Verizon Makes Collaboration Key to Building Telehealth Biz

Nancy Green, managing principal, Verizon Health IT Services

Nancy Green, managing principal, Verizon Health IT Services

October 11, 2013 – Verizon’s approach to delivering telehealth services may or may not be the most ambitious of any service provider in the country, but it’s clearly the most visionary when it comes to shaping an agenda tuned to a deep understanding of health industry needs. In this interview with ScreenPlays editor Fred Dawson, Nancy Green, managing principal of Verizon Health IT Services, describes how a hands-on approach to tailoring solutions to the highly varied needs of health providers and insurers is positioning Verizon to cover all the bases as this fast-growing vertical becomes more coherent. Her perspective offers useful insight into the forces and entities that are driving what promises to be an important service opportunity for all telecommunications providers.

ScreenPlays – How is Verizon going about structuring its services for the health care industry?

Nancy Green – What we’ve moved toward is a services practice group within Verizon enterprise that is focused on health care – a kind of innovations incubator based on what we’re doing through our interaction with the health care ecosystem, the providers, payers, etc.

It boils down to an enablement strategy. We’re trying to enable that ecosystem to provide better, faster care with compliance to the emerging requirements of payers, regulators and the new health law. We’re helping to take away the inhibitors that are slowing growth in telehealth and using the power of the Verizon platform to help that. Our goal is the enablement of the telehealth ecosystem, what it means in the cloud, in telemedicine, in pharma, etc.

SP – What kind of organizational and personnel structure are you bringing to this market?

Green – Our group is run by a chief medical officer with sales organizations for each sector – providers,  pharma, payers.  We do not provide clinical services, but we have clinicians who are PhDs, physicians, RNs – professionals who are there to help with solution sets around workflows or the usability of solutions for things we’re looking to do.

We have partnerships with clinical partners, large organizations for the clinical aspects. They might work with someone who wants a scientific proof of the efficacy of a product. We don’t do that, but we do have a clinical trial arm that works through these partnerships with the involvement of some of our clinicians.

SP – You cite an annual revenue stream for your telehealth practice that now tops $5 billion and is growing. That’s a big number. What goes into that calculation?

Green – It’s the current revenue generated across all Verizon companies, not just wireless, for anything we sell to the health care sector. We have the same type of group for finance, retail and manufacturers. So, for example, the share of Verizon’s metro transport revenues generated by hospitals and other facilities is calculated as part of the business our group is responsible for.

SP – How long have telehealth services been identified as a separate practice under your group?

Green – I’ve been here four years, so the group was organized about four or five years ago. We had some vertical-focused marketing before that, but it wasn’t broken out the way it is now. My own background is in healthcare.

SP – How would you characterize your approach to this market? Are you selling specific branded services on a kind of cookie-cutter basis, or is it more complex than that?

Green – You start to look at the scope and scale of Verizon and you realize we have a larger role to play. So where we’re playing is focused on enablement. We don’t go out and say here’s our telester program. We’re not clinical service line specific. We’re bringing the benefits of the cloud, technology enablement, transport and sector expertise to help you do what you’re looking to do.

SP – Telemedicine, the ability to remotely provide medical services like patient monitoring, is seen as a big opportunity for telecom providers. How does your approach to telehealth generally translate into building this side of the business?

Green – When you look at how telemedicine technology is marketed today, the word is so generic, it’s like Kleenex. You have to ask, what are you talking about? When we look at remote patient monitoring in the home, it’s a question of  whether it’s monitoring of vital signs, data from sensors in the home, data taken from patients when they’re stationery or while they’re walking around – there are all kinds of monitoring included in the telemedicine bucket.

We have technology partnerships in that arena that allow us to help create the services specific to providers’ needs. We did a huge  development initiative a couple of years ago – a kind of come one, come all where we said we’ll help put a communications module in your device to make sure you’re certified for use on our network. That program has created a foundation for our customers as they look for the technologies they need to serve specific needs.

One way to look at it is we’ve done a base level of world domination to enable all types of services in this sector on the Verizon network. We’re making sure we’ve populated the space with things that can send the data over our network through partnerships with suppliers of end points like Tandberg and Cisco and all the big telemedicine vendors like InTouch. This enables us to work with hospitals, physicians and other care-giving organizations whatever their needs are. They may go to market with the services on their own or with us through joint marketing arrangements.

