Telehealth visits generate significant cost savings for adult cancer patients younger than 65, according to a new research article.

Cancer is among the most expensive medical conditions to treat in the United States, according to the National Cancer Institute (NCI). Direct costs include multiple types of treatments such as surgery, chemotherapy, and radiation therapy. Indirect costs include travel expenses and lost employment productivity for clinical visits.

The new research article, which was published by JAMA Network Open, examines indirect cost savings for more than 11,000 patients with more than 25,000 telehealth visits at Moffitt Cancer Center, the only NCI-designated Comprehensive Cancer Center in Florida. The telehealth visits were conducted from April 1, 2020, to June 30, 2021.

The study accounts for two indirect costs: roundtrip car travel and loss of productivity because of travel and the additional time associated with in-person visits compared to telehealth visits. The researchers divided visits in three categories: new visits for patients who had not received previous care at the cancer center, established visits for patients who had received previous care at the cancer center but were referred to a new subspecialty for consultation, and follow-up visits for patients who had visits for care in the same subspecialty they had received previous care at the cancer center.

The study has several key data points:

• Based on two cost models for telehealth visits, the mean total saving in indirect costs ranged from $147.4 to $186.1 per visit
   
• For new and established telehealth visits, the mean total cost savings per visit ranged from $176.6 at $0.56 per mile of travel to $222.8 at $0.82 per mile of travel
   
• For follow-up telehealth visits, the mean total cost savings per visit was $141.1 at $0.56 per mile of travel to $178.1 at $0.82 per mile of travel
   
• About 3,790,000 roundtrip miles were avoided, which generated more than 75,000 hours of savings in total driving time
   
• Telehealth visits generated about $1,170,000 savings in lost income because of driving time and about $467,000 savings in lost productivity because of visit time
   
• The mean driving cost savings per telehealth visit ranged from $83.2 at $0.56 per mile of travel to $122.0 at $0.82 per mile of travel

“These findings suggest that telehealth saves time, travel, and money for patients, which could improve care delivery and may reduce the financial toxicity of cancer care,” the study’s co-authors wrote.

INTERPRETING THE DATA

The indirect cost savings from cancer telehealth visits are substantial, the study’s co-authors wrote. “Telehealth was associated with a total savings of 3,789,963 roundtrip travel miles, which equates to traveling 152.2 times around the earth, and a total savings of 75,055 roundtrip drive hours, which equates to 8.6 calendar years. An additional 3.4 calendar years (29,626 hours) were saved in clinic visits by using telehealth.”

Travel is a significant factor in cancer care, the co-authors wrote. “The burden of travel has been identified as an important factor that can change access to diagnosis, treatment of cancer and participation in clinical trials. Transportation is a key determinant of healthcare access and has been identified as an important source of out-of-pocket nonmedical costs for patients receiving cancer care. Patients without adequate transportation are more likely to miss appointments and rely on emergency department care, and there is substantial variability in the estimated parking costs throughout cancer treatment.”

Rural cancer patients could benefit most from telehealth, the co-authors wrote. “A recent study noted that the number of rural hospitals has decreased over the last decade, resulting in almost double the number of people living outside a 60-minute radius of major hospitals and longer drive times to receive care. Thus, telehealth could be beneficial among rural patients in particular.”

The study underestimates the indirect cost savings generated by telehealth cancer care, the co-authors wrote. “We did not consider the cost savings of telehealth for cancer caregivers. Caregivers for patients with cancer spend substantial time and effort to coordinate and attend appointments with patients. … Therefore, savings from telehealth would be even higher if caregivers’ savings from lost productivity were accounted for, especially when telehealth has the ability for multiple caregivers to join the same appointment from various geographical locations.”

The post ‘TELEHEALTH SAVES TIME, TRAVEL, AND MONEY FOR PATIENTS,’ CANCER RESEARCHERS FIND appeared first on mTelehealth.

January 10, 2023

Krupal B. Patel, MD, MSc^1,2; Kea Turner, PhD, MPH³; Amir Alishahi Tabriz, MD, PhD, MPH³; et alBrian D. Gonzalez, PhD³; Laura B. Oswald, PhD³; Oliver T. Nguyen, MSHI³; Young-Rock Hong, PhD, MPH⁴; Heather S. L. Jim, PhD³; Anthony C. Nichols, MD⁵; Xuefeng Wang, PhD⁶; Edmondo Robinson, MD, MBA^7,8; Cristina Naso, MEd⁹; Philippe E. Spiess, MD, MS^9,10

Author Affiliations Article Information

JAMA Netw Open. 2023;6(1):e2250211. doi:10.1001/jamanetworkopen.2022.50211

Key Points

Question  What are the estimated cost savings of using telehealth among patients with cancer?

Findings  This economic evaluation of cost savings from completed telehealth appointments included 11 688 patients younger than 65 years, with 25 496 telehealth visits at a National Cancer Institute–Designated Comprehensive Cancer Center from April 1, 2020, to June 30, 2021. According to cost models, the estimated mean total cost savings ranged from $147.4 to $186.1 per visit.

Meaning  These findings suggest that telehealth saves time, travel, and money for patients, which could improve care delivery and may reduce the financial toxicity of cancer care.

Abstract

Importance  Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth.

Objective  To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery.

Design, Setting, and Participants  An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute–Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021.

Main Outcomes and Measures  The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract–level median hourly wages were used.

Results  The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.

Conclusions and Relevance  In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.

Introduction

Financial toxicity includes both objective financial burden (ie, costs) and subjective financial distress.^1,2 Costs of cancer care include: direct cost of care (cost sharing through higher deductibles, copayments, coinsurance, and even entire cost of care for uninsured patients) and indirect costs of care (lost productivity and cost of driving to and from appointments).^1,3 Patients with cancer have greater time-based costs than those without cancer (eg, time spent traveling back and forth to appointments and time spent receiving medical care).^4–6 Strategies are needed to reduce the direct and indirect costs of cancer care delivery.

The rapid adoption of telehealth during the COVID-19 pandemic has allowed patients to receive care in a location that is convenient for them, which may reduce the costs of cancer care. To date, there has been limited research regarding the cost savings of telehealth among patients with cancer. The COVID-19 pandemic is providing a unique opportunity to estimate the potential cost savings of telehealth in oncology care.⁷ Although it is well established that patients with cancer experience substantial financial toxicity, few studies have explored the indirect costs that they face. Thus, this study focused specifically on an oncologic population from a comprehensive cancer center with a substantially large sample size to estimate the indirect cost savings (driving costs and lost productivity) from telehealth visits.

Methods

This was an economic evaluation estimating cost savings from completed telemedicine visits at Moffitt Cancer Center (MCC), the only National Cancer Institute (NCI) –Designated Comprehensive Cancer Center in Florida. Data from telehealth visits were collected from April 1, 2020, to June 30, 2021. All patients aged between 18 and 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. All patients were offered telehealth if deemed appropriate by the clinical team. Telehealth visits were not offered to patients who needed physical examinations beyond what can be assessed during a telehealth visit. Patients who presented in person for chemotherapy infusion and/or radiation treatment were excluded from the analysis. This study was exempt from MCC institutional review board approval with a waiver of informed consent from patients because the study was deemed low risk. This study used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guideline.⁸

Due to the COVID-19 pandemic, implementation of telehealth at MCC was accelerated in March 2020. Telehealth was defined as care delivered through a videoconferencing platform in real time. Starting in April 2020, MCC instituted videoconferencing for their telehealth visits. Patient visits were defined as new, established, or follow-up. New patient visits were patients not having received any previous medical care from MCC; established patient visits had received care at MCC previously but were referred to a new subspecialty for consultation; and follow-up patient visits were seen at MCC for follow-up care by clinicians in the same subspecialty they had previously received care from.

