Telemedicine Pilots Target Chronic and Complex Illnesses

A new bill sent to the Senate in early April aims to expand telemedicine services for chronic disease management for Medicare recipients. The bill, Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017, also known as CHRONIC, is looking to expand reimbursement for the use of live video-conferencing systems to enhance at-home care.

With telemedicine tipping into the mainstream, the bill is well timed. Although there are certainly still challenges for the technology, recent studies are showing that telehealth is saving both hospitals and residents in rural regions thousands of dollars each year, and more pilot programs are proving telemedicine to be a critical factor in effectively treating diseases that make it more difficult for patients to travel.

Teleneurology Eases Treatment for Multiple Sclerosis

Physical and geographical issues make it difficult for patients with MS, an autoimmune disease of the brain and spinal cord impacting 400,000 people in the U.S., to make it to neurology office appointments for treatment. But a new study by the University of California, Riverside School of Medicine is setting out to see whether telehealth tech could effectively address this issue.

Funded through a $100,000 grant from biotechnology company Genentech, the study will follow up on a previous MS-focused telemedicine pilot launched in collaboration with the Landon Pediatric Foundation.

The study will randomly assign participating adults to an intervention group that uses telemedicine or a control group that relies on patient visits to test several variables, including quality of life, mental health and pain levels, among others.

“The goal is to determine whether the home telemedicine approach works as well as usual care — that is, office visits with the neuro-immunologist. This is a pilot study and it may not be able to show whether MS telemedicine in patients’ homes is better than usual care, but if it appears to be equivalent — and if patients and families like it better because of its convenience and comfort – then the pilot study will provide useful preliminary data to guide larger research studies in the future,” Elizabeth Morrison-Banks, a health sciences clinical professor who studies MS and the researcher in charge of the study, said in a statement.

Using Telemedicine in Complex Cases

With the aim to allay much of the overwhelming cost associated with chronic diseases, Banner Health, a 28-hospital health system, is moving its telehealth program beyond the intensive care unit and focusing on its most complex population of patients: those diagnosed with five or more chronic diseases, FierceHealth reports.

Alongside the threshold of five chronic diseases, patients must have a minimum of $20,000 in healthcare costs in the last 12 months, although Deb Dahl, vice president of patient care innovation at Banner Health, told FierceHealthcare that most patients who fall into this category have healthcare costs that are “well above that.” A recent Agency for Healthcare Research and Quality report reflected on the high cost of complex cases as well, noting that 5 percent of the patient population accounts for more than half of healthcare spending.

For this reason, the Banner Health program looks to telemedicine as a means to improve care while also reducing the cost of treatment for these patients. It aims to better monitor chronically ill patients by catching subtle changes in weight or blood pressure, allowing for immediate treatment and allowing the patient to stay at home instead of taking a trip to the hospital for a more difficult issue down the line.

Patients in the program are all equipped with technology provided by Philips, including a tablet that allows them to communicate with healthcare professionals, as well as tools to monitor their vital signs, such as blood pressure cuffs and glucose monitors.

“With that data and vital sign data, the software tool in the telehealth center literally [calculates] early adverse trends and our health team can intervene to turn those around,” Dahl told the source.

The program seems to be showing signs of early success, with a study conducted by Banner Health noting that the program reduced hospitalizations by nearly 50 percent during the first year, and 30-day hospital readmission rates dropped by 75 percent. The hospital system also saw benefits, as costs were reduced by 34.5 percent.

"We have been able to make significant improvements with our most complex patients over long periods of time, and the results can potentially be applied to better manage the health of other patient populations,” said Dahl in a statement around the study.