How comfortable would you be seeing your doctor through a mobile phone or tablet? Tele-medicine holds promise from bringing some types of medical care to rural areas, while also reducing costs for non-emergency physical and mental health needs. Technology and acceptance are advancing, though the use of telehealth is still small.
“The thing they put on me is this patch, which transmits to my phone,” says Gretchen Cottrell
Gretchen Cottrell is on the cutting edge of telemedicine. Her patch sends health data through a specialized mobile phone to a monitoring service. She lives at Loretto’s Lucille Manor and is part of the PACE CNY inclusive care program.
“I get a phone call. The first thing they ask me is, ‘how are you feeling; are you feeling o-k?’ and I respond, yes, because if I respond any other way, I’m going to have an ambulance parked at my door.” .
The monitor and Gretchen have a face-to-face conversation through a tablet every day, through the service, “Imagine Monitoring Intervention Center.”
A nurse with Imagine has in front of her information from a blood pressure cuff and fingertip oxygen sensor that Gretchen has.
“Usually for a daily check in, our patients schedule their calls. We just go over how they’re feeling overall, their vital signs, (and) if they’re wearing one of our patches, if their heart rhythm’s good and basically their overall well-being.”
Doctor Douglas Tucker is Medical Director for the PACE program. He says the telehealth monitors help complete a continuum of care.
“They call into our morning meeting every day, which is a comprehensive (meeting). The whole care team gets together and talks about patients that might have had trouble overnight, a physician that can intervene acutely. Maybe that person doesn’t need to go to the E.R. that night, but can be seen in the clinic in the morning, and that can all be facilitated through this whole process.”
Tucker says the combination of the patch, blood pressure and blood oxygen sensors catches health problems – from just not taking medication to an emergency – much faster than any person could on their own, or even observation in an assisted living facility.
“We look at our patients that have a higher risk. So, if you have a heart condition, if you have a lung condition, if you have prior admissions to the hospital for those kids of things, those would all be things we would be more likely to recommend having this sort of service.”
Excellus Bluecross Blueshield here in Syracuse is finding the acceptance for tele-medicine is increasing. In a recent report, they found the number of specific telehealth visits tripled between 2016 and 2018 … more than 14-thousand connections among its patients. And the insurer extrapolates that to estimate that more than 180-thousand telemedicine visits took place statewide last year.
Excellus Chief Medical Officer Doctor LouAnne Ginagreco says there are a number of reasons it works – from access to convenience.
“In rural medicine examples or maybe in an area where you’re not familiar with what care is available. Sometimes it can be challenging when you’re in the workplace, or at home, you have the whole family that you’re responsible for, getting the family packed-up in the car, or seeking transportation can be a challenge too. So, being able to access care in your own home can make that easier.”
As an insurer, she adds, Excellus wants to make a good match between efficient care and the situation at hand.
“We want to make sure that our patients are getting care at the right level for the specific medical need. So, if there’s an opportunity to have high-value care, where you’re getting a great quality of care that’s medically appropriate at a lower cost, we want to make sure that’s being optimized. And we know there are some conditions that are served well through telemedicine.”
For example, heart disease, Hypertension, skin disorders and diabetes are all conditions that a medical expert through telemedicine could make a diagnosis. That could lead to a prescription or an indication that more direct care is needed. They also found behavioral health works well through telemedicine – from anxiety to depression to attention disorders.
Mei Kwong is Executive Director of the Center for Connected Health Policy studying and helping implement telehealth. She adds counseling for addiction treatment works, especially as part of an approach to the opioid crisis.
“You could use that to monitor how somebody is doing on that medication as well. Most of these programs are focusing more on providing mental and behavioral health services, which there is a great need for. You don't have a counselors who are trained to do that in a lot of these areas that are hard hit (by opioids).”
While Kwong agrees acceptance of telemedicine is growing, she’s hearing a few things from health consumers.
“Why can’t I get this is actually the biggest question I’ve been getting. What (consumers) are doing is, they’re going through their health plans, if they do have a health plan (offering telehealth), asking, ‘why is my health plan directing me to this organization, as opposed to me just getting it from my regular doctor.”
And that’s because lots of telehealth is handled through third parties. IN the PACE example, Gretchen has developed a relationship with the third party providers who are monitoring her vital signs and overall health – in connection with the local clinicians. Kwong wonders if the third-party vendor model works best for patients.
“Sometimes (insurers) contract with third party vendors that provides all the telehealth services rather than letting their in-network providers provide the services via telehealth. And I do have concerns about that. It's like, is that information getting back to the primary care provider, how's that connection?”
Giangreco with Excellus believes it will continue to grow.
“As awareness around telemedicine increases, I think we will see more utilization. I think we’re going to see more adoption in the medical community as well, as another tool and another resource to make sure that we’re maintaining that contact with patients and that we’re able to insure that people have the preventative care, the chronic care, as well as acute care needs met. So I think we‘re going to see that growth.”
Excellus found still more than half of consumers don't know about telehealth. Kwong, with the Center for Connected Health Policy, calls it a bit of a catch 22 with doctors needing to implement telemedicine systems, insurers having to decide how and what procedures to pay for, and consumers learning about it and particpating. Not to mention, she adds, policy decisions.
Whether handled in house or through a third party, telehealth holds promise to improve access to medical care … and save costs by avoiding unneeded trips to a doctor or emergency room. Not to mention – peace of mind.
“My daughters all think it’s fantastic,” says Gretchen Cottrell. “I’ve got two of them that are nurses, and they say, ‘Mom, you don’t know how easy it’s making it for you and them.’”
This story has been updated with copy corrections.