The Growth of Telehealth to Better Address Complex Disease Care

Stakeholders understand that health care delivery in the U.S. continues to be fragmented, expensive, hard to access, and not driven by the patient experience.

Fueled by a need to tame costs, provide better care to patients in remote areas, meet the needs of a growing aging population, support the surging number of patients with chronic conditions, while addressing the shortage of clinicians, telehealth is increasingly being seen as a promising solution for the shortcomings of health care delivery. And interest is growing.

According to Endocrine Today, in 2016, the telehealth budget for the Department of Veterans Affairs was $1.2 billion, and in 2017, Kaiser Permanente health system had more telehealth visits than in-person visit. A 2017 survey from the American Telemedicine Association (ATA) found that 83 percent of respondents were likely to invest in telehealth that year, 98 percent of health leaders feel telehealth services create an advantage over organizations that do not offer it, and 84 percent feel offering telehealth services strongly expands an organization’s coverage and reach.

Perhaps most importantly, these services are something that consumers want. A 2017 Accenture survey found that 78 percent of patients want better access to telehealth and mHealth tools, citing convenience as a driving factor. It’s also a strong indication that these tools could engage patients, helping them to be prescription adherent and better equipped to manage their conditions, leading to improved health outcomes.

Telehealth’s impact on chronic disease

Chronic disease in the U.S. continues to be hugely problematic. The numbers are growing and comorbidities associated with chronic disease are costly and common. However, research is showing telehealth and mHealth tools have the potential to make an impact.

A program launched at the Veterans Affairs (VA) Pittsburgh Healthcare System saw improved blood sugar control in veterans with type 2 diabetes using telemedicine.

According to Clinical Innovation + Technology, the study compared 442 veterans with type 2 diabetes enrolled in a telediabetes program, with 407 veterans with type 2 diabetes who received conventional care. The remote program (which merged electronic consultation from an endocrinologist diabetes specialist with ongoing telephone-based care) was able to provide patients with a specialist consultation within 10 days, compared to 37 for an in-person consultation. Both groups saw comparable improvements to blood glucose, validating the telediabetes program as being as effective as in-person care.

“Without incurring any travel, our electronic consultation program provides equally efficacious diabetes care with significantly expedited access,” said Archana Bandi, MD, the study’s senior investigator and the clinical director of Telehealth Services for VA Pittsburgh Healthcare System. “This type of e-consult is a viable alternative to traditional face-to-face care delivery, especially in remote areas with a shortage of endocrinologists.”

To be most effective, telehealth and mHealth tools need to be personalized in order to best meet the unique needs and preferences of each person.

“You have to fit the technology to the patient,” says Ruth Weinstock, MD, PhD, distinguished service professor and division chief of endocrinology and metabolism at the State University of New York (SUNY) Upstate Medical University in Syracuse. “Young patients love their smartphones, and I can tell you my [older] patients cannot see the print on the smartphones, or they have arthritic hands, so it is not one-size-fits-all.”

Telehealth, mHealth, to meet complexities of behavioral and mental health

Providers and payers are evolving patient wellness to include mental and behavioral health, in relation to physical health, the care for which can also be met by telehealth and mHealth tools.

“Many individuals who have medical problems have co-morbid psychiatric illnesses, and to maximize the clinical outcome for these various medical conditions one cannot afford to ignore the mental health aspects of that individual’s care,” says Lewis Levy, chief medical officer at Teladoc.

Teladoc launched its Behavioral Health Navigator in the U.S. in April 2018 which, the company explains, is an integrated care service that provides specialized “navigation” support and coordination, combined with virtual access to expert providers for those facing mental health conditions. The program is already seeing impressive results in Canada where it was introduced in 2017, with Teladoc reporting that patients have seen “a 32% decrease in depression symptoms, 31% reduction in anxiety symptoms, and 20% reduction in stress symptoms” using the service.

A 2018 study published in Psychiatric Services found that using smartphones to deliver interventions to patients with serious mental illness was just as effective as traditional in-person therapy, showing “superior patient engagement”. According to Mobi Health News, the technology used in the study includes an app, a clinician dashboard, and support from an mobile health specialist. Patients can access videos, audio clips, or written materials at any time. Users are also prompted to take daily assessments which are sent to a specialist.

An impressive 90 percent of patients that received care through the app stayed with the program, compared to just 58 percent of the group receiving in-person therapy.

Telehealth and mHealth tools can also help patients overcome the stigmas commonly attached to behavioral and mental health conditions (and that often deter patients from getting help) by giving patients more choices on how they receive care. Whether that’s through an app, a phone call, texting, a face-to-face visit with a health coach, or a combination of these. Digital health tools provide the ability for patients to receive a high-level of care outside of the four walls of a clinic, on their terms.

Wider adoption of telehealth needed

Patients living with complex illnesses face formidable barriers to care, many of which telehealth tools and programs can help improve. Telehealth has proven extremely useful in supporting patients in underserved and rural areas, and those regions impacted by clinician shortages, an area where mental health has been particularly hard hit. The scope of the opioid crisis has also greatly elevated the need for a wider acceptance of telehealth. Individuals living in rural pockets report higher rates of prescription opioid misuse than their urban counterparts, yet, only about 3 percent of all opioid treatment programs are situated in rural areas—a gap in care that telehealth could help close.

Having the option to check in with their care provider via video, phone, text or email to ask questions, or even determine if a trip to the clinician’s office or hospital is necessary, makes care much more manageable for patients and payers. Patients may be more likely to pursue critical follow-up care or respond to symptoms before they become larger issues if connecting with a care provider is faster and easier, reducing the hefty costs associated with ER visits. Similarly, closing this gap in care would also mitigate prescription non-adherence and abandonment, and their subsequent costs.

Despite the benefits we are seeing with telehealth, reimbursements are difficult, slowing the process of greater adoption.

A report from Sage Growth Partners found, “Healthcare executives are eager to adopt telemedicine to more readily connect patients to providers, especially when certain specialists are physically unavailable on site. However, widespread telemedicine adoption has been hindered by the uncertain reimbursement and regulatory landscape.”

What is clear is that patients desire more control over their health care experience,  an asset which telehealth and mHealth tools can provide. Giving patients more options as to how they access care can only boost patient engagement, leading to the long term health outcomes everyone is looking for, but providers and payers will need to be onboard

Frances Dare, managing director of Accenture’s virtual health services explains, “As more and more patients take control of their own healthcare in the age of consumerism, provider organizations must be able to offer meaningful choices for virtual care, in-person care and a combination of both.”