Statistical Analysis

We assessed patient time, travel, and indirect cost savings from using telehealth for cancer care delivery (Figure 1). Analyses were guided by the framework recommended by Sanders and colleagues⁹ for assessing the time and transportation costs of patients. Time savings were calculated as the difference between the roundtrip time required to travel from each patient’s home address to an in-person consultation at MCC, plus in-person consultation time vs the time required to attend a telehealth visit from home (ie, time savings = roundtrip drive time + [time for in-person consultation – time for telehealth visit]). Travel savings were calculated as the roundtrip driving distance in miles from each patient’s home address to an in-person consultation at MCC. Indirect cost savings were calculated as the roundtrip costs associated with traveling from each patient’s home address to an in-person consultation at MCC. This included 2 components: the costs of travel and the potential loss of productivity due to the medical visit.

The American Community Survey (ACS)¹⁰ was used to determine census tract–level data for hourly median income per year. The census tract income data were then matched to the patient’s address. This analysis focused on patients younger than 65 years, because these patients were more likely to be employed full time than those aged 65 years or older.

Two different models were generated with a combination of 2 different mileage rates and hourly wage rates determined via ACS census tract level data. Driving distance traveled in miles was calculated in October 2021 by Buxton Company,¹¹ an analytics organization that uses Alteryx’s¹² analytic platform to provide geospatial data. Briefly, the locations are geocoded, and distance is calculated between the 2 geocoded locations by finding the route that results in the least amount of drive time between the 2 locations.

Calculations for different models were conducted using R (R Project for Statistical Computing).¹³ Details are available in the eMethods in Supplement 1. Data were analyzed from April 2020 to June 2021.

Results

A total of 25 496 telehealth visits for 11 688 patients were conducted for patients aged between 18 and 65 years during the study period. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits (Figure 2A). The eTable in Supplement 1 highlights the demographics of the telehealth visits. Median (IQR) age was 55.0 years (46.0-61.0) among the telehealth visits, with 15 663 visits (61.4%) being women, 18 443 visits (72.3%) having private insurance, and 18 360 (72.0%) visits by White non-Hispanic individuals. In travel, an estimated 3 789 963 roundtrip miles (804 969 for new or established visits and 2 984 994 for follow-up visits) were saved, equating to 75 055 hours (15 422 new or established visits and 59 633 for follow-up visits) of savings in total driving time. Per visit, telehealth was associated with mean (SD) savings of 148.6 (143.7) roundtrip travel miles and 2.9 (2.3) hours of roundtrip driving time (Table 1, Figure 2B and 2C). An additional 29 626 hours of in-clinic visits were saved by using telehealth with a mean (SD) savings of 1.2 (0.13) hours per visit (Figure 2D). For new or established visits, telehealth was associated with mean (SD) savings of 177.6 (161.6) roundtrip travel miles, 3.4 (2.6) hours of roundtrip driving time and 1.5 (0.0) hours of in-clinic time per visit (Figure 2B, 2C, and 2D). For follow-up visits, telehealth was associated with mean (SD) savings of 142.4 (138.8) roundtrip travel miles, 2.8 (2.3) hours of roundtrip driving time and 1.1 (0.0) hours of in-clinic time per visit (Figure 2B, 2C, and 2D).

Telehealth was associated with an estimated $1 170 160 savings in lost productivity (income) due to driving time, $467 247 savings in lost productivity due to visit time, and $1 637 407 total savings in lost productivity (Table 2, Figure 2B, 2C, and 2D). For new or established visits, the following savings were noted: $245 113 savings in lost productivity due to driving time, $104 522 savings in lost productivity due to visit time, and $349 655 total savings in lost productivity. For follow-up visits, the following savings were noted: $925 027 savings in lost productivity due to driving time, $362 725 savings in lost productivity due to visit time, and $1 287 752 total savings in lost productivity. Mean (SD) savings in lost productivity per visit due to driving time were $45.9 (41.5) per visit overall, and $54.1 (47.9) for new or established visits and $44.1 (39.7) for follow-up visits (Table 2, Figure 3A). Mean (SD) savings per visit in lost productivity due to visit time was $18.3 (5.9) per visit overall, and $23.1 (6.9) for new or established visits and $17.3 (5.1) for follow-up visits. Estimated mean (SD) total savings per visit from lost productivity was $64.2 (43.6) per visit overall, $77.2 (50.6) for new or established visits, and $61.4 (41.4) for follow-up visits. Total driving-cost savings ranged from $2 122 379 at $0.56/mile (Figure 3B) to $3 107 777 at $0.82/mile (Figure 3C). For new or established visits, total driving-cost savings were $450 782 at $0.56/mile to $660 074 at $0.82/mile, while for follow-up visits, total driving-cost savings were $1 671 597 at $0.56/mile to $2 447 695 at $0.82/mile. According to cost models, the mean (SD) driving cost savings per visit ranged from $83.2 ($80.5) at $0.56/mile to $122.0 ($118.0) at $0.82/mile (Table 2, Figure 3B and 3D). For new or established visits, the mean (SD) driving cost savings per visit ranged from $99.6 ($90.5) at $0.56/mile to $146.0 ($132.6) at $0.82/mile, and for follow-up visits, the mean (SD) cost savings per visit was $79.7 ($77.7) at $0.56/mile to $116.7 ($113.8) at $0.82/mile. According to cost models, the mean (SD) total cost savings per visit ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile (Table 2, Figure 3B and 3D). For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.

Discussion

This economic evaluation study uses a large data set collected at an NCI-Designated Comprehensive Cancer Center to estimate patients’ savings from using telehealth. From April 1, 2020, to June 30, 2021, a total of 25 496 telehealth visits were conducted. Telehealth was associated with a total savings of 3 789 963 roundtrip travel miles, which equates to traveling 152.2 times around the earth, and a total savings of 75 055 roundtrip drive hours, which equates to 8.6 calendar years. An additional 3.4 calendar years (29 626 hours) were saved in clinic visits by using telehealth. Depending on the visit types, mean savings in lost productivity per visit due to driving time ranged from $44.1 to $54.1, mean savings in lost productivity due to visit time ranged from $17.3 to $23.1, and mean total savings in lost productivity per visit ranged from $61.4 to $77.2. Mean driving cost savings per telehealth visits ranged from $79.71 to $146.0 depending on visit type and model used. Mean total cost savings per visit ranged from $141.1 to $222.8 depending on the visit type and model used.

Some of the main arguments for implementing telehealth are to increase access to care, patient convenience, and cost savings in outpatient clinics.¹⁴ Telehealth may also provide an opportunity to reduce emergency department visits, readmissions, and patient mortality.¹⁴ As patients’ financial costs of cancer care increase, telehealth may reduce their burden of travel including costs associated with parking and lodging, and lost income from missing work.

