The Growth of Telehealth & Chronic Care Management in the Wake of COVID-19

The Growth of Telehealth & Chronic Care Management in the Wake of COVID-19

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By Richard Korecky, PharmD

Animals can adapt, but humans are infinitely adaptable. COVID-19 made us change how we lived, worked, played, shopped, and more for over a year. Humans primarily responded by taking precautions: wearing masks, staying distant, and hand-washing. Hanging plastic and plexiglass were used universally around the globe. Open hours – hours that we would encounter each other were slashed. In China, streets were disinfected using specially adapted trucks. We sanitized shopping carts, ladders, cars, strollers, and countertops, to say nothing of the massive amount of PPE we used to stay safe. Think back on the adaptations humans made; in a bid to survive.    

There were points in 2020 where hospitals were thought to be unsafe, where physicians’ offices were thought to ‘have the virus, and keeping facilities clean was at the top of every healthcare professional’s mind. Patients needing critical care deferred their visits, taking dangerous risks to avoid infection. While the virus proliferated in many regions globally, some adaptations in how we practice medicine proved to help reduce risk while also improving efficiency and accessibility to care.   

During the pandemic, providers and their organizations planned to avoid in-person care. As Healthcare professionals, we protect our patients and ourselves from unnecessary disease exposure at all times. Telehealth and Chronic Care Management (CCM) proved they could safely reduce in-person care. These services already had a small foothold in the medical marketplace. Remote care thwarts person-to-person transmission of disease. According to the CDC, “Many professional medical societies endorse telehealth services and provide guidance for medical practice in this evolving landscape. Telehealth can also improve patient health outcomes.”

Telehealth and CCM reduced barriers to care for the most vulnerable and underserved patient populations. Patients who lacked transportation for in-person visits, rural patients, who lived far from their provider, chronically ill patients, who had difficulty leaving home, could benefit from a physician’s care. CCM is a service designed to enhance the quality of care and clinical outcomes for patients with multiple chronic diseases by increasing their engagement with clinicians. It also improves the overall management of their chronic conditions. 

These benefits were significant for those infected with COVID-19. Studies show that patients with chronic diseases such as asthma, COPD, heart conditions, cancer, autoimmune diseases, diabetes, kidney and liver disease, and others may be at an increased risk of contracting COVID-19. Patients with these comorbidities experienced a greater chance of more severe COVID-19 symptoms, including pneumonia, respiratory failure, and death. Ensuring that chronic diseases are well-controlled is an essential step in limiting the spread of Covid-19 and future viruses.

Telehealth services, such as CCM, promote clinical safety during viral outbreaks by limiting unnecessary personal contact, something that can be beneficial to public health in or out of a pandemic, during flu season, or to limit the spread of other infectious diseases. Many conditions that typically cause patients to seek a visit with their primary care physician may be appropriate for a telehealth evaluation. During the pandemic, the Centers for Medicare and Medicaid Services (CMS) was ordered to pay providers for telehealth services delivered to any Medicare beneficiary. This provided an opportunity for the healthcare system to evaluate telehealth and limit the spread of this virus. This change in CMS guidelines, while temporary, could serve as the stepping stone to broader acceptance of telehealth services by policymakers and payers as the benefits of this technology become more widely understood.  

The U.S. Department of Health & Human Services also said, “We encourage providers to adopt and use telehealth as a way to safely provide care to your patients in appropriate situations…” Patient and provider preferences have shifted dramatically due to the somewhat forced introduction to telehealth over the last year. A recent survey revealed that 83% of patients and 91% of providers expected to use telehealth services, even after the COVID-19 pandemic ended and they safely resume in-person activities. This is in contrast to pre-2020 telehealth surveys, which consistently found that both patients and providers had relatively low levels (10-30%) of preference and experience in using telehealth. Interestingly, satisfaction rates were very high of those who had used telehealth services in the past (often 90% or greater). 

Telehealth services, like CCM, clearly can improve the health of patients and caregivers, engage difficult-to-reach patient populations, and reduce the impact of acute infectious diseases, like COVID-19. In the wake of the 2019 pandemic, it is becoming clear that COVID-19 provided a sudden spike of demand for telehealth and that telehealth and CCM delivered by keeping people distant and safe. Telehealth and CCM will probably gain traction from these events from the standpoint of preparedness, as infectious diseases constantly challenge our population. We can take comfort in the sheer volume of human adaptations made during the pandemic and our innate ability to repeat the process for future challenges.    

Contact PharmD Live today to find out more about CCM for your chronically ill patient population. We can help your practice provide critical Medicare services to your patients and improve your efficiency and patient outcomes.

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References

● Bashshur RL, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, et al. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health. 2014;20(9):769–800

● Centers for Medicare & Medicaid Services. President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak. CMS.gov. Published online March

17, 2020. https://www.https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak

● Monkowski D, Rhodes LV III, Templer S, et al. A retrospective cohort study to assess the impact of an inpatient infectious disease telemedicine consultation service on hospital and patient outcomes [published online April 19, 2019] Clin Infect Dis. doi:10.1093/cid/ciz293

● Schurrer J, O’Malley A, Wilson C, McCall N, Jain N. Evaluation of the Diffusion and Impact of the Chronic Care Management (CCM) Services: Final Report. Washington, D.C. Mathematica Policy Research. 2 Nov 2017; cited 26 March 2020.

● US Center for Disease Control. Coronavirus Disease 2019: People who are at higher risk for severe illness. CDC.gov. Published online March 26, 2020. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/people-at-higher-risk.html

Welch BM, Harvey J, O’Connell NS, McElligott JT. Patient preferences for direct-to-consumer telemedicine services: a nationwide survey. BMC Health Serv Res. 2017;17(1):784. Published 2017 Nov 28. doi:10.1186/s12913-017-2744-8

Ramaswamy A, Yu M, Drangsholt S, Ng E, Culligan PJ, Schlegel PN, Hu JC

Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study J Med Internet Res 2020;22(9):e20786 doi: 10.2196/20786

Andrews E, Berghofer K, Long J, Prescott A, Caboral-Stevens M Satisfaction with the use of telehealth during COVID-19: An integrative review International Journal of Nursing Studies Advances Volume 2, 2020,100008,ISSN 2666-142X, https://doi.org/10.1016/j.ijnsa.2020.100008.

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