ACCESS

Access

The Model

The project described is supported by Grant Number 1C1CMS331351-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies

Payers

No payers are excluded from participation. After three years, cost of the telehealth system will be carried by the hospital and not the payers. Therefore we are not focusing on payer engagement for this model. The innovation in the payment model for this program is that, after the funding period, hospitals in the state will reimburse the consultation for the neuro-emergent disorder on a per encounter basis.

In a current program for rural stroke care, 11 hospitals pay approximately $600 per consultation with a UNMH neurologist. The hospitals will fund their telehealth consultation cost by reimbursement that allows local hospitals to treat their patients, rather than transporting them. Therefore reimbursement from insurance goes to the local hospital.

Targeting Medicaid and CHIP Populations

We will not necessarily target Medicaid and CHIP population. All patient presenting to a spoke hospital with a neuro-emergent condition in need for a specialist consult will be enrolled. Our calculation show that more then half of the target population will be CMS beneficiary. Please refer to the executive summary for the exact insurance status breakdown of target population.

It is important, that an expected 140,000 people will become eligible for Medicaid over the next several years. This was not calculated into the cost savings model. This change would affect the CMS return on investment, logically by increasing the expected return.