The burden of travel has been identified as an important factor that can change access to diagnosis, treatment of cancer and participation in clinical trials.^15,16 Transportation is a key determinant of health care access and has been identified as an important source of out-of-pocket nonmedical costs for patients receiving cancer care.¹⁷ Patients without adequate transportation are more likely to miss appointments and rely on emergency department care,¹⁵ and there is substantial variability in the estimated parking costs throughout cancer treatment.¹⁸ In addition, a recent study noted that the number of rural hospitals has decreased over the last decade, resulting in almost double the number of people living outside a 60-minute radius of major hospitals and longer drive times to receive care.¹⁹ Thus, telehealth could be beneficial among rural patients in particular.²⁰

In the models previously mentioned, we did not consider the cost savings of telehealth for cancer caregivers. Caregivers for patients with cancer spend substantial time and effort to coordinate and attend appointments with patients. In 2020, 53 million individuals were caregivers, 6% of whom were caregivers for patients with cancer. The vast majority of caregivers (80%) help with transportation; 18% report high financial strain; and 45% have experienced at least 1 financial impact as a result of caregiving.²¹ Although the current study was focused on indirect cost savings from patients’ perspectives, future studies should include caregivers’ indirect cost savings as often patients and caregivers function as a unit and share expenses. Therefore, savings from telehealth would be even higher if caregivers’ savings from lost productivity were accounted for, especially when telehealth has the ability for multiple caregivers to join the same appointment from various geographical locations.

Although telehealth offers considerable cost savings to patients with cancer, it is well documented that telehealth adoption is affected by the digital divide. Factors associated with financial toxicity (eg, age, insurance, race, and education) are also associated with the digital divide.²² Future studies are needed to address inequities in telehealth uptake. Additionally, telehealth requires substantial infrastructure costs and investments from health systems with buy-in from administrators and clinicians to ensure high patient satisfaction.²³

Limitations

Our study has several limitations. This analysis was retrospectively conducted at a tertiary/quaternary referral center, and so roundtrip travel distances may be higher than usual because this is a destination center for cancer care. Our assumption of employment rates and incomes for patients younger than 65 years may vary. Additionally, a percentage of patients on active treatment or following treatment may not be fully employed given their functional status, thus affecting the savings from lost productivity. Because we were unable to accurately capture employment among older adults, patients aged over 65 years were excluded; however, future studies should examine cost savings in this population. Cost savings due to lost productivity assumed that all patients are nonsalaried and the loss due to travel time and hours of visit time could not be made up for. Therefore, the savings in this study might be considered a maximum amount of lost productivity. This study only considered telehealth visits that were completed via synchronous videoconference, and the costs of electronic devices and internet access were not considered. This study also did not assess other factors likely to affect cost savings, such as rural vs urban residences, race, education, or insurance type, all of which should be explored in future studies. Finally, further data are needed if long-term oncologic outcomes with telehealth visits are equivalent to those seen in person, which can change costs of treatment.

Conclusions

Patients with cancer spend a substantial amount of time and money traveling to receive care. Using a large data set, we found that cancer care delivery via telehealth was associated with time, travel, and cost savings for patients with cancer, which may reduce the financial toxicity of cancer care. Future studies should explore other cost savings, such as the savings to cancer caregivers and how these vary for rural and urban patients with cancer.

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Article Information

Accepted for Publication: November 18, 2022.

Published: January 10, 2023. doi:10.1001/jamanetworkopen.2022.50211

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Patel KB et al. JAMA Network Open.

Corresponding Author: Krupal B. Patel, MD, MSc, Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612 (krupal.patel@moffitt.org).

Author Contributions: Dr Patel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Patel, Alishahi Tabriz, Gonzalez, Wang, Spiess.

Acquisition, analysis, or interpretation of data: Patel, Turner, Gonzalez, Oswald, Nguyen, Hong, Jim, Nichols, Wang, Robinson, Naso.

Drafting of the manuscript: Patel, Nichols.

Critical revision of the manuscript for important intellectual content: Patel, Turner, Alishahi Tabriz, Gonzalez, Oswald, Nguyen, Hong, Jim, Wang, Robinson, Naso, Spiess.

Statistical analysis: Patel, Wang, Naso.

Obtained funding: Patel.

Administrative, technical, or material support: Patel, Turner, Alishahi Tabriz, Gonzalez, Robinson, Naso.

Supervision: Patel, Gonzalez, Jim, Nichols.

Conflict of Interest Disclosures: Dr Gonzalez reported receiving personal fees from Sure Med Compliance and personal fees from Elly Health outside the submitted work. Dr Jim reported being a consultant for Janssen Scientific Affairs and Merck, and reported receiving grants from Kite Pharma outside the submitted work. Dr Spiess reported being the Vice Chair of the National Comprehensive Cancer Network Penile/Bladder Guidelines Panel, President of the Global Society of Rare GU Tumors, and a board member of the Societe of Internationale D’Urologie Journal outside the submitted work; none of these roles are compensated. No other disclosures were reported.

Data Sharing Statement: See Supplement 2.

Additional Contributions: The authors would like to acknowledge the members of Moffitt Cancer Center’s Planning and Market Data Analytics Department for their help with data curation and analysis, and April Manna, MS, for administrative assistance. Editorial assistance was provided by the Moffitt Cancer Center’s Office of Scientific Publishing by Gerard Hebert, MA, and Daley Drucker, BA. No compensation was given beyond their regular salaries. We would also like to thank donors to the COVID-19 Fund at Moffitt Cancer Center for their generous support, which helped to fund research to improve the quality and cost savings offered through Virtual Health.

References

1.

Witte  J, Mehlis  K, Surmann  B,  et al.  Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications.   Ann Oncol. 2019;30(7):1061-1070. doi:10.1093/annonc/mdz140PubMedGoogle ScholarCrossref

2.

Zafar  SY, Abernethy  AP.  Financial toxicity, part I: a new name for a growing problem.   Oncology (Williston Park). 2013;27(2):80-81.PubMedGoogle Scholar

3.

Yabroff  KR, Zhao  J, Zheng  Z, Rai  A, Han  X.  Medical financial hardship among cancer survivors in the United States: what do we know? What do we need to know?   Cancer Epidemiol Biomarkers Prev. 2018;27(12):1389-1397. doi:10.1158/1055-9965.EPI-18-0617PubMedGoogle ScholarCrossref

4.

Yabroff  KR, Guy  GP  Jr, Ekwueme  DU,  et al.  Annual patient time costs associated with medical care among cancer survivors in the United States.   Med Care. 2014;52(7):594-601. doi:10.1097/MLR.0000000000000151PubMedGoogle ScholarCrossref

5.

Yabroff  KR, Davis  WW, Lamont  EB,  et al.  Patient time costs associated with cancer care.   J Natl Cancer Inst. 2007;99(1):14-23. doi:10.1093/jnci/djk001PubMedGoogle ScholarCrossref

6.

Yabroff  KR, Mariotto  A, Tangka  F,  et al.  Annual report to the nation on the status of cancer, part 2: patient economic burden associated with cancer care.   J Natl Cancer Inst. 2021;113(12):1670-1682. doi:10.1093/jnci/djab192PubMedGoogle ScholarCrossref

7.

Novara  G, Checcucci  E, Crestani  A,  et al; Research Urology Network (RUN).  Telehealth in urology: a systematic review of the literature. how much can telemedicine be useful during and after the COVID-19 pandemic?   Eur Urol. 2020;78(6):786-811. doi:10.1016/j.eururo.2020.06.025PubMedGoogle ScholarCrossref

8.

Husereau  D, Drummond  M, Augustovski  F,  et al.  Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 explanation and elaboration: a report of the ISPOR CHEERS II Good Practices Task Force.   Value Health. 2022;25(1):10-31. doi:10.1016/j.jval.2021.10.008PubMedGoogle ScholarCrossref

9.

