Remote Health Services and Telehealth PDF

Remote Health Services and Telehealth February 5, 2024 Carly Brown, PharmD Clinical Pharmacist Center for Clinical and Translational Science University of Mississippi School of Pharmacy UMMC Center for Telehealth Objectives Provide overview of remote health services and challenges in rural health ca...

Remote Health Services and Telehealth February 5, 2024 Carly Brown, PharmD Clinical Pharmacist Center for Clinical and Translational Science University of Mississippi School of Pharmacy UMMC Center for Telehealth Objectives Provide overview of remote health services and challenges in rural health care Discuss UMMC Center of Excellence in Telehealth Explore the impact of COVID-19 pandemic on telehealth services Rural Health Care in Mississippi Population (2021): 2.94 million Population living in rural MS: 810,168 (51.2%) Demographics 57.7% - White 37.8% - African American 3.4% - Hispanic or Latino 1.1% - Asian Reference: Mississippi Census 7/21 Challenges in Rural Health Care Workforce Shortages Socioeconomic Factors Health Inequity Reference: Health Resources and Services Administration (HRSA): Rural Health Information Hub. Grant #U56RH05539. Available at: ruralhealthinfo.org Workforce Shortages Health Professional Shortage Area (HPSA) Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) Can be geographic areas, populations, or facilities with shortages in primary, dental, or mental health care providers MS has 179 total primary care HPSA designations (2023) Identify geographic areas and populations with a lack of primary care sources for an area or population Access to Education Rural Demographics Rural Practice Characteristics Economics Reference: Health Resources and Services Administration (HRSA): Rural Health Information Hub. Grant #U56RH05539. Available at: ruralhealthinfo.org https://www.ruralhealthinfo.org/topics/health-care-workforce Socioeconomic Factors Poverty Health Insurance Coverage Distance and Transportation Food Deserts Internet Access/Bandwidth Reference: Health Resources and Services Administration (HRSA): Rural Health Information Hub. Grant #U56RH05539. Available at: ruralhealthinfo.org Health Inequity Chronic Disease Injury-related Death Social Stigma and Privacy Issues Health Literacy Reference: Health Resources and Services Administration (HRSA): Rural Health Information Hub. Grant #U56RH05539. Available at: ruralhealthinfo.org Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks Reference: Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from https://health.gov/healthypeople/objectives-and-data/social-determinants-health Workforce Strategies Optimize the Use of Health Professionals in Rural Areas Use of interprofessional teams – coordinated and efficient care, extend the reach of each provider Ensure all professionals are practicing to full extent of training and scope of practice Removing state and federal barriers to professional practice Changing policy to allow expansions to scopes of practice Removing barriers to the use of telehealth to provide access to remote health care Strategies to Improve Access Care Delivery Models Team-based Care Models Comprehensive Medication Management (CMM) Models Community Pharmacy Enhanced Services (CPESN) Community Health Worker Models Telehealth Remote Health Services Patient Centered Medical Home Patient Centered Medical Home Patient Centered Medical Home Patient Centered Medical Home Patient Centered Medical Home Comprehensive Care Accessible Services 5 Core Functions PatientCentered Care Quality and Safety Coordinated Care The Joint Commission (TJC) National Committee for Quality Assurance (NCQA) Utilization Review Accreditation Commission (URAC) Accreditation Association for Ambulatory Health Care (AAAHC) Website www.jointcommission.org www.ncqqa.org www.urac.org www.aaahc.org Founded 1951 1990 1990 1979 About An independent nonprofit organization, The Joint Commission is the nation’s oldest and largest standardssetting and accrediting body in healthcare. To earn and maintain its Gold Seal of Approval, and organization undergoes an onsite survey by a survey team at least every three years. Labs are surveyed every two years. TJC is governed by a board of commissioners. NCQA uses measurement, transparency, and accountability to highlight top performers and drive improvement. It began in the early 1990s by measuring and then accrediting health plans. NCQA’s mission has grown to measure the quality of medical providers and practices. Most NCQA employees work on HEDIS and accreditation, certification, and recognition programs URAC is an independent, nonprofit accreditation agency based in Washington DC whose mission is to advance healthcare quality through leadership, accreditation, measurement, and innovation. URAC was founded in 1990 as a thirdparty healthcare quality validator. URAC uses evidence-based measures and develops standards through inclusive engagement with a broad