Investing In Telemedicine To Improve Access To Care
The company has given more than $4 million to community health partners focused on the same goal
By Sarah Wolf, Media & Community Relations
Around the time he turned six, Dan Kaye’s parents noticed their son was experiencing occasional involuntary movements.
The episodes were infrequent and mild, but out of concern, the Kayes alerted Dan’s pediatrician.
Over the next several months, Dan’s symptoms worsened. By the time he turned seven, the behavior was more frequent and disruptive – especially in school. After being referred to a specialist at Children’s National Hospital in Washington, D.C., the Kayes got some answers.
While the diagnosis of Tourette syndrome wasn’t a surprise, Dan’s parents were still overwhelmed by the news and anxious to learn how this condition and required treatment might disrupt their son’s life. Months later, the impact hasn’t been as dramatic as the Kayes had feared.
That’s because Dan’s neurologist, Dr. Marc DiFazio, participates in one of the first telemedicine programs designed specifically for adolescents in the mid-Atlantic region. The program is one of nine that last year received funding from CareFirst BlueCross BlueShield as part of the region’s largest health insurer’s broader effort to expand access to health care through telemedicine.
To date, CareFirst has committed more than $4 million to community health care organizations focused on the same goal of improving patients’ health by offering telemedicine services. The grants have allowed health clinics, hospitals and other providers throughout the region to treat thousands of patients – many of them uninsured or underinsured – for routine check-ups, behavioral health and substance abuse issues and other specialty care needs.
“Our investment in telemedicine is focused on supporting those programs and community partners that are harnessing existing technology and repurposing it to suit the health care needs of a specific population lacking access to care,” said Maria Harris Tildon, CareFirst Senior Vice President of Public Policy and Community Affairs.
Meeting Health Care Where It’s Needed
In recent decades, health care providers and insurers have used advancements in technology to change the way health care needs are met. As a result, the use of telemedicine – caring for patients remotely over the phone or online -- has grown.
By 2018, about 7 million patients are expected to use telemedicine services, up from 350,000 patients in 2013, according to an IHS Technology report.
Video: Telemedicine grant recipients discuss programs' progress
With a service area spanning three jurisdictions and encompassing a racially, ethnically and socioeconomically diverse population, CareFirst saw telemedicine as an effective way to remove traditional barriers to care and provide health care solutions to vulnerable and underserved populations in the community. Some of those barriers include a lack of access to reliable transportation and the inability to travel many miles from rural areas to visit a provider.
Programs like the one Dan is using through Children’s National Hospital allow him to receive follow-up care through visits conducted via the family computer.
“CareFirst has been a valuable partner in this process, helping us adapt to rapid changes in the health care environment that have occurred, even since receipt of the grant just 18 months ago,” said Dr. Craig Sable, Associate Division Chief of Cardiology and former Telemedicine Director at Children’s National. “[They are] taking the lead in adopting and promoting use of innovative technology that will improve health care outcomes, increase patient and provider satisfaction, and reduce health care costs.”
Initial Investment
In 2013, CareFirst issued its first request for proposals (RFP) from community health centers and nonprofit organizations using telemedicine to expand access to behavioral health care services and substance use recovery programs.
Four organizations – Associated Catholic Charities, Atlantic General Hospital, La Clinica del Pueblo and Sheppard Pratt Health System – received more than $1.3 million combined over a three-year period.
With an investment of more than $50,000, Associated Catholic Charities (ACC) could purchase and install technology that improved access to telepsychiatry for more than 100 youths in Baltimore City and Anne Arundel and Allegany counties. The money also allowed Associated Catholic Charities to hire psychiatrists and clinical nurse practitioners.
For ACC, the funds came at a crucial time, when the organization’s MindCare for Marylanders video-conferencing program was fully reliant on Medicaid billing mechanisms, said Dr. Robert Canosa, Director of Community Resources at Associated Catholic Charities.
“Without this fusion of funds, we would have had to suspend the initiative until other resources could be obtained,” Canosa said. “[CareFirst’s support] dramatically improved our ability to provide psychiatric services to clients, and aided in our recruitment and retention of psychiatrists and clinical nurse practitioners – professionals who may not be as available to provide necessary services in more remote areas.”
