The mean age of patients was 54 and more than two-thirds were women. A total of 53% had diabetes, 45% dyslipidemia, 41% hypertension, 30% thyroid dysfunction, and 12% osteoporosis. As for the study results, Rabia A. Rehman, MD, from the University of Tennessee Health Science Center in Memphis, and colleagues found that the rural test group showed improved glucose control with use of telemedicine for endocrinology consultation. Some  improvement in lipid patterns was also observed.

Rehman and colleagues noted that the prevalence of endocrine diseases is increasing in rural areas of the United States.  For example, in some parts of the countryside, the prevalence of diabetes is about 17% higher than in urban areas. The shortage of rural physicians, in particular endocrinologists, compounds this disparity, she said.

“The findings of this study demonstrate that the telemedicine program providing endocrine consultation using video-conference technology is effective in improving outcome measures in diabetes and other endocrine disorders,” the researchers concluded.  However, larger prospective studies need to be conducted to confirm these results, they said.

To learn more, read the article Telemedicine Brings City Docs to Rural Patients.

_____________________

Primary source: American Association of Clinical Endocrinology
Source reference:
Rehman R, et al “Tele-Endocrinology: Bridging the gap in endocrine care via tele-medicine” AACE 2012; Abstract 253

The telehealth program, kicked-off by the Department of Veterans Affairs in 2003, recorded 1.3 million consultations in the past year, according to Adam Darkins, MD, the VA’s chief consultant for telehealth services. Darkins said the VA’s telehealth program has seen 30% reductions in bed days of care and 80% patient satisfaction rates and saved an estimated $1,900 per person annually since 2005, moving it well beyond the “pilot” stage.

To learn more, check out the article VA telehealth program to grow at brisk clip.

Early last May, SYKES joined over 250 exhibitors at the largest ATA (American Telemedicine Association) conference to date.  For many thought leaders within the Telehealth and Telemedicine fields, the ATA  conference provides the perfect opportunity to participate in the evolution of healthcare, as leading innovators and cutting-edge technologies come together to expand access to primary and specialty care as well as chronic disease management.  While the conference does a great job of building up the hype, attendees are often left with the same unanswered question, when will Telehealth and Telemedicine be widely accepted and reimbursed practices?

I believe the grand promise of this field will be realized incrementally.  After attending this year’s event, it was obvious that, like an old car, telehealth is being sold in parts or “care specialties”.  Some fieldss of telemedicine like radiology and neurology are far ahead of other medical specialties that are in their infancy, like cardiology.  From the telehealth side, for practices like remote patient monitoring, reimbursement is holding up adoption by health systems, but is being utilized by insurers and home care agencies with private funding sources.  Until the legal credentialing and reimbursement issues can be addressed, the adoption of telemedicine will continue to lag behind the rapid advancement of technology.  Once return of investment and improved patient outcome data are readily available, reimbursement should follow close behind.

In one of ATA’s panel held discussions, Jim Murphy, Vice P:resident of Healthcare Strategy for SYKES Assistance Services, noted that the telemedicine and health IT camps need to develop a shared partnership before the quality of healthcare can be improved.  Jim also mentioned that, “Privacy, security, data integrity, and interoperability are all part of the health IT world, but they will eventually become home to the telemedicine world.”  The panel projected that by 2015, many electronic medical record (EMR) vendors will have interfaces for telemedicine applications, but they will require collaboration with health IT to develop national standards.*

Many of ATA’s attendees, are currently working to eliminate Telemedicine and Telehealth barriers so that further innovation can be made.  While this process has been slow at times, our healthcare system is evolving.  After all, change may not be easy, but it is inevitable.

A 10 for health would probably mean that you are not overweight, exercise daily, eat healthy, don’t smoke, don’t use alcohol excessively, eat dinner with your family regularly, sleep 7-8 hours a night and have an annual physical.

Most of us are not a 10 on the health scale, and statistics say that half of us are overweight or obese.  We have all heard that being overweight can and ultimately will lead to diabetes, cardiovascular disease, joint failure among other diseases and most significant of all, lower our quality of life.

Hearing about our future diseases doesn’t seem to motivate us to change, because the diseases haven’t knocked on our door yet, and we really don’t know what it is like to have those diseases, but there is a trend brewing that hopes to help us prevent the onset of these diseases by encouraging better lifestyle habits early on.

How will we learn to be healthier?  Your health care provider may want to be in better touch with you.   She/He may want to engage with you regularly via a “facebook-like” communication tool, helping you to set health goals and ask you things like, “How many hours did you sleep on average, this month,” or “How many minutes did you exercise this week?”  Or they may want you to check your blood pressure every day and report it, watching for trends that could lead to trouble, and contact you to help you manage a health issue before it becomes a chronic problem.