range of stakeholders AAHC was founded to encourage and assist ambulatory healthcare organizations to provide the highest achievable level of care for recipients in the most efficient and economically sound manner. AAHC accomplishes this by the operation of peer-based assessment, consultation, education, and accreditation programs Patient Centered Medical Home PCMH-certification NCQA URAC Joint Commission AAAHC Currently, 13,000 practices housing 67,000 clinicians are PCMH-certified 21 million beneficiaries receive care in PCMH-certified facilities Patient Centered Medical Home Comprehensive Primary Care Plus (CPC+) was a national advanced primary care medical home model that aimed to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation Reference: https://www.cms.gov/priorities/innovation/innovation-models/comprehensive-primary-care-plus Patient Centered Medical Home Patient Centered Medical Home Patient Centered Medical Home Funding Awards FY 2020 - Mississippi Total Funding to Mississippi: 17 health centers received awards totaling $1,563,857 Clinical Quality Improvers: 11 health centers received awards totaling $275,976 Health Center Quality Leaders: 3 health centers received awards totaling $113,889 National Quality Leaders: 1 health centers received awards totaling $32,692 Access Enhancers: 4 health centers received awards totaling $63,250 Health Disparities Reducers: 4 health centers received awards totaling $88,550 Advancing Health Information Technology (HIT) for Quality: 17 health centers received awards totaling $149,500 Patient Centered Medical Home (PCMH) Recognition: 14 health centers received awards totaling $840,000 Health Resources and Services Administration (HRSA). Health Center Quality Improvement FY 2020 Grant Awards (August 2020). https://bphc.hrsa.gov/programopportunities/fundingopportunities/qualityimprovement/states/MS.html Health Center Grantee State Clinical Quality Improvers Health Center Quality Leaders National Quality Leaders Access Enhancers Value Enhancers Health Disparities Reducers Advancing Health Patient Centered Information Medical Home Technology (HIT) (PCMH) Recognition for Quality Centra l Mi ssissippi Ci vic Improvement Association, Inc. MS $0 $0 $0 $0 $0 $0 DELTA HEALTH CENTER, INC. MS $19,189 $0 $0 $0 $0 $0 $4,600 $0 Ma nta chie Rural Health Ca re Inc MS $0 $0 $0 $0 $0 $0 $10,750 $30,000 Coa s tal Family Health Center, Inc. MS $38,803 $0 $0 $23,000 $0 $34,500 $10,750 $80,000 EAST CENTRAL MISSISSIPPI HEALTH CARE INC MS $0 $0 $0 $0 $0 $0 $8,250 $45,000 Grea ter Meridian Health Clinic, Inc MS $14,266 $0 $0 $0 $0 $0 $8,250 $70,000 AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC. MS $0 $0 $0 $0 $0 $0 $7,100 $45,000 Cl a i borne County Family Health Center MS $9,675 $0 $0 $0 $0 $0 $4,600 $0 FAMILY HEALTH CARE CLINIC, INC. MS $56,145 $0 $0 $0 $0 $0 $10,750 $150,000 Fa mily Health Center, Inc. MS $19,387 $0 $0 $0 $0 $0 $10,750 $50,000 MS $14,553 $0 $0 $0 $0 $0 $8,250 $0 MS $21,869 $0 $0 $0 $0 $0 $9,600 $30,000 MS $0 $32,692 $32,692 $0 $0 $0 $4,600 $45,000 SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. MS $53,949 $0 $0 $0 $0 $0 $8,250 $80,000 Acces s Family Health Servi ces, Inc. MS $18,304 $37,566 $0 $5,750 $0 $8,625 $10,750 $95,000 North Mi s sissippi Pri mary Health Ca re, Inc. MS $0 $43,631 $0 $11,500 $0 $25,875 $10,750 $55,000 OUTREACH HEALTH SERVICES INC MS $9,836 $0 $0 $23,000 $0 $19,550 $10,750 $35,000 Dr. Areni a C. Ma llory Community Hea lth Center, Inc. Jefferson Comprehensive Health Center Inc AMITE COUNTY MEDICAL SERVICES, INC. Health Resources and Services Administration (HRSA). Health Center Quality Improvement FY 2020 Grant Awards (August 2020). https://bphc.hrsa.gov/programopportunities/fundingopportunities/qualityimprovement/states/MS.html $10,750 $30,000 Remote Health Services Community Comprehensive Medication Management Models The most accessible healthcare provider Reference: https://ncpa.org/sites/default/files/2021-12/esbc-slides.pdf Medication Therapy Management CDC Community Pharmacists and Medication Therapy Management https://hdsbpc.cdc.gov/s/article/Pharmacists-Community-Pharmacists-and-Medication-Therapy-Management Remote Health Services Community Pharmacy Enhanced Services Community Pharmacy Enhanced Services Network (CPESN) Clinically Integrated Network Increase in Value Based Contracting with Community Pharmacies CPESN Mississippi Remote Health Services Community Health Worker Models Community Health Workers Bridge the gap between healthcare providers and those in the community Make home visits Help patients navigate complex health information systems Advise and help connect patients to needed care Reference: https://msdh.ms.gov/page/19,25574,123.html Remote Health Services Telehealth Expert Care is just a screen away U NIVERSITY OF MISSISSIP P I MEDICA L CENTER CENTER FOR TELEHEA LTH Mississippi Diabetes Telehealth Network A Collaborative Approach to Health Care Delivery 34 Partners 35 MS Diabetes Telehealth