As a typical case of how we go about working with care givers, we’re working with providers in Alaska who are putting together a telestroke practice by building a network of neurologists to serve patients at clinics and other remote facilities. We’re engaged in enabling their efforts with all the elements they need across the board. And when they’re ready to take the service to the home, we’ll release a two-fold product around using video for those consultations.

SP – So in terms of integration with EMR and specific systems tied to those specific telestroke conditions, that again would be handled and organized by the organization you’re selling service to?

Green – We can help with integration. Everyone is a one off. We’ve done some things that have made integration easier where there are toolkits and APIs to integrate security or something like that. But when you’re integrating data from one source to another that requires a lot of mapping. We can help with that through our professional services. But more often than not they already have teams that do that. They just say get us the feed and we’ll do the integration.

SP – What kind of pricing models do you use?

Green – Some of our services coming out this year are being priced a little differently where it’s kind of a per-patient, per-month structure, especially with some of the remote patient monitoring services, and that’s pretty standard in that space. When you’re setting up a network, cost depends on how many end points and whether you’re using fixed or mobile network assets. You can have a network where you have five fixed offices and five ERs in a network and the rest of them are iPads or tablets or whatever, and the physicians are actually doing work on those devices when they’re on the move between clinics.

When you’re doing transitional care – not everybody does it – most of the time it’s happening through organizations that own most or all the pieces of the transition. This is a provider who also owns the home care, also owns the hospice, the physical therapy and labs. Otherwise they’re dropping the transitional care, because it’s so difficult to work with other organizations. The other organizations doing that are accountable care organizations where they have to do that. Those are all clinical pieces that touch each other. The entities within those organizations have to recognize that they’re going to be doing this together. We can technologically put them all together. Maybe they want to enable access through a shared portal to the electronic records from different locations, and we need to authenticate that that’s a home care nurse with a legitimate need to access a provider network who might not normally be in  that network.

SP – Does most of the emphasis in developing telehealth reside in rural areas?

Green – It doesn’t matter whether the setting is rural or not. It’s happening all over the place. If you think about the five boroughs of New York, there are federally regulated urban health shortage areas having to do with number of physicians per population segment. You find metro areas where it takes people an hour and a half or two hours to get to a neurologist or dermatologist. So they’re using telemedicine even in those particular areas.

SP – Are things taking shape around telehealth where you have an opportunity as a service provider with a national footprint to work with providers in ways more regionally positioned providers would not?

Green – I’d say yes and no. It depends on the type of organization. But most health care is delivered in communities, not as a national system. You might have a national organization with hospitals in many localities, but they really work at the community level. Usually organizations undertaking a community-level initiative want to be sure they can work within states or counties bordering their areas. They can’t provide health care to all the patients they serve without all the institutions in the region getting on the same page. So we’re helping them as they try to get across walls of separation. For example, Baylor doesn’t particularly like Texas Health, because they’re competitors, but you’re building a southwestern telemedicine network they’re probably going to be working together even though they’re competitive.

Same is true with affordable care organizations. I as an ACO can’t provide a good network for my purposes without a huge communications network, a very open communications network that’s supporting free flowing data, free flowing video, delivering information about patients whether it’s to payers, home care givers, hospices, labs or hospitals. This is difficult when everyone is starting out with disparate systems that don’t communicate with each other.

We might get a call from an anchor tenant like Baylor saying, “You’re a big partner of ours, what can you do to help us with this initiative?” Or, “I already have a strategy and know what I need to do. Let’s talk about what I need to put around it.” A lot of time the key issue has to do with securing access to data. Now people are sharing data they’ve never shared before. So our ability to identify and authenticate users has to fit the structural layers and categories of the health care industry. We have to be able to authenticate you as a prescriber of Schedule 2 drugs, which are at the highest level of security, so you can prescribe a treatment over a mobile device. We’ve put that in place all the way through the DEA (Drug Enforcement Administration) approval process. So the high-level security system we use in the banking, financial worls has been adapted for health care.

SP – So if somebody wants to offer a telemedicine service monitoring residential patients, it’s not you who’s going to those people and saying, sign up for my telehealth care service. It’s somebody who has contracted with you to provide support for such services who’s going out and offering that to specific providers?

Green – We’re going out after organizations to provide better services for them. More often than not, whether we’re going to them or they’re coming to us with a particular problem they’re trying to solve, it’s about that communications and integration problem. “I’m trying to put together a video-enabled consultation service across multiple counties, and then I want to get into the homes. How do I get that data to come into my EMR (electronic medical records) system?”

