Low-income patients and veterans living in rural areas face challenges with getting convenient access to high-quality healthcare care.
Case in point: In rural Laurel Fork, Virginia, there is a shortage of mental health and primary care services.
So local leaders there are tackling that challenge with technology as part of the Tri-Area Community Health Center to offer telehealth as part of a remote patient monitoring program for patients with diabetes. Patients are given an internet-connected home monitor that enables endocrinologists to monitor the patient’s blood glucose levels daily, as well as their dietary intake and physical activity.
As a result of that initiative, patients’ A1C levels dropped by 2.2 points on average, Federal Communications Commissioner Brendan Carr told FierceHealthcare.
Connected care such as remote patient monitoring and telehealth represents the future of healthcare, Carr said: "It's the healthcare equivalent of moving from Blockbuster to Netflix."
The FCC can play a role in this movement by helping to fund the connectivity needed to ensure that all communities get a fair shot at benefiting from new telehealth technologies, Carr said. The FCC will be voting at a July 10 meeting on a $100 million Connected Care pilot program (PDF) to develop new telehealth and virtual care programs for underserved populations, including rural residents and veterans.
The program, unveiled in July 2018, would establish a three-year pilot to be funded by the FCC's Universal Service Fund to help healthcare providers defray the costs of broadband service to enable low-income patients and veterans to access telehealth services.
According to the Notice of Proposed Rulemaking, the FCC is proposing funding that would cover up to 85% of the costs of the patient connectivity needed for these telehealth pilots. The program would support a limited number of projects over a three-year period with controls in place to measure and verify the benefits, costs, and savings associated with connected care.
While the FCC has long targeted deployments in such a way to connect healthcare facilities, the move is a big step forward because it means connecting individual patients—including those who may live in extremely remote locations.
Since the early 2000s, the FCC has supported rural broadband connections to brick-and-mortar healthcare facilities through the Universal Service Fund. This enabled some early rural telehealth applications, such as securely connecting with a specialist at a facility across the country while a patient visited their closest clinic.
The new pilot program represents the next step to expand patients' access to telehealth by supporting rural connectivity not just to facilities but to patients themselves.
"Technology that’s limited to the confines of a brick-and-mortar hospital does little to help communities or patients that are long miles and many hours away from those facilities," Carr said in published comments (PDF) during a visit to the Tri-Area Community Health Center in rural Virginia last month.
Carr, who grew up in Virginia, noted that in rural Carroll County, diabetes rates are about one-third higher than the national average. Income levels in the county are about one-third below the national average. The closest hospital is in another state, he said.
In speaking with healthcare providers and patients in rural areas, Carr said he has heard that transportation to healthcare facilities is a significant barrier, as it's either unavailable or too costly.
"At a maternal care facility in Lexington, Virginia, providers said it was one of the biggest issues they have. They have expectant mothers who are 30 weeks pregnant coming in for their first visit because they didn’t have the ability to get in to see the doctor before," he said.
He lauded the work at rural health clinics across the country to leverage remote monitoring technologies to close that healthcare gap. He also noted that telehealth has significant value beyond diabetes management.
"We have seen a lot of remote patient monitoring initiatives that connect patients to mental health professionals to address the opioid crisis and alternative pain management counseling outside of prescribing opioids," he said. "There is the potential to use connected care to address a number of healthcare needs, from tele-stroke care to high-risk pregnancies and maternal care and pediatrics."
"We are looking at a diverse group, geographically, and a diverse set of conditions," Carr said of the FCC's pilot program.
In addition to improving patient health outcomes, telehealth and remote patient monitoring initiatives have the potential to lower healthcare costs, he said.
A remote patient monitoring program run by the Veterans Health Administration cost $1,600 per patient compared to the $13,000 it costs for more traditional care, Carr said. A diabetes telehealth trial run by the University of Mississippi Medical Center resulted in nearly $700,000 in annual savings due to reductions in hospital readmissions alone. Assuming just 20% of Mississippi’s diabetic population enrolled in this program, Medicaid savings in the state would be $189 million per year, he said.
The FCC's proposal has the support of a number of healthcare organizations, including the American Hospital Association (AHA) and ACT | The App Association.
The AHA said (PDF) the Connected Care pilot program is a "critical next step towards delivering affordable telehealth services to those Americans who need it the most."
ACT said the proposal is an "important step towards realizing the potential for cutting-edge digital health technology that reduces costs and drastically improves health outcomes for some of the most vulnerable Americans."
Digital tools are necessary to effectively and efficiently address significant health challenges to America’s most underserved populations, particularly in rural areas, including diabetes, opioids, high-risk pregnancies, and heart disease, ACT said, but without broadband access, these tools won’t reach the people who need them the most and, ultimately, save lives.
"The pilot would reach over 18 million veterans that need help in addressing unique health challenges. Further, the new data generated by the pilot will help build more evidence that digital health tools improve health outcomes and reduce costs," ACT said.