Network Purpose: To improve clinical outcomes and care coordination for chronic disease management Increase access to care Bring healthcare resources into the patient’s home 36 Eligibility Target Number 200 Inclusion Criteria: 37 Patient at the NSMCSRHC 18 years of age or older Prior diagnosis of diabetes mellitus Not pregnant Hemoglobin A1C greater than or equal to 7% based on prior or current testing at the NSMCSRHC Sustainable Change: The 3 E’s Education + Engagement + Empowerment Education Phase 1 38 Engagement Phase 2 Behavior Change Phase 3 Personal Empowerment Phase 4 MS Diabetes Telehealth Network HbA1c 1.7% Medication Compliance 96% Health Session Compliance 83% Retinopathy Found 9 cases Weight Loss 71 pounds Miles Saved 9,454.11 No Hospitalizations or ER visits for DM 39 Preliminary results on first 100 patients MS Diabetes Telehealth Network Update 40 Empowering Patients with Technology “Education is not a building…it is learning and I’ve learned so much!” “This program works. I have learned more in this program than I did when I was in a hospital.” “I never thought to look into my shoes” “I have learned more in the few months of being in this program than I have in 17 years of having diabetes” 41 Patient Feedback 97% 99% 93% 93% Strongly Agree /Agree Strongly Agree /Agree Strongly Agree /Agree Strongly Agree /Agree I would recommend this program to others. I feel this is an important step in my care. The equipment was easy to use. If I had a problem, someone was available to help me. Copyright © 2017 Care Innovations, LLC. All rights reserved. *All other third-party trademarks referenced herein belong to their respective owners. 42 Lessons Learned 43 Smaller Tablet – Patients need tablets that are more mobile No tethered devices – Cords and cables cause confusion and increased technical issues Affordable options – Blood glucose strips were not affordable Connectivity – Wireless connectivity limited – Provide patients with cellular network connectivity Future Research 44 Larger sample size Random assignment of treatment Patient and provider satisfaction Analysis of cost effectiveness Introduction to the UMMC Center for Telehealth 45 Center for Telehealth History Diagnostic test interpretation Adult and Pediatric Cardiology 1990s 46 Full-time staff assigned to Telehealth First videoconferencing of telemedicine Emergency Medicine TelePsychiatry Begins 2003 2008 2011 Center for Telehealth formed 24/7 Telehealth Call Center 2013 Center for Telehealth History Remote Patient Monitoring program is launched 2014 47 Telehealth Center of Excellence awarded to UMMC 2017 Video is embedded within Epic using Cisco ExtendedCare 2020 FCC Funding for RPM Telehealth Center of Excellence awarded to UMMC 2021 2021 Telehealth Modalities Deliver care using interactive media and electronic information exchange (e.g., video, monitoring, transmitted images) 48 Benefits of Telehealth Telehealth improves access, efficiency, quality of health care delivery​ 49 UMMC CENTER FOR TELEHEALTH: A SNAPSHOT 53 of Mississippi’s 82 counties are more than a 40-minute drive from specialty care. The Center for Telehealth extends care by providing specialty services across multiple care settings. SETTINGS SERVED Community Hospitals & Clinics Corporations Federally Qualified Health Centers (FQHCs) Mental Health Clinics Patient’s Homes Prisons Schools & Colleges Adult Services KEY SERVICES PROVIDED Alzheimer’s / Dementia Care (The MIND Center) Infectious Diseases Mental Health Services Cardiology Radiology Corporate Health Emergency Medicine Dermatology Pediatric Services Cardiology Child Development Child Safe Center Genetics Neurology Mental Health Services What is Remote Patient Monitoring? 51 Remote Patient Monitoring (RPM) A form of telehealth that uses technology to enable monitoring of patients outside of conventional clinical settings Uses digital technologies to collect health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations 52 Remote Patient Monitoring (RPM) 53 Remote Patient Monitoring (RPM) 54 Remote Patient Monitoring Programs Current RPM Programs 55 Diabetes Hypertension Congestive Heart Failure End Stage Renal Disease Maternal Hypertension Adult Obesity Cardiac Rehabilitation Chronic Obstructive Pulmonary Disease Key Partnerships Specialty clinics at UMMC Federally Qualified Health Centers (FQHCs) Insurance Companies Outside hospitals/health centers RPM Program Workflow 56 Remote Patient Monitoring Telemonitoring kit Linked with Epic EHR Full tech support 57 Health education RN daily monitoring Safety alerts & protocols Patient engagement Weekly team meetings Monthly/biweekly data reviews PharmD med titration and med reconciliation Algorithms developed by physicians Breakout Session Utilizing RPM equipment for hypertension 58 New Patient – Onboarding 59 Initial Intake Process 60 Initial Intake Process 61 Review Week Workflow DM Bi-Weekly HTN Monthly 62 Goals of Therapy Hypertension – Average BP