It’s not bi-furcated into categories. It’s organizations saying they need to get into telehealth care in a comprehensive way that utilizes these resources to maximum value from in-care points of hospitalization to clinics all the way to out-patient, etc.

SP – Is the ability to deliver care to the home a priority in these efforts?

Green – The first priority is to have EMR systems and video support in place at primary facilities. We have clients trying to reach into the communities, not necessarily all the way into the home but more into communities first, probably having to do with building a case for reimbursements under ACO rules. A lot of it has to do with community health centers or senior centers, retailers with pharmacies that have touch points where patients can come in and be able to be taken care of by a clinician of some kind. The trend is they’re trying to get out from secondary and tertiary hospitals into smaller communities. So we work with partners that have built that type of business – telemedicine kiosk partners or organization that have already solved the where-do-I-go-to-have-this-done-and-have-it-be-integrated and just need strong partners for network, security and authentication.

We have clients, several large provider organizations, who are piloting kiosk types of telemedicine units to go to these locations rather than coming into an ER visit. Or they’re trying to work direct-to-employer types of programs where they can manage care right on the employer premises to reduce the need for people to go to ER or elsewhere for care. And some are going all the way to the home. Those initiatives are normally aimed at providing services for chronic care patients. When we look at expanding care to the home, there’s a chronic care element first and then there’s the idea of expanding service to provide care for other people. is one of our partners. They offer a full telemedicine-enabled enclosed kiosk with video cameras, stethoscope, weight scale and other instruments all built in. A patient can roll a wheelchair in there and have a direct interaction with a physician. They can’t draw blood, but they can provide a pretty broad range of care. Some other kiosks are not as enclosed and might be set up in a space where there’s some local clinician type care with the physician remotely located. It’s a bit of the wild west – almost an alternative to minuteclinnics. It doesn’t mean it’s going to result in the replacement of minuteclinics. It’s just another way to provide care out into the community.

SP – Is everything done on a walk-in basis or can patients set up appointments in advance?

Green – You can set up an appointment. But where a large provider network is involved it’s their doctors. They’ve built out a network that says, “When someone comes in I can act. I have someone sitting there that can take the call.” In some cases the service might be outsourced to independent doctors. Physicians can’t provide services to patients in a state they’re not licensed in. So most of those services have multiple-licensed doctors.

SP – What is the balance in terms of money-saving incentives driving telehealth between independent initiatives on the part of insurers and what’s mandated by federal or state regulations?

Green – I wish there was more push from the federal level. It would go faster. It’s a little bit of both. Payers are driving some of it. Thirty-two states have reimbursements for telemedicine of some kind in some way. But for general populations of physicians who want to do second or third follow-up visits over telemedicine, they don’t get paid for that. However, for them there’s the incentive of better ROI on their treatment, because they can see more patients that they need to spend a little more time with, and it’s not clogging up their system. There’s less overhead and all that kind of stuff. So the funding has to do with a kind of ROI base. We work with a lot of people on the ROI piece of it for a better workflow, better systems, better access, increased access to care, those kinds of things.

And the payer side is how do I take those chronic care patients and stop them from doing a $10,000 ER visit? That’s where the remote patient monitoring comes in. Some of the insurance companies have said they’ll pay for some of that.

SP – So that’s a big issue, getting to a point where there’s some systemization on the monetization of all this.

Green – Yeah. When our entire system works on the basis of fees for service, there need to be incentives. That’s why these ACOs who are paid for performance are more likely to look at things. There’s not a need to be paid back for something.

SP – We’re seeing video playing an ever bigger role in virtualized care, not just where teleconferencing is involved, but for purposes of educating patients while they’re in the hospital and during transition care. How do you see this unfolding?

Green – It depends on what the situation is. In the kiosk and other remote care environments, video supports the consultation process between patient and physician. We’re doing quite a bit of work with organizations who are doing post- and pre-op consultations over a network or wireless app where they want a person to go in and look at the procedure. Maybe the content is sitting in our cloud or the customer’s cloud. Patient education is a big piece of what’s going on.

SP – Are you partnering with people who generate such content?

Green – Most organizations have their own content. We’ll just house, host and secure it. There are lots of services out there that people can purchase content from. For example, an organization can go to these sources to buy a library of diabetic care with videos and documentation covering the field.

SP – This has really given us a much deeper look into how this market is evolving and Verizon’s approaches to it. Thanks so much for taking time to speak with us.

Green – My pleasure. I enjoyed it.