Would you be willing to participate in regular dialogue with your primary care physician like this?

I am an 8-YES.  What are you?

I’ve recently had the pleasure of reading an insightful new report published by Harvard doctors in the Stanford Social Innovation Review.  In the report, titled Realigning Health with Care, not only are the statistics and ideas set forth relevant, but they’re proven to work in other parts of the world (and US pilot studies) where there are, and will be, dramatically insufficient numbers of primary care providers, facilities, and dollars available.

The report outlines how the utilization of non-medical care workers and community outreach facilities identify and source for remedies of health issues – i.e., lack of adequate food and housing which are common prerequisites for chronic disease – frees up physicians, nurse practitioners and PAs to manage cases requiring a higher skill level while bringing basic care to more individuals.

The article also highlights convenience clinics as a lower cost emerging resource in US healthcare.  And though the article does not address telehealth and telemedicine, many share my belief that if we include it (using telemedicine kiosks and remote or IVR based follow-ups to keep individuals diagnosed with chronic conditions connected and in adherence to a care plan) combined with universal EHR analytics to identify “at-risk” individuals – we will see a lower number of ER visits and less need for high cost healthcare.

This report is worthwhile read! To get the full article, click here.

If ACOs are guided to improve patient outcomes and reduce costs (unnecessary readmissions, treatment complications, etc) the pharmacists’ provision of MTM is a vital component.

What is Medication Therapy Management?
MTM is an emerging, personalized appointment service provided by pharmacists that optimizes therapeutic outcomes for individual patients. These services may include (but are not limited to) medication review for drug interactions, drug duplication, costs/ incorporation of generics, communication and review with the primary care provider for recommended treatment adjustments; and personalized patient education to ensure proper use.

Why should ACOs incorporate MTM services into their care model?
Experts estimate that in the United States 1.5 MILLION preventable, adverse medication-related events occur each year that result in $177 BILLION in injury and death.  (American Pharmacists Association)

What are the Benefits to the Patient?

• One-on-one time allows the pharmacist to fully analyze patients’ current medication therapy, including OTC medications and vitamin/herbal supplements.
• Patients gain valuable knowledge about their medication therapy and learn to take an active role in optimizing the success of their treatment.
• Careful analysis of patients’ medication therapy allows the pharmacist to monitor for drug-drug, drug-disease, and drug-food interactions
• Cost analyses are performed to ensure patients are treated in the most cost-effective way.
• Dosing regimens are reviewed to increase dosing convenience (which could improve adherence)
• Drug review can reduce patient discomfort and increase quality of life (patient satisfaction)

Who is Currently Eligible to Receive MTM Services?
MTM is a CMS provision requirement for some Medicare Part D recipients (Medicare’s Prescription Drug Plan) reimbursed by the Part D insurer.  Certain patient criteria must be met for the service to kick in, and patients are notified that they are eligible.  Patients can refuse the service (probably the ones who need it most).  Some non-Part D Insurance providers cover MTM, but many do not.

Who benefits the MOST from an MTM program?

• Patients with multiple providers and use multiple pharmacies (universal EMR would really help here, especially ones where patients could enter their OTC and herbal supplements they are taking).
• Patients who require additional education about their medications (most of us)
• Patients on multiple long term medications, or who have a chronic condition (asthma, CHF, diabetes, high blood pressure, elevated cholesterol, etc.)
• Patients who require close monitoring  (on anticoagulants, insulin)
• Patients (and caregivers) in care transitions, especially after hospital discharge in their home or care facility environment. (Do they have their new meds, know how to take them, are they compatible with other medications and know dietary restrictions/interactions?)
• Patients with a new prescription or a dosage change to their current treatment regimen.

After recent conversations with several pharmacists who currently provides MTM services, average cost for an MTM consult varies between $40.00 and $75.00 (good bang for the buck, cheaper than my monthly hair appointment, and far more economical than an emergency room admission) and can take up to an hour.  Follow-up appointments run about $35.00.  Anyone can request an MTM appointment and patients can contact their insurer to determine if the service is a covered benefit.  Some companies offer the service via telephone (another potential growth area for telehealth).  There are advanced MTM certification programs for pharmacists, but according to pharmacists I spoke with, all pharmacists have the knowledge to provide this type of service, but depending on the institution they are practicing in , time constraints and work flow may not allow for an appointment based, thorough review (Walgreens provides it, I asked).

