Rural America is perhaps the place that needs telehealth the most. However, rural health systems face multiple challenges when it comes to establishing large-scale virtual care programs—from spotty broadband connectivity to reimbursement issues to a lack of patient awareness.
Sanford Healththe largest rural health system in the country, held a conference last week to discuss how rural providers can overcome the obstacles they face and create sustainable models of care for telehealth and remote patient monitoring. Panelists Jim Weinstein, Microsoftsenior vice president of health equity and innovation and Sherry Dodd, vice president and general manager of Medtronic Care Management Services details three rules rural providers need to keep in mind as they move forward with virtual care.
Let the data guide you
Weinstein acknowledged that virtual care, like all healthcare, is confusing and complex — and health systems haven’t figured out how to master its delivery. As consumer-centric companies like it Amazon and CVS Health breaking in to offer patients across the country more convenient and affordable care, he believes the healthcare industry needs to start small. He argues that the real champions for virtual care should be rural providers.
Believing that rural providers have specific population health data that can inform the strategic design of effective virtual care programs, Weinstein said those providers should begin by mapping data at the county level to quantify the effectiveness of the virtual care model for certain rural populations. He saw this as a crucial step that could ensure that the reach of virtual care is targeted at patients who would benefit the most, such as Millenials with chronic conditions, rather than “throwing things at the wall to see what remains’.
Optimizing EHR data becomes even more important as rural health system revenue streams become increasingly compromised, Weinstein pointed out. He urged rural providers to use local data to determine specific patient needs, design programs based on that data and closely monitor utilization levels, and then gradually expand their programs based on the feedback they receive .
Make room to explore VBC
As rural providers create and scale virtual care programs, Dodd pointed out that they need to be aware of how challenging it will be to succeed in a fee-for-service environment. First, service fee reimbursement is usually calculated by a fax machine – estimates can be difficult because this model is not built for digital technology. The second reason Dodd cites is that many fee-for-service reimbursement models rely on patient engagement. To reimburse patients for remote monitoring, she said some payers require providers to demonstrate that patients are compliant 20 days a month.
“If you’re developing a reimbursement model with outsiders for remote monitoring and you have 20 percent of the population that doesn’t do Day 20, you get zero reimbursement for that month,” Dodd said. “So what I wouldn’t want to happen is that we stop relying on the reimbursement-for-service construct because there’s this whole patient engagement part. This can make the use of the technology worse because ultimately the money doesn’t come in.”
Dodd believes that value-based health care models are better suited for virtual care in rural areas and urged health plans to experiment with these care models sooner rather than later. She said the health care system urgently needs to understand how to optimize value-based care for virtual care delivery models, pointing out that “integrated delivery networks are the main golden opportunity for experimentation.”
Prioritize personalization
Dodd said more than 90 percent of remote patient monitoring programs “fail completely.” Those who succeed – she called them Department of Veterans AffairsThe remote monitoring program as a rare deviation—look at the overall needs of patients. This means not only looking at patients as more than a disease state, but also taking into account all of their preferences, such as their communication styles or what time of day they like to connect with their caregivers.
Medtronic provided most of the remote patient monitoring technology the VA uses in its virtual care program, and she said a big reason the program has been successful is that it takes into account the different technologies each veteran prefers. For example, some veterans find wearables inconvenient, and some like getting their care plan through an app rather than calling their doctor.
Personalized care generally leads to better health engagement and therefore better outcomes, according to the Dodd. In order for rural virtual care programs to be personalized, she said, providers need to pay attention to what technologies work best among their patients.
Photo: Maria Simcic-Navrocka, Getty Images