Sanders  GD, Neumann  PJ, Basu  A,  et al.  Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine.   JAMA. 2016;316(10):1093-1103. doi:10.1001/jama.2016.12195
ArticlePubMedGoogle ScholarCrossref

10.

American Community Survey (ACS) 2019. Accessed November 30, 2022. https://www.census.gov/programs-surveys/acs

11.

Buxton Co. Accessed October 15, 2021. https://www.buxtonco.com/

12.

Alteryx. Accessed October 15, 2021. https://www.alteryx.com/

13.

R: a language and environment for statistical computing. 2019. Accessed November 30, 2022. https://www.R-project.org/

14.

Tuckson  RV, Edmunds  M, Hodgkins  ML.  Telehealth.   N Engl J Med. 2017;377(16):1585-1592. doi:10.1056/NEJMsr1503323PubMedGoogle ScholarCrossref

15.

Ambroggi  M, Biasini  C, Del Giovane  C, Fornari  F, Cavanna  L.  Distance as a barrier to cancer diagnosis and treatment: review of the literature.   Oncologist. 2015;20(12):1378-1385. doi:10.1634/theoncologist.2015-0110PubMedGoogle ScholarCrossref

16.

Nipp  RD, Lee  H, Gorton  E,  et al.  Addressing the financial burden of cancer clinical trial participation: longitudinal effects of an equity intervention.   Oncologist. 2019;24(8):1048-1055. doi:10.1634/theoncologist.2019-0146PubMedGoogle ScholarCrossref

17.

Wolfe  MK, McDonald  NC, Holmes  GM.  Transportation barriers to health care in the United States: findings from the National Health Interview Survey, 1997-2017.   Am J Public Health. 2020;110(6):815-822. doi:10.2105/AJPH.2020.305579Google ScholarCrossref

18.

Lee  A, Shah  K, Chino  F.  Assessment of parking fees at National Cancer Institute-designated cancer treatment centers.   JAMA Oncol. 2020;6(8):1295-1297. doi:10.1001/jamaoncol.2020.1475
ArticlePubMedGoogle ScholarCrossref

19.

Diaz  A, Schoenbrunner  A, Pawlik  TM.  Trends in the geospatial distribution of inpatient adult surgical services across the United States.   Ann Surg. 2021;273(1):121-127. doi:10.1097/SLA.0000000000003366PubMedGoogle ScholarCrossref

20.

Bynum  AB, Irwin  CA, Cranford  CO, Denny  GS.  The impact of telemedicine on patients’ cost savings: some preliminary findings.   Telemed J E Health. 2003;9(4):361-367. doi:10.1089/153056203772744680PubMedGoogle ScholarCrossref

21.

National Alliance for Caregiving (NAC) in Collaboration with AARP. Caregiving in the US. May 2020. Accessed October 31, 2021. https://www.caregiving.org/wp-content/uploads/2021/01/full-report-caregiving-in-the-united-states-01-21.pdf

22.

Roberts  ET, Mehrotra  A.  Assessment of disparities in digital access among medicare beneficiaries and implications for telemedicine.   JAMA Intern Med. 2020;180(10):1386-1389. doi:10.1001/jamainternmed.2020.2666
ArticlePubMedGoogle ScholarCrossref

23.

Turner  K, Bobonis Babilonia  M, Naso  C,  et al.  Health care providers’ and professionals’ experiences with telehealth oncology implementation during the COVID-19 pandemic: a qualitative study.   J Med Internet Res. 2022;24(1):e29635. doi:10.2196/29635PubMedGoogle ScholarCrossref

The post Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer appeared first on mTelehealth.

November is Diabetes Awareness Month. More than 37 million U.S. adults live with this chronic condition, which can cause a variety of complications, such as stroke, kidney disease, heart disease and blindness.

To help address this epidemic, Dr. Sos Mboijana argued in a recent interview that providers should incorporate remote patient monitoring (RPM) into the standard of care for diabetes. Dr. Mboijana is a primary care physician and the assistant chief medical information officer at Kaiser Permanente’s Mid-Atlantic medical group.

Kaiser launched its RPM program for diabetes care in 2017 in California, and it has since spread to the health system’s other regions.

Dr. Mboijana asks all his patients with diabetes to participate in the program. He gives them a Bluetooth-enabled glucometer (a handheld machine that measures their blood sugar) and ensures that they sign up for the “KP Health Ally” app. As patients measure their blood sugar daily, the glucometer transmits their blood sugar data to the app and to their care team.

“It’s a mechanism for us to reach into the patient’s home and connect them to the healthcare team,” Dr. Mboijana said. “It further allows us to coordinate care, adjust care and adjust medicines.”

When treating chronic conditions like diabetes, having access to a continuous flow of patient data is critical, according to Dr. Mboijana.

When a patient is newly diagnosed with diabetes, their treatment plan will usually involve a new medication, often Metformin. Medication types and quantities often change for diabetic patients across the course of their life, so it’s rare that a patient will stick with the exact same prescription they received on Day One forever. With a continuous flow of blood sugar data, a patient’s care team can sooner figure out which adjustments need to be made to the care plan.

“When I started practicing initially, the standard for a patient with a new diagnosis was to collect all the data that we can, assign them for diabetic education, and then maybe a follow up with a month or a few weeks. And then we get into this cadence of about every three months. Essentially, what I would get is a snapshot in time of what’s happening with the patient. But diabetes is a dynamic clinical condition, and it’s a chronic medical condition. Things go up and down,”  Dr. Mboijana explained.

About 40,000 patients are enrolled in Kaiser’s RPM program for diabetes. Dr. Mboijana said that providers across the country should create similar programs, as he thinks it’s “integral to the whole care package that we should be offering patients.”

He also pointed out that diabetes can often lead to a host of complications. For example, diabetic retinopathy is the leading cause of blindness in working-age U.S. adults. Because RPM improves providers’ ability to intervene with diabetic patients’ care plans sooner, it can play a huge role in decreasing the amount of complications that occur.

“If we can track diabetes, in terms of chronic disease management, and improve on that from a population health standpoint — not just cast Kaiser Permanente patients, but everybody — the upside is dramatic,” Dr. Mboijana said.

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Type 2 Diabetes is a chronic condition that affects over 400 million individuals worldwide, and can lead to major health issues if not properly managed. In recent years there have been significant advances in the treatments available for people with diabetes. Thanks to new technologies, such as telehealth, outcomes for patients living with the disease are improving from year to year. In this blog, we will highlight the importance of managing type 2 diabetes, and how telehealth is improving the ways patients manage their condition.

The Importance of Managing Type 2 Diabetes

For patients with type 2 diabetes, blood sugar management is critical for avoiding or delaying the development of health-related problems. According to the American Diabetes Association, individuals with type 2 diabetes are more likely to develop cardiovascular illness, kidney disease, nerve damage, and other health problems. To avoid these complications, it is critical to control the disease by adopting a healthy lifestyle and taking medication as directed.

How Telehealth is Improving Care for Type 2 Diabetes

Telehealth is a fast-growing care delivery method that uses technology to provide healthcare services remotely. It allows patients to obtain care from providers who are not physically present, which increases access to both regular, and urgent care. There are many potential applications for telehealth, including mental health counseling, physical therapy, and disease management. Telehealth can also be used for preventive care, such as health screenings for pre-diabetes diabetes, and educational resources for patients who may be at risk for developing diabetes.

