A long and deeply-reported feature story in The Washington Post on Tuesday put a spotlight on the stark effect that an epidemic of chronic illness is taking on too many millions of Americans.

"Forty years ago, small towns and rural regions were healthier for adults in the prime of life