Telehealth: Access to Healthcare Using New Technology

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The advent of technologies for face to face video conferencing have led to exciting new possibilities to revolutionize medical care.  With apparent shortages of physicians predicted in the future, our patients need another method of obtaining necessary healthcare.  The trend to high deductible, high copay insurance plans have left many patients reluctant to seek care in expensive traditional settings like ER’s, Urgent Cares, and doctors offices.  Now, for $40-$50, patients can see their doctor for minor medical conditions, or chronic medical disease management through telehealth.  Convenient, cost effective medical care delivered to their own homes or offices without traveling or waiting in a office, ER or UC.  Many companies and the health care industry in general are adapting and reacting to this new technology.  Many insurance plans now cover telehealth visits for nominal $10-$15 copays, saving patients hundreds of dollars.  Employers appreciate the cost savings to their insurance plans and patients appreciate the low cost, and convenience of telehealth.

You can schedule a Telehealth appointment with me if you are in Nebraska, where I am licensed.  I am usually only available on the site by appointment so you must call my office number, or email my office to schedule the visit so I can be logged in and waiting to see you.  You must select me from the available physicians after you have logged in and registered.  You must download the App from your App store or register on line at Amwell.com to use your desktop or laptop computer.

Steps:

  1. Be located in Nebraska, where I am licensed.
  2. Install the Amwell App on your phone or iPad through your App store.
  3. Input you medical, insurance, and demographic information on their secure site.
  4. or Register for Amwell on their website, Amwell site
  5. Notify my scheduler that you would like a Telehealth visit, call (308)534-8383 or email us at statesfamilypractice@yahoo.com
  6. Log in to the Amwell site or App at the scheduled time and select me as your provider.

History of Telehealth:

Q: How long has this type of service been available and who’s using it?

  • Rural community hospitals and mental health facilities have been using telehealth for years to expand access to specialists and psychiatrists in underserved areas.  Care had to be received at a medical office though.
  • The government’s VA system has been using telehealth to care for veterans, again they must be at a facility.
    • Recently they have introduced in home services.
    • Called Banner iCare, must have at least 5 chronic conditions.
    • They have shown 45% reduction in hospitalizations, 32% reduction in care costs.
  • In Alaska it was estimated that telehealth saved the state $8.5 M in one year in Medicaid related travel expenses.

Q: What type of care can be obtained?

  • Primary care mostly but consultation with specialists are becoming available.
  • Psychological services like counseling
  • Dietary and Nutritional services with a dietician
  • Health coaching is available as well.

Current State of Telehealth:

Q: How does it work?  How does a patient seek medical care using telehealth?

  • The newest innovations are called mhealth, for mobile health.
    • These products utilize smartphones and tablets, as well as desktop and laptop comuters.
    • Patients download an  App, then register and log on.
      • Input their health history: medical conditions, medications, allergies, pharmacy and current symptoms.
      • They can input their vital signs.
      • Then they activate a visit and the doctor is usually available in in 1-2 minutes unless with another patient.

Q: How does it work from the doctors side of the visit?

Doctors are credentialed with the various products and trained to use them.  If a doctor makes himself available to see telehealth patients he is notified when a patient requests a visit.  The doctor then utilizes the physician App and initiates a visit with patient after reviewing the health information input by the patient.  The doctor can see and talk to the patient and then come to a diagnosis and treatment plan.  The App then can be used to send in a prescription and document and bill the visit.  Patient follow up can be accomplished through the App for quality control.

Q: What kind of gadgets are required?

  • Really not much, commonly available devices.
    • Computer, iPad, smartphones
  • Kiosks are available in malls and pharmacies, like a phone booth
    • High Def video, BP cuffs, thermometers, ear scopes, heart monitors, glucometers.
  • Devices are being developed to measure patient data and transmit it to the provider.
    • even EKG’s at home and wearables (smart watches)

Q: Which insurance companies in NE cover telehealth?

  • I found that BCBS of NE covers telehealth.
    • using Amwell product
  • Aetna/Coventry did not.
  • My daughter’s company in Lincoln is now offering telehealth services, Cigna?
    • through MD Live.
  • Medicare and Medicaid still have some restrictions but these are rapidly changing.
  • CMS just released, last week, a statement of “Next Generation ACO model” which will reportedly cover telehealth services to medicare and medicaid patients.
    • ACO product, like SERPA ACO here in Nebraska.

Q: What type of visits are possible in telehealth?

  • Respiratory infections
  • Injuries
  • rashes
  • fevers
  • chronic medical condition management
    • Diabetes
    • Hypertension
    • Obesity
  • NOT: pain pills, or chest pain in older adults, emergencies.

Q: Who are the big players in developing the technologies?

  • American Well, Amwell https://amwell.com
    • this is the product I use.
    • many brand names of products offered under various titles through insurance companies and major employers.
  • Dr On Demand www.doctorondemand.com
  • MD Live https://www.mdlive.com
  • SnapMD
    • lets a provider or network set up their own branded product, can interface with existing EHR
  • John Sculley, former CEO of Apple is involved in the industry as a capital venturist.

Future of Telehealth:

Q: What are the projections for growth in the industry?

  • In 2013 there were 250,000 patient visits.
  • By 2018 it is projected to be 3.2 million.
  • Amwell’s study:
    • 64% of Americans are willing to use video conferencing for health care.
      • Average wait time nationally to see doctor, 18.5 days.  Telehealth < 3 minutes
    • 57% of doctors are willing to use telehealth to care of patients.

Q: What web sites or Apps are available today to allow people to utilize telehealth?

  • Amwell, this is the site I utilize.

  • MD Live
  • Dr On Demand
  • May be coming to your doctor’s office in the future through a self branded product.

Conclusion:

We are seeing a paradigm shift in health care delivery.  Keep an open mind about changes in medical care.  Ask your doctor’s office if they are planning to implement telehealth services.   Check with your insurer or employer to see if telehealth is a covered benefit or plans to become one.  Download an App and become familiar with it.  Then, if the need arises for convenient, cost effective access to medical care you may just find yourself using this new technology.

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