Telehealth platforms offer a range of features including options for patients to log their blood sugar levels, remote patient management tools for healthcare providers, and additional patient resources. Each of these features has its own unique benefits that can improve patient care. For example, when patients keep track of their daily blood sugar levels, they can recognize what patterns and habits contribute to healthy readings. The remote patient management tools help providers proactively manage the patient’s health without the need for frequent in-person healthcare visits

Enhanced Patient Engagement

Telehealth increases accessibility to healthcare services and enhances patient engagement throughout the care process by providing continuous monitoring. Better access to care is achieved by providing a virtual communication platform for healthcare providers and patients to connect virtually at any time. This is especially beneficial for patients living in rural areas where access to quality care is limited. In addition, telehealth can improve patient engagement by providing a convenient way for patients to receive education and support services. It can also provide constant monitoring to keep diabetes under control and prevent complications.

With telehealth, patients with type 2 diabetes can get check-ups and questions answered in the comfort of their homes. Patients can track their blood sugar levels at home using monitoring devices such as blood sugar meters, diabetic test strips, or insulin pumps. Although quarterly and semi-annual testing may still necessitate in-person visits, many other symptoms of diabetes management may be handled virtually.

Daily Self-Management With Telehealth

It can be difficult for diabetic patients to self-manage and reach their goals if they are not regularly guided by a healthcare professional. Patients may have difficulty monitoring blood sugar levels, injecting insulin correctly, and recognizing changes in their condition due to a lack of training. Therefore, regular medical attention from a healthcare specialist or accredited diabetes educator is required to maintain and improve their health.

Patients can use telehealth platforms to access daily self-management tools such as checklists to ensure they are getting the right amount of exercise, eating the right diet, and taking medications on time. They can also collaborate directly with various members of their care team through these platforms, including their primary care provider, diabetes educators, or other specialists. Individuals who are provided with the tools they need to improve their self-management will be more likely to adhere to their routines and avoid the negative effects of diabetes over time.

Utilizing Telehealth To Manage Type 2 Diabetes

Many different telehealth platforms can be used to help manage type 2 diabetes. These platforms can be used to track blood sugar levels, monitor medication adherence, and provide education and support. Some telehealth platforms, such as aTouchAway also offer additional features, such as the ability to schedule appointments and send reminders. It is important that all healthcare providers choose the right telehealth platform that best fits their patients’ needs.

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The experience of cancer — of getting a cancer diagnosis, surviving cancer, losing someone to cancer — has touched virtually every American family. 

This is personal for the President and First Lady, like it is for so many of you.

As Vice President, in 2016, Joe Biden led the Cancer Moonshot with the mission to accelerate the rate of progress against cancer. The cancer advocacy, patient, research and health care communities responded with tremendous energy and ingenuity.

Now, President Biden has reignited the Cancer Moonshot and set a new national goal: if we work together, we can cut the death rate from cancer by at least 50% over the next 25 years, and improve the experience of people  and their families living with and surviving cancer. 

We can make real progress toward ending cancer as we know it.

It will take all of us doing our part.  Join us.

We Need Your Help

Achieving the bold goals laid out by President Biden and First Lady Jill Biden will take all of us.  Progress will be informed by patients, caregivers, and families and made by all parts of the oncology community and beyond.  President Biden calls on the private sector, foundations, academic institutions, healthcare providers, and all Americans to join the mission of reducing the deadly impact of cancer and improving patient experiences in the diagnosis, treatment, and survival of cancer. We invite all Americans to share perspectives and ideas; — organizations, companies, and institutions to share actions they plan to take as part of this mission.

Share Your Ideas and Stories

Ending cancer as we know it will take all of us doing our part.

We know that the best ideas, the stories that will inspire change, and the actions that can help deliver on this bold mission come from across the United States and beyond. 

President Biden is calling, on the:

• Scientific community to bring its boldest thinking to this fight;
• Medical and public health community to improve their outreach to and support for underserved communities, to help patients and families have the best experience possible while living with and surviving cancer, and to improve patient outcomes;
• Private sector to step up — to develop and test new treatments, to share more data and knowledge, and to collaborate on tools that can benefit all Americans; and
• People living with cancer and survivors, their caregivers and families,  and those who have lost someone to keep sharing their perspectives and experiences and to keep pushing for progress.

The goals and priorities for the Cancer Moonshot must be informed by those with direct experience with cancer. 

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The internet, COVID-19 pandemic and increased access to smartphones and laptops has changed the way people shop, bank, travel and work. It also has changed how people manage their health care.

Telehealth, including telemedicine and virtual visits, uses digital information and communication technologies to access health care services remotely and manage your health care. It’s often thought of as remote communication or monitoring between a health care team and the patient or caregiver.

Asynchronous and synchronous communication

Some interactions are asynchronous, meaning communication that doesn’t happen at the same time. For example, a patient sends a message through an online portal and the health care team responds at a different time. Or a patient completing an online survey about symptoms to update the health care team.

Remote monitoring, which is asynchronous technology that collects and reports temperature, weight and other vital signs, allows the health care team to check a patient’s status without a visit to a health care facility. Any identified problems are usually addressed quickly.

In contrast to these examples are synchronous interactions, in which the patient and health care team communicate in real time. A telephone conversation is synchronous communication and an important part of a health care journey. Virtual visits use online technology to allow the patient and team to see and hear each other in real time. These synchronous communication telehealth options extend health care to meet patient needs.

Telehealth options are available for general health care, acute needs or specific conditions. Virtual visits became common because of the needs of the COVID-19 pandemic. Two years later, oncology professionals recommend telehealth interactions when appropriate for the patient or the caregiving team.

Telehealth and cancer care

For many people with cancer or malignant diagnosis, telehealth has become an important part of their care. It may be appropriate for medical oncology, hematology, consultations, second opinion consultations and surgical consultations.

Many patients use portal online messages throughout their cancer journeys to communicate medication side effects, changes in condition or send questions to the health care team. Other common telehealth options during cancer care are virtual visits and telephone conversations. These extend care and options for patients, regardless of geography. Occasionally, remote monitoring is part of cancer treatment plans as well.

Some appointments and treatments cannot be conducted virtually. The health care team recommends in-person or virtual visits based on the needs and treatment plan for each patient.

Telehealth benefits

There are multiple benefits of telehealth for all patients, but especially for people with a chronic or complex health condition, such as cancer, including:

• Greater access
  Telehealth can bring cancer experts to people who live in remote communities. It can provide people with choices to meet with specialists who don’t live where they do, especially when they are seeking a second opinion on a complex cancer diagnosis. Patients who don’t have good access to devices or internet may be able to participate in virtual appointments by using cancer center clinic resources and assistance.
• Reduced travel time and expense
  Cancer care requires many appointments, and patients often travel significant distances to receive the care they need. Some appointments, especially consultations or general checkups, can be completed virtually. This reduces travel time and expense for the patient and family. Not every appointment can be conducted using telehealth but saving travel expenses a few times can make a significant difference.
• Larger support network
  Most of the time, patients who receive care in Oncology attend visits with a family member or other support person. Virtual visits allow remote family members to participate in important conversations, ask questions and lend support, regardless if they live across the street or across the country.
• Improved energy
  Gearing up to travel to and from an appointment can be a challenge, especially if a person is experiencing severe fatigue due to cancer treatment. Participating in virtual visits can be less draining and preserves energy for recovery.
• Improved safety
  Hospitals and clinics are safe to visit and receive care. However, traveling to and from appointments does increase a person’s exposure to infectious diseases in the community, such as influenza and COVID-19. Mobility and falls are concerns for some people. Remaining at home to receive care can keep the person safe.

