By Dave Skibinski / Nov 29, 2018
As November is American Diabetes Month, providers seeking a suitable virtual care offering to embark upon their first serious foray into telemedicine need look no further than a diabetes management program.
Regardless of whether a provider has committed to a telemedicine strategy already or is exploring the opportunity, a virtual care program serving patients living with diabetes is a relatively low-risk and low-cost approach that generates measurable results.
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We know the statistics: Diabetes is a growing epidemic, striking nearly one in ten adults in the United States, and an even higher percentage when considering the top consumers of healthcare services. The biggest demographic of consumers, seniors, have a rate of diabetes greater than one in four.
Most of those who are diagnosed with Type II diabetes lead normal lives, but diabetes unchecked can lead to chronic complications such as cardiovascular disease, stroke, vascular disease, renal disease, neuropathy and retinopathy, conditions that consume considerable healthcare resources. Diabetes and diabetes-related conditions consume an astounding 25 percent of healthcare expenditures in the United States.
Because diabetes is a chronic disease requiring patients to seek care from providers on a regular basis, it makes the condition an ideal case of the benefits of telemedicine. Diabetes requires regular and consistent monitoring and management, and telemedicine can be a key component of a comprehensive program to accomplish this.
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Virtual care technology has matured so that providers can deliver the services that best fit their patient population and clinical approach. There are service providers that can take over aspects of the management of diabetes patients and while not necessarily invisible to the consumer, can trim costs. However, these models can put provider groups at risk of losing patients as they compete with these same outsource providers for other services.
For providers that want to manage the complete care of their patients within their systems, many of the services needed for these patients can be facilitated by telemedicine partners who offer cloud-based, white-label platforms. These offerings can be scaled across multiple service lines and management is maintained by the trusted provider and staffed by their own clinical personnel. These software-based telemedicine platforms connect an entire health system or hospital’s medical service lines covering a patient and all their specialists. An enterprise platform is exactly that – a platform that extends across the service lines and departments creating operational efficiency, reducing costs, and reducing risk, by enhancing care coordination, and communication between patients and clinicians.
Further supporting providers as they move into telehealth is the Centers for Medicare and Medicaid Services (CMS). On July 12, 2018, CMS proposed changes to help modernize Medicare and restore the doctor-patient relationship. As stated by the CMS, the proposals are designed to fundamentally improve the nation’s healthcare system and increase the amount of time doctors and clinicians can spend with patients by reducing the burden of paperwork that clinicians face when billing Medicare. Within the proposals, new changes to its Physician Fee Schedule (PFS) and Quality Payment Program (QPP) outline the potential expansion for virtual care through provisions in the proposed CY 2019 PFS which support access to care using telecommunications technology. Unlike direct-to-consumer telemedicine program models, the proposals emphasize the importance of existing and trusted patient-to-provider relationships and how virtual communications can assist healthcare needs. If passed, the CMS will pay physicians for virtual check-ins and for time spent reviewing patient photos or videos.
This past October, CMS also proposed a rule that would allow Medicare Advantage plans greater flexibility to offer telehealth benefits. To potentially take effect in 2020, CMS detailed that plans would allow government-funded telehealth benefits to all members whether they live in rural or urban areas. The CMS press release explains, “it would also allow greater ability for Medicare Advantage enrollees to receive telehealth from places like their homes, rather than requiring them to go to a health care facility to receive telehealth services. Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.”
Additionally, on September 5, 2018, the American Medical Association (AMA) announced the release of the 2019 Current Procedural Terminology (CPT) code set, scheduled to go into effect on January 1, 2019. According to the AMA’s press release, the revisions include 335 code changes that are designed “to reflect key trends in patient care” such as connected health tools. Three new codes will allow for doctors to connect with their patients at home and gather data for care management and coordination. Additionally, there are two new interprofessional internet consultation codes for the use of nonverbal communication technology to coordinate patient care between a consulting and treating physician. The new codes and descriptors can be imported straight into existing claims and billing software.
Enhancing strengths of clinical staff
When it comes to helping patients manage diabetes, a well-designed telemedicine workflow will be adapted from existing procedures and programs that are in use in a physical clinic. Telemedicine platforms today have become sophisticated to include a complete feature set that moves virtual visits from simple consultations to examinations and more comprehensive patient management.
Telemedicine can also enable remote patient monitoring for chronic conditions like diabetes as different tracking devices, sensors or equipment can gather and transmit data to the cloud for analysis and utilizing physician defined parameters, detect when patients have a decline in health care status. When that decline occurs, the telemedicine platform can be utilized to engage the patient in a timely and personal manner. Two of the most helpful features of a telemedicine platform are the ability to conduct on-demand and virtual urgent care sessions. For example, if a diabetes patient encounters and issue needing a clinician’s attention, he or she can enable a timely on-demand virtual visit with their healthcare provider and be evaluated without having to make what could be an unnecessary clinic visit. Second, medication and testing adherence are key to successful diabetes management. Patients can schedule timely appointments from the comfort of their own home to make sure they are on track or to get answers to any questions they may have.
Telemedicine provides all the tools necessary to enable clinical staff to be proactive rather than reactive, improve outcomes, and prevent hospitalizations. At the same time, by managing diabetes with a telemedicine program, a provider can efficiently and at lower cost expand programs related to wellness management, nutrition counseling, and behavioral health that enhance good health rather than treat symptoms.
Increasing patient satisfaction
A recent Centers for Disease Control and Prevention study of rural Type I diabetes patients under the care of the Veterans Administration found that telehealth care resulted in a decrease in mean hemoglobin A1c and glucose variability among the population, as well as no significant increase in hypoglycemic episodes. The VA experienced reduced travel expenditures per patient. In response to the key survey question, “would you recommend telehealth to other patients,” the program scored 100 percent among those surveyed.
“Specialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction,” according to the study. “Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.”
One of the nation’s leaders in telehealth innovation and one of SnapMD’s partners is the University of Mississippi Medical Center (UMMC) National Telehealth Center of Excellence. In October 2017, the Federal Health Resources and Services Administration (HRSA) recognized UMMC’s Medical Center as one of two Telehealth Centers of Excellence, the agency’s top award given to programs at public academic medical centers. UMMC continues to focus on the importance of scaling telehealth programs and can offer telehealth in more than 35 specialties, and tele-emergency care with emergency departments in 17 rural Mississippi hospitals. Altogether, the health system connects with more than 200 healthcare locations across the state, accounting for 500,000 patient visits in 69 of the state’s 82 counties.
User adoption, especially in rural locations like Mississippi, is commonly identified as a potential challenge for patients. Many patients do not have an internet connection and traveling to appointments can be costly or complicated to schedule. On the provider end, platforms must have easy-to-use interfaces and functionalities for a variety of service lines. Working with many specialists presents unique requirements in each care setting and the telemedicine software should be equipped to accommodate care team needs.
Building upon success
Today’s next-generation telemedicine platforms help providers better serve their diabetic patients by enabling care to be delivered via on-demand and scheduled visits, providing increased access to convenient care. With virtual care options for physicians, advance practice providers and other care extenders, providers can improve resource utilization with a goal of reducing the cost of care. Using these advanced telemedicine tools allows providers to increase patient engagement and improve patient adherence, with the goal of achieving better outcomes. For diabetic patients, virtual visits allow for better access to high-quality and timely care to improve outcomes and reduce the total cost of care. This includes access diagnostic, therapeutic and educational support in a timely, convenient manner, ensuring continuity of care and improving treatment adherence.