The idea of telemedicine (defined by Wikipedia as “the use of telecommunication and information technologies … to provide clinical health care at a distance”) is almost as old as the idea of telecommunication itself. The National Academies of Sciences, Engineering and Medicine noted in a 2012 report that the British medical journal The Lancet in 1879 speculated about doctors one day using the newly invented telephone “to reduce unnecessary home visits”; by 1925, futurists were imagining the use of yet-to-be-perfected video to treat patients over a distance.
Earlier this year ICS embarked on a pilot program called Care Connections. The object: to increase the medical knowledge of our members’ home health aides so they can help prevent the kinds of health issues that often lead to hospitalizations and re-hospitalizations. The aides are being trained to notice warning signs—discolored skin, high blood pressure, complaints of dizziness, etc.—of potentially dangerous conditions that they can report to the member’s care management team, which can then decide if intervention is necessary.
For some of those whose clients are particularly at risk, for example ICS members with a history of multiple recent hospitalizations, the pilot includes a phablet (part smartphone, part tablet) that the aide can use to keep the team informed of the member’s health in real time. The device is task-specific: it can receive calls but can call out only to the aide’s supervisor and 911. It can also send and receive emails to and from the team. But its main application is as an electronic health monitor.
Ordinarily, the aide uses the phablet to answer simple questions about the member’s health status. If everything is stable, the answers to the health questionnaire will not raise any flags. But if a question draws a change in answer from one day to the next (say, if the patient’s skin is a different color from usual, which might mean a dangerous pressure ulcer is developing), it will trigger an immediate alert to the care management team. If the team is alarmed by the information, they can call the aide and even videoconference with her and the member to plan a course of action.
With Care Connections, ICS has firmly entered the brave new world of telemedicine!
Telemedicine: Promise and Worries
For years, when people talked about telemedicine, they were talking mainly about its usefulness in rural America, where a single hospital might serve an area extending thousands of square miles. Now a company called Pager offers an Uber-like smartphone app that can link a New York City resident in need of a house call with a doctor willing to make it within a couple of hours. Telemedicine is being explored in a variety of specialties, from nursing, pharmacology, psychiatry and rehabilitation, to name just a few. Down the road, we may even be seeing robots performing telesurgery!
Using a smartphone as a medical tool may seem like a no-brainer; in fact, it’s not as straight-forward as you might think. Proponents of the technology have long argued (with some evidence) that telemedicine can save billions of dollars and radically reduce the number of visits to doctors’ offices and hospitals. Opponents worry that if the field is not carefully regulated, long-distance telemedicine could take the place for most people of the kind of person-centered care that can only be practiced face-to-face.
Laws May Vary
States are grappling with the implications of telemedicine in ways that vary from statehouse to statehouse. Earlier this week, Delaware became the twenty-ninth state to require insurance companies to pay providers of telemedicine for their services. The Delaware law even requires that telemedicine providers be paid “on the same basis and at least at the rate” they pay for hands-on visits. On the other end of the spectrum, in April the Texas Medical Board placed restrictions on consultations by video, requiring patients to visit a doctor in person before being permitted to be treated over distance by the same practice. The American Academy of Pediatrics just adopted the Texas standard as its own.
The ICS Care Connections pilot is one of the rare experiments with telemedicine in the Medicaid-Medicare world. While most states that regulate telemedicine include provisions for Medicaid payment, New York is one of only a handful that extend coverage of telemedicine to participants in plans for people dually eligible for Medicaid and Medicare, like ICS Community Care Plus FIDA-MMP.
The American Medical Association, the American Hospital Association and other industry groups believe Congress needs to expand the use of telemedicine in Medicare. According to Kaiser Health News, “Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it…. In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services — barely a blip compared with the program’s total spending of $466 billion, according to a study in the journal Telemedicine.”
The ICS Touch
We expect that our experiment with telemedicine in the Care Connections project, which is built on knowledge from a study we undertook in 2014, will enable us to apply the ICS touch to the advancement of this medical technology for our members in their long-term care. Yes, the promise of saving money is one incentive for getting this technology right. At least as important to ICS, however, is the hope that telemedicine can enable our members to stay home, stay healthy and stay independent.