Page 7 Case Studies in Telehealth Adoption Centura Heal that Home Telehealth as the Standard of Care

34 FALL 2013 VoLume 27 / NumBeR 4 www.himss.org
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FoCuS: 30 DAyS To MAke A DiFFerenCe focus: title

the addition oF Patient educational modules had

the complementary impact of increasing the patients’

feelings and knowledge of self-management.

private insurers, though at least eleven priate medications and dosages for the n ■ Improving the patient experience of
states have some form of coverage under patient. This can be done in a manner with care (including quality and satisfaction).
their Medicaid programs. 10,11 Model policy which patients are satisfied, and providers n ■ Improving the health of populations.
language proposed by the American Tele- are appropriately, but not overly, involved. n ■ Reducing the per capita cost of health-
15
medicine Association for consideration Second, it is possible in a 30-day program care.
by states includes RPM in its definition of to also implement a consistent patient edu- The success with this program pro-
11
telemedicine services to be covered. In cation program, including tests, that yields vides confidence that not only is this pro-
spite of its inclusion in the model language, increased patient self-efficacy, or the confi- gram scalable across many patients, both
states that are passing telehealth parity dence and knowledge to implement behav- nationally and globally, but that the basic
laws, which mandate private insurance iors that will improve outcomes, from med- elements – combining the three aspects of
coverage of some telemedicine services, ication adherence to diet management and mobile remote patient monitoring, short-
often establish coverage for a narrow selec- exercise. ened provider feedback intervals, and
12
tion of services delivered to rural areas. By combining these two efforts into patient engagement/education – should be
To cover the services such as provided one program, patients are able to see first- considered when addressing other con-
in this study, then, an organization must hand the impact of appropriate medica- ditions, such as congestive heart failure
view it is an investment for which a return, tion therapy on their condition, while (CHF), chronic obstructive pulmonary
such as reduced healthcare costs under a also learning about the various types of disease (COPD), and diabetes. jhim
capitated or shared savings plan, reduced antihypertensive medications in their edu-
readmission penalties for hospitals, or pre- cational program, which should increase Ram Dandillaya, MD, FACC, FCCP, is Vice clinical
vention of more costly conditions and acute the recognition of the important value of chief at the cedars-sinai heart institute, maintains
events can be recognized. Further study medication adherence to the medication a private cardiology and internal medical practice,
of the economic benefits of this program most appropriate to their condition. Simi- and is medical director for both the West coast
should be considered, in order to increase larly, having a single clinical contact, the ultrasound institute and cardiorad Partners. he
the likelihood of reimbursement under TSC, providing both the telephone-based is board certified in cardiovascular diseases,
current fee-for-service programs, though interaction regarding the RPM, and the nuclear cardiology, echocardiography, cardiac
fee-for-value or free-for-quality programs education—as an extension of the pro- computed tomography, and internal medicine and
may readily embrace such a program, fol- vider’s office—should increase the trust has a clinical interest in preventative cardiology,
lowing the lead of organizations such as in and felt importance of the educational peripheral vascular disease, and cardiopulmonary
the Veterans Administration and Kaiser content and sessions. 14 exercise testing (cPet). in addition to being a
Permanente. 13 Further work is needed to evaluate the fellow of the american college of cardiology, dr.
Our results yield several important con- specific financial and economic impacts of dandillaya is a member of numerous societies,
clusions. First, it is possible to significantly this 30-day program, but the reduction in including the american heart association’s council
reduce blood pressure on a population by physician office visits and associated pro- on clinical cardiology, the american society
implementing a 30-day program that uses vider and patient costs, and reduction in of nuclear cardiology, the society of Vascular
RPM to extend the reach of the patient’s provider intervention times to change med- ultrasound, the los angeles and american society
provider into the home (or wherever the ication therapy, coupled with a relatively of echocardiography and the american college of
patient is), for the purpose of monitoring, low-cost monitoring solution should have Physicians, having research published in numerous
evaluating the effectiveness of existing a positive economic impact. If so, this pro- scientific journals, and presented abstracts at
treatments and true blood pressure, and gram could be seen as positively impacting conferences. in 2009, dr. dandillaya was elected to
making adjustments to identify the appro- all three of the Triple Aim elements: a two-year term as Vice President of the cedars-