There are limitations to telehealth. Sometimes technology doesn’t work as well as designed. It’s important to have a plan with your health care team to call on the telephone if there is an issue connecting to a virtual visit.

Some people have no or limited internet access and may have to travel to a local clinic to participate in a virtual visit with specialized providers at other sites. Others don’t have or don’t feel confident using a mobile device or may need to have an exam done in person. Telehealth may not be appropriate for these patients. However, it’s an important tool to have that can extend options for care.

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The start-up healthcare chain is designed to emphasize wellness and continuity of care through a unique NP-driven model.

KEY TAKEAWAYS

The Good Clinic’s NP model evolved from the shrinking volume of primary care practices in the United States.

Patients need more than urgent care clinics; rising chronic diseases require that healthcare do more continuity of care.

By next year 50 The Good Clinics are expected to be in operation.

A primary care clinic start-up is differentiating itself by being the first primary care group staffed only by nurse practitioners (NPs).

Minneapolis-based The Good Clinic chain is designed to emphasize patient engagement, continuity of care, and an emphasis on wellness and convenience through a unique nurse practitioner-driven model, says Larry Diamond, CEO of Mitesco Inc., which operates The Good Clinic brand.

More than half of U.S. states—26 states, Washington, D.C., and two U.S. territories—have granted patients full and direct access to care by NPs in adopting Full Practice Authority (FPA), according to the American Association of Nurse Practitioners (AANP).

FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing. This regulatory framework eliminates requirements for NPs to hold a state-mandated contract with a physician as a condition of state licensure and to provide patient care.

SHORTAGE OF PHYSICIANS

The Good Clinic’s NP model evolved from the shrinking volume of primary care practices in the United States, which in turn, occurred because of low reimbursement rates to primary care physicians, Diamond says.

“What’s happened over time is because reimbursements are low, physicians graduating from medical school with these huge student loan bills can’t afford, even if they wanted to, to go into primary care, and so the number of new docs coming out of medical school who want to go into primary care has been waning,” he says.

“The AMA (American Medical Association) says there’s a shortage of about 25,000 to 35,000 primary care providers, which is one of the reasons why all of these urgent care centers have popped up, because in America today, it’s typically two to five weeks’ waitlist to get in to see your primary care provider for just a normal visit, a physical, or just a follow-up,” Diamond says. “So, America learned, ‘Oh, if I have an earache, a sore throat, or a cut, let me run over to the urgent care clinic,’ and the challenge there is that we stopped providing care and just started fixing problems.”

But the prevalence of chronic diseases requires that healthcare do more than simply fix problems, he says.

“Diabetes is at an all-time high, and pulmonary issues, well, they all start somewhere and it’s typically because they’re not addressed earlier in their disease process,” he says. “And the government finally has recognized that if you focus on prevention, you can avoid a lot of the costs associated with people developing chronic illnesses, and then deteriorating with them, where it always costs more to address a problem later in its cycle.”

Nursing is better aligned to primary care from a philosophy perspective than medicine, Diamond says. “Nursing is about working with a patient over time, to help them overcome some of the challenges that they’re experiencing, where medicine has evolved to be much more about ‘one and done. Let me do something and solve the problem,’” Diamond says. “And with chronic illness in America, it’s not typically a ‘one and done’ type of solution.”

WHOLE-PERSON FOCUSED

Good Clinics began when the physicians that started MinuteClinic, which has since been sold to CVS, added Diamond to their team to create a primary care model that was whole-person focused—one that considered physical health, behavioral health, stressors, and how they use the healthcare system.

“The concept is about, ‘How do I take care of a person soup to nuts?’ [by] considering complementary and alternative medicine or whatever the person is interested in—yoga, meditation, supplements, vitamins, standard medicine—and to have a relationship where we co-develop a wellness plan with that person.”

For example, the adolescent population has been struggling with depression and anxiety after COVID and are frequently prescribed antidepressants by behavioral health services.

“No. 1, they’re not looking at their physical health to understand “How is their nutrition?” because nutrition in adolescents really is the start point of how you feel mentally, behaviorally. We were finding thyroids that are not operating at the levels they should be, and we’re finding that their vitamin D and vitamin B levels are not the adequate level,” Diamond says. “Nutrition is the first starting place when you’re trying to address behavioral health issues, and unfortunately, so many of the behavioral health services operate in isolation of primary care.”

STARTING IN FPA-FRIENDLY STATES

The company’s first clinic opened in February 2021, and by the end of the year it had six clinics operating around Minneapolis. This year, it expects to open an additional 12 clinics in Minnesota, Colorado, and Arizona and by next year 50 clinics are expected to be in operation in states where NPs can freely practice at the top of their license.

And though NPs have FPA in slightly more than half of U.S. states, that doesn’t preclude The Good Clinic from expanding into states where NPs don’t have FPA, Diamond says.

“Nurse practitioners pretty much in every state have the ability to practice; what changes as you go state to state is they often have to practice under the tutelage, from a quality control perspective, of a physician,” he says. “There are different levels—a physician [may have to] review chart review or they may have to sit in on a certain number of patient visits with a particular nurse practitioner. So, you can operate our model in all 50 states; it just becomes a little bit more expensive.”

Georgia and Texas, for example, have the highest level of quality assurance, and Florida requires a physician to sit in on all medical exams. But that won’t prohibit The Good Clinic from expanding into those states.

“It just lowers it on the list,” Diamond says, “as to where we’re going to want to start.”

“NURSING IS ABOUT WORKING WITH A PATIENT OVER TIME, TO HELP THEM OVERCOME SOME OF THE CHALLENGES THAT THEY’RE EXPERIENCING, WHERE MEDICINE HAS EVOLVED TO BE MUCH MORE ABOUT ‘ONE AND DONE.’”

— LARRY DIAMOND, CEO, MITESCO INC.

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Remote patient monitoring can help enhance chronic care management in many ways, including allowing clinicians to track their patients daily and adjust treatment plans in real time.

May 27, 2022 – Amid the rapid expansion of virtual care, remote patient monitoring (RPM) has emerged as a reliable tool for treating both acute and chronic conditions.

RPM involves leveraging connected digital tools to record personal health data in one location that a provider reviews at a different location, either in real time or later, according to the Department of Health and Human Services’ Health Resources and Services Administration.

RPM programs employ different devices, like weight scales, pulse oximeters, blood glucose meters, blood pressure monitors, and heart monitors. These enable providers to keep track of patient health metrics between clinic visits and adjust treatment plans as needed, making RPM a beneficial tool for long-term chronic disease management. Further, hospital-at-home programs have proved to be a viable alternative to in-hospital stays for patients with chronic diseases.

Here are some of the chronic conditions that could benefit from RPM services:

DIABETES

There is strong evidence showing that RPM can improve diabetes care, and as a result, providers are increasingly incorporating the care modality into their diabetes services.

A study published in 2019 showed that patients with more frequent and regular participation in remote monitoring had lower hemoglobin A1c levels — which measures average blood sugar — at the end of the program.

Even during the COVID-19 pandemic, RPM helped providers manage type 2 diabetes patients. A study conducted at St. Joseph’s/Candler health system in Savannah, Georgia, showed that an RPM platform managed by a pharmacist helped reduce A1c levels by 2.2 percent over a six-month period in 2020.