Significant findings on this topic are that patients rarely request an MTM visit on their own.  This, I believe, is because there is a lack of awareness of the availability and benefits of such a service and a huge lack of awareness of the potential for drug interactions, particularly with over-the-counter medications and herbal supplements.   How about physicians start prescribing MTM to their patients when adding or changing prescriptions?

Post hospital discharge and any physical care transitions are a good place to initiate MTM services and the Patient Centered Medical Home (PCMH) platform is where it should live and dwell (a no-brainer).

I welcome any contributions you can make on your program or plans for MTM services in your organization.

More on MTM:

http://www.samhsa.gov/data/2k10/TDR013AdverseReactionsOlderAdults/AdverseReactionsOlderAdults_HTML.pdf

http://www.amcp.org/aco.pdf

http://www.amcp.org/data/jmcp/018-031.pdf

The report divides the telehealth industry into two segments, delineating “telehospital-clinic” providers (hospitals sponsoring and operating telehealth programs from their facilities) from “telehome” providers (which monitor and track patients via telehealth). Of the two segments, the telehome market is growing the fastest at an annual rate of 22.5% per year and is projected to rise to $9.7 billion by 2016.  The telehospital-clinical market is progressing at a slower rate of about 17% growth per year and is expected to rise to $17.6 billion by 2016.

Read complete article …

After reading the 369 comments on this article, I noticed several recurring misconceptions about Accountable Care Organizations (ACOs).

THE TRUTH ABOUT ACOs

First, only a physician group or health system with physicians can apply for and run an ACO. Hospitals may be on a team or included in a health system but cannot start an ACO on their own, with the exception of certain rural facilities. Health insurance companies may be a partner of a health system as well, but may not lead the ACO or initiate funding for one.

Second, the fundamental objectives of ACOs are to:

1. Increase Patient Satisfaction
2. Create a patient centered system through care coordination
3. Reduce Costs

There are some 34 benchmarks that must be met by a certain percentage to receive the CMS bonuses in the Shared Savings Program; however, the purpose of moving toward the ACO model is to improve patient care, primarily through care coordination.

Third, the goal of ACOs is to make sure the patient sees a primary care physician more, NOT LESS, and the goal is to keep patients connected and not lost to follow up.

CARE COORDINATION

What does care coordination mean? It means that a patient who goes to the hospital gets a follow up call from someone the day after they are discharged home (or to a long term care facility) to make sure they, or their care providers, understand their discharge instructions and have made a follow up appointment with their primary care physician. It means that they have their medications and know how to take them. It means that the pharmacist can see all of the patent’s medications (via the patient’s Electronic Medical Record–EMR) and can review and make sure that there are not medications on the list that might cause an adverse interaction, and correct it before it becomes a problem. If any of these areas are not complete, the patient care coordinator/navigator/advisor who contacted the patient can contact the appropriate party to facilitate so the patient has what they need for an optimal recovery, and hopefully will not have an unnecessary hospital readmission. This world where there is a platform for all health care providers in a system to view each other’s care activities for a particular patient is called a Medical Home–another goal of ACOs.

The EMR and Medical Home platform of an ACO provides the primary care physician a comprehensive list of interventions the patient has had so that there are not redundancies in ordering tests, because they are all there listed in one place, hence, no money waste for unnecessary or repeat procedures.

HEALTH INSURER AS RESOURCE

One key role of the health insurance provider in the ACO is to be a resource for patient registry data, in order to identify and facilitate better management of the high risk, high usage, and high cost patients. There are many ways to improve care for these groups–patients with congestive heart failure (CHF), diabetes, and asthma, etc., including various telehealth activities (another important activity for ACOs to carry out). Remote monitoring of pertinent biometrics such as blood pressure, oxygen saturation, weight, blood glucose, peak flow, INR, etc. can be monitored at home and transmitted automatically to the patient’s EMR so trends in the wrong direction can be headed off at the pass, before they end up in the emergency room (high cost area).

So there is a team of players in the successful implementation of an ACO, not a top down, “We say you do it this way” approach. The patient is at the center, not the insurance company, hospital, or provider, but all are necessary to make it work.

I have read most of the ACO documents and have spoken with enough health centers with early ACO involvement to know that I hope my primary care provider becomes an ACO. It makes sense to me that I’m a satisfied customer–asked to give my feedback, have someone looking out for me, and that we are all working toward ways to hold down the cost of my healthcare. I understand that botox is not covered, but I want it in my EMR in case of an allergic reaction.

To keep up on the latest news and information on the ACO market, follow the SYKES TeleHealth news feed for Accountable Care and Telemedicine.

READ MORE:

Telemedicine: Opportunities for Medical and Electronic Providers