And while CareFirst’s support for ACC enabled the organization to reach more patients – including those in rural areas like Allegany County, Md. – grant recipient La Clinica del Pueblo was focusing its efforts on an underserved population in a more urban setting.
According to the District of Columbia’s Department of Health, Hispanics were the third-fastest-growing group in the District’s population in 2010.
When CareFirst was seeking community partners for its initial telemedicine initiative, La Clinica del Pueblo saw an opportunity to expand mental health services to a severely underserved Spanish-speaking population in the District.
La Clinica’s two-pronged approach allowed for patients to be treated off-site by a bilingual psychiatrist via teleconferencing, while also establishing new partnerships with existing community health centers, further expanding access to Spanish-speaking providers in an area where demand was high.
After the three-year investment, La Clinica had provided mental health services to more than 300 District residents and had successfully implemented a telemedicine infrastructure that will continue to benefit patients after CareFirst’s funds are exhausted.
Measuring Impact
As CareFirst has continued to invest in telemedicine programs, the company also has worked extensively to develop evaluation techniques and metrics that the insurer and the individual grant recipient can use to measure the impact of dollars invested.
Even in the earliest stages of funding – the application process – grant applicants are asked to state goals on a variety of performance measures, including patient utilization, patient and provider satisfaction and improved health outcomes. These can vary based on the amount of the investment, the length time associated with implementation, the target population and the type and availability of health care services.
CareFirst receives guidance from a diverse panel of reviewers – internal and external experts who can evaluate a proposal to determine if stated objectives are attainable, measurable and in line with CareFirst’s overall giving strategy.
As CareFirst provides funding, progress on stated outcomes is monitored through a preset work plan, measuring performance, identifying challenges and making accommodations when necessary.
“With most of our larger community investments, the goal is a combination of increased patient satisfaction, improved health outcomes, and reduced costs,” said Hosanna Asfaw-Means, CareFirst Grants Program Manager. “When we talk about telemedicine, sustainability is also a major priority.”
As telemedicine services become more widespread, CareFirst and its community health partners will take a closer look at their investment and sustainability of their program. That will reveal the full impact telemedicine is having on a rapidly changing health care landscape.
Later this year, CareFirst plans to convene its community partners working to expand telemedicine services at a forum to discuss progress, challenges and successes.
“Regardless of their size or scope, these organizations have a shared experience having been through this process,” Asfaw-Means said. “Their patients all face barriers to care, each of them has to navigate regulatory mandates in their respective jurisdictions, and they could all benefit from additional resources and support.”
Aiming For Growth
Three years after its initial RFP, CareFirst doubled down on its investment, committing more than $2.7 million to nine organizations developing or expanding existing telemedicine programs -- this time beyond the scope of behavioral health.
“What CareFirst is doing is putting up their money in order to provide more efficient health care that will reduce costs,” U.S. Sen. Benjamin Cardin, D-Md., said in July during a demonstration of a new telemedicine initiative for mental health patients served by one of CareFirst’s grant recipients, Sheppard Pratt Health System’s Mosaic Community Services in Baltimore. “But it doesn’t reduce costs overnight – it’s an investment to reduce costs. And that’s what we need to do in our health care system.”
Related: CareFirst Awards Nearly $3 Million To Regional Telemedicine Programs
University of Maryland Baltimore Foundation is using CareFirst’s grant to link nursing home residents with emergency department physicians, reducing avoidable transfers and hospital admissions.
The Queen Anne’s County Department of Health is using its grant to expand a program that provides frequent users of its emergency in-home care services with video conferencing technology.
And partners like Children’s National are using telemedicine to expand access to pediatric specialty care for kids like Dan Kaye.
In the months since his diagnosis, Dan has continued to receive follow-up treatment through Children’s telemedicine program. During a recent event highlighting CareFirst’s investment, a dog barked in the background as Dan’s father Jon participate in a virtual demonstration of one of his son’s telemedicine visits.
Jon and Dr. DiFazio simulate the patient experience for a boardroom full of hospital executives and elected officials – all of whom have lent their support to the types of programs helping those like Dan receive access to the care they need through telemedicine.