mobile devices, and health data will be increasingly created, used and shared in a digitally dispersed environment by all industry stakeholders. Health systems, hospitals and providers are at the center of digital health innovation as they are responsible for identifying the key areas of need, and licensing or developing digital health solutions that work. While the regulatory framework is currently lagging, I anticipate that the laws will “catch up” in some areas and will remain complex and unclear in others, and government agencies will remain highly interested in how these technologies are used by patients/consumers and providers.