In addition to type 2 diabetes patients, RPM tools can be used to improve care for young children with type 1 diabetes. Stanford Children’s Health in Palo Alto, California, conducted a study that showed 53 percent of children provided with continuous glucose monitors reached the standard of care goal of having an A1c below 7 percent.

“There has been debate in the medical community about when is too early to start diabetes technology,” Priya Prahalad, MD, Stanford Children’s Health pediatric endocrinologist and member of the Maternal and Child Health Research Institute at Stanford Medicine, previously told mHealthIntelligence. “And I think what we are able to show is that starting diabetes technology early does not have any adverse effects on patients and families. It does not decrease their quality of life.”

Among providers, RPM strategies are increasingly being applied to diabetes care. In April, UBMD Pediatrics, a medical group in New York State, announced a collaboration with Cecelia Health to enhance care for children with type 1 diabetes by providing RPM.

Last year, the University of Mississippi Medical Center partnered with a federally qualified health center to increase access to diabetes care through RPM.

HYPERTENSION

Several studies have found that RPM can help maintain and decrease hypertension or high blood pressure (BP).

One published in 2018 showed that 81 percent of hypertension patients who enrolled in a home-based BP monitoring program achieved their BP goal in about seven weeks. Another study showed an RPM program that combined home BP monitoring with virtual nursing support helped maintain and even reduce BP during the pandemic.

Not only that but home-based BP measurements were found to be more reliable and accurate than those taken in clinics or kiosks.

Based on this clinical evidence, several providers have incorporated RPM into their hypertension treatment programs.

Last year, Northwestern Medicine piloted OMRON Healthcare’s VitalSight RPM service for its high-risk hypertensive patients. The service provides patients with the necessary devices to measure and share BP readings with their care team.  

And it’s not just the major health systems — smaller facilities with fewer resources are also turning to RPM to manage hypertension. In January, North Carolina-based federally qualified health center Robeson Health Care Corporation announced a partnership with HealthSnap that would enable it to offer RPM to more than 2,500 patients living with hypertension.

CANCER

Research showing that RPM can be used to enhance cancer treatments was available long before the pandemic.

In a study published in 2016, some patients receiving routine outpatient chemotherapy at Memorial Sloan Kettering Cancer Center were asked to report 12 common symptoms via tablet devices. Health-related quality of life improved for patients who reported their symptoms via the tablet than those who received usual care, which did not include remote self-reporting of symptoms. Further, patients receiving the intervention were less frequently admitted to the emergency room or hospitalized.

More recently, researchers at Huntsman Cancer Institute at the University of Utah found that the patients who participated in its adult oncology hospital-at-home program were 58 percent less likely to be admitted for an unplanned hospital stay than those not in the program.

Amid the recent disruptions in cancer care, RPM has helped ensure continued care access for cancer patients in their own homes, including those who contracted COVID-19.

A study published last September showed most COVID-19-positive cancer patients enrolled in an RPM program agreed that the program was worthwhile, enabled better management of their COVID-19 symptoms, and made them feel more connected to their care team.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems.

Studies show that RPM can be used to improve care for COPD patients, including one where researchers concluded that “remote monitoring of COPD patients holds promise for detection of exacerbation events.”

Another study published in 2021 revealed that RPM could help make COPD diagnoses and treatment more efficient.

In addition, research indicates that patients are ready to use a telemonitoring system for at-home pulmonary rehabilitation. The study published in 2018 shows that 98 percent of the participants agreed the system was easy to use and said they would be willing to use it throughout the pulmonary rehabilitation period.

As the initial COVID-19 surges slowed, providers and payers began adding COPD care to their home monitoring programs.

In 2021, West Tennessee Health modified its RPM platform to monitor patients with congestive heart failure and COPD, and Deaconess Health made a similar move.

Humana also launched a home healthcare service last year that included RPM. The payer announced plans to develop care pathways for members with various chronic conditions, including COPD.

As RPM becomes further integrated into care delivery, the physical boundaries of the healthcare system will shift, opening up possibilities for more comprehensive chronic care management.

The post 4 Chronic Care Use Cases for Remote Patient Monitoring appeared first on mTelehealth.

The most powerful drivers for digital home hospital adoption are advances in telehealth, remote monitoring and emerging digital technologies that facilitate high quality, cost-effective care beyond hospital walls.

By GARY MANNING

May 4, 2022 at 4:19 PM

In 2005, a study in the Annals of Internal Medicine demonstrated that digital home hospital, or hospital-at-home, solutions delivered better clinical outcomes, shorter average length of stay, higher patient and family satisfaction, fewer complications and significant cost savings, compared to traditional inpatient care. Since then, other research has shown similar findings including 70% reduced readmission rate, 40% lower cost and improved patient mobility for patients managed at home.

Despite these measurable benefits, adoption of hospital-at-home models is limited. However, several factors have recently converged to hospital at home implementation.

Pioneered by Johns Hopkins in 1995, the innovative hospital-at-home model provides hospital-level care in a patient’s home as an appropriate and, in some cases, better substitute for acute hospital care.

Current digital home hospital care models typically require eligible patients to be identified in the emergency department or an ambulatory care site. Once patients are admitted or accepted into the program, clinicians visit daily and all necessary care infrastructure—from infusion services to medication delivery devices to remote monitoring—is set up in the home.

Why now?

The Deloitte Center for Health Solutions identified several key reasons why hospitals are seeking to transform their business models, including the desire to reduce costs, maximize technology, better engage consumers, boost clinician satisfaction and compete with healthcare disruptors from Walmart to Amazon.

The digital home hospital concept offers potential for addressing all these challenges, especially given healthcare systems, physicians and patients alike embraced virtual care and digital technologies with newfound enthusiasm during the pandemic. Managing patient care virtually allowed patients fearful of Covid-19 exposure to be treated at home when possible. Simultaneously, hospitals stretched beyond capacity by waves of Covid-19 patients—and juggling limited resources—were able to hold more hospital beds available for more acutely ill patients.

In addition to the pandemic’s broadening acceptance for telehealth, it removed a major hurdle to digital home hospital adoption by spurring CMS and other payers to begin covering care provided outside of hospitals, including in patients’ homes.

McKinsey & Company estimates that up to $265 billion worth of care services for certain Medicare beneficiaries could shift from medical facilities to homes by 2025—without a reduction in quality or access. This critical change in reimbursement policies enables healthcare providers to cost-effectively expand care access to more patients while eliminating the need for substantial investment in building or acquiring more inpatient facilities.

Consumer expectations for improved care experiences are also accelerating interest in hospital-at-home models. Although hospitals are the gold standard of care for acute illness in the U.S., they can be expensive and uncomfortable, especially for older patients who frequently suffer delirium, contract hospital-associated infections or decline in function.

The digital technology edge

The most powerful drivers for digital home hospital adoption, however, are advances in telehealth, remote monitoring and emerging digital technologies that facilitate high quality, cost-effective care beyond hospital walls.

First, continuous remote patient monitoring (cRPM) sensors are improving in quality and data capture while also becoming smaller, easier to wear and more economical. Second, the pervasive use of smartphones and mobile apps allows clinicians and patients to stay in contact and share vital health information. Third, volumes of data can be stored in the cloud and accessed in near-real-time. These solutions are designed not only to emulate the care that patients receive in a hospital, but to enhance it. And last, FDA-cleared artificial intelligence (AI) algorithms can be used to analyze multivariable patient data and support the delivery of personalized insights that can transform care. In fact, the Deloitte Center for Health Solutions identified AI and machine learning as significant transformers of healthcare in the next 10 years.

Patient-centric care 

The digital home hospital model provides an outstanding opportunity for hospitals to offer patient-centric care, which encourages active collaboration and shared decision-making between patients, families and clinicians to design and manage customized and comprehensive care plans.

For example, many in-patients receive periodic visits in their room from clinicians to spot check their vitals, whereas digital home hospital patients can be conveniently monitored, continuously, and often passively. This way, clinicians can closely track key health indicators, receive alerts to early signs of potential deterioration and check in with patients through a mobile app, text or video call. This allows the right care to be provided to the right patient at the right time—focusing on both the patient’s physical comfort and emotional well-being.

In the digital home hospital model, patients—especially those with a chronic condition such as heart failure or COPD—feel more confident and comfortable that they are being constantly monitored, as do their family members and others who play a role in decisions and communication about their care. Clinicians now have access to patient-reported outcomes and hard data to make informed care decisions, such as whether to continue monitoring and treating patients at home or admit them to the hospital. The ubiquitous use of EMRs across health systems also helps ensure that digital home hospital care delivery can be entered into patient records to keep all care providers updated on a timely basis.

The digital home hospital environment also can support improved medication adherence, crucial to patient outcomes. For example, adding a layer of cRPM on top of multiple daily clinician visits, as part of the digital home hospital model overall, provides an opportunity to monitor patients for changes in vital signs that might indicate side effects or non-compliance.

Hospital at home in action

Let’s consider a hypothetical scenario to illustrate the benefits of the digital home hospital model. A 70-year-old woman with NYHA Class II Heart Failure and atrial fibrillation (afib) visits the ED with palpitations, anxiety and shortness of breath.

The ED physician determines she is having poor rate control of her afib and changes her medication dosage. After a consult with the hospitalist, she is admitted to a hospital-at-home program (instead of an inpatient bed) and receives training on the cRPM solution, which includes a chest patch and mobile smartphone app.

The app links her to a clear explanation of her new medication regimen and information about her condition to share with family members. Her home health nursing team sends messages to remind her to respond to daily check-in surveys.

When the patient overexerts herself a couple of days later, the app immediately asks her to answer a few questions and shares the results with her care team. A nurse reaches out to further assess her status, advising rest and re-educating on when to take her medication—avoiding an unnecessary ED visit. Moving forward, the home health team continues to monitor her activity, vital signs and progress as she engages in her rehab exercises on her app.

A positive outlook 

All signs point to the hospital business model of the future looking radically different than today’s version. Digital home hospital solutions are going to be pivotal in their ability to improve the patient experience. With the right technology, clinicians can deliver hospital-level care to more patients in the right place—which for many, is in the comfort and familiarity of their own home.

The post Evolving hospital-at-home models benefit patients and providers appeared first on mTelehealth.

Remote patient monitoring (RPM) provides clear benefits for clinicians, health systems and patients. Patients can stay at home, and go about their daily routines, while their conditions are monitored, reassured in the knowledge that action can be taken if needed. Meanwhile, health providers can plan resources knowing which ongoing patient conditions can be managed remotely, requiring fewer in-person appointments.

The rising trend of RPM

The COVID-19 pandemic highlighted the important role RPM can play in effective healthcare. A recent government health and social care policy paper cited the need to, “maintain the pace of adoption seen through the pandemic, when … consultations moved online, clinicians and other staff worked from home, people were monitored remotely, including in care homes, and information flowed more effectively between care settings.”

At a time of social distancing, monitoring patients remotely helped minimise gatherings in waiting rooms and reduced strain on a stretched health system. However, even before the pandemic two clear factors drove demand for RPM. The first, a changing population demographic with a higher percentage of older patients with more complex health needs, and the second, ongoing and continued pressures on a health sector faced with resource constraints.

Through RPM, health and social care providers can track a range of conditions including chronic obstructive pulmonary disease, diabetes and sleep apnoea. Care workers and doctors can collect the data they need to make informed decisions, all without patients having to leave their homes.

Devices, including wearables, capture regular patient readings. These can include measures of lung capacity and blood pressure, for example.

The opportunities for RPM extend to social care too. Assisting the elderly and vulnerable so they can live independent lives while being monitored for their wellbeing helps improve quality of life. Being able to monitor patients taking their medication helps make this possible. Pill dispensers set to open at relevant times are a simple but valuable way of facilitating this.

The technology making RPM possible

RPM technologies must be quick and easy to setup and use. Transmitting data from patients’ devices back to healthcare organisations cannot depend too heavily on patient-side infrastructure, such as Wi-Fi or fixed lines. These may not be available and, even if they are, they may require a level of patient knowledge to set up that would complicate RPM deployment.

Data transfer must also be reliable, and security is exceptionally important. After all, patient data is among the most sensitive information there is.

Solutions providers need insight into their deployed devices and the ability to effectively manage their active connections. Many providers will have thousands of devices out there and will want a simple, effective way of monitoring and controlling these.

All of which means the right connectivity choice is central to effective RPM and healthcare organisations, and their solutions providers, should weigh up their options carefully.

Making the right cellular choice

Cellular connectivity for RPM gives control over implementations. For patients, it is the simplest way to get up and running as it makes no demands on their own broadband, mobile connections or technical know-how as RPM devices can be used straight out of the box

It provides flexibility too, as RPM solution providers can choose connectivity type, network and tariff according to each deployment. Network bandwidth, for example, will depend on application type and the levels of data being transferred.

Typically, 4G will support higher bandwidth applications requiring fast, secure and resilient connectivity. Low power wide area networks (LPWANs) are ideal for devices with low data throughput and low power use, for example battery-operated devices. Meanwhile, for solutions that require two-way device communication, fixed private IP addressing allows secure connectivity via virtual private networks (VPNs).

As cellular connectivity evolves, it offers enhanced functionality that makes it the ideal choice for RPM. One recent innovation is the eSIM, a clever new take on the traditional mobile SIM that can be provisioned ‘over-the-air’ to adapt or change the profile or applications held on the SIM. A provider may wish to do that to change network to, for example, access a different tariff or improve coverage. For multi-national deployments, eSIMs are particularly convenient as they make it possible to use the same SIM in all devices, and simply provision for each local network, with adherence to local regulations governing security and data privacy.

Working with a partner

Healthcare and solutions providers implementing RPM don’t want to spend time thinking about which network or cellular technology provides the best solution. They need reliable partnering so they can concentrate on patients, and not technicalities.

As RPM data is so sensitive, they will also want to trust in a managed service provider accredited for ISO 27001 to provide the reassurance that processes, and data transfer, are secure.

An IoT connectivity platform provider takes away the inconvenience RPM providers would otherwise have of ‘stitching’ coverage together across multiple mobile network operators, and the complexity of managing SIMs across those networks.

A ‘network of networks’ approach simplifies cellular connectivity for RPM. It can also offer full visibility to solutions providers, across their SIM estates, with control and the capability to scale up or down as required.

Healthcare and technology intersect where innovation and increasing knowledge creates exciting possibilities for the future. RPM is a growth area of healthcare with the potential to expand to support more patient groups and conditions. Digital healthcare creates a growing need for secure, reliable and always-on connectivity, with cellular connectivity supporting healthcare providers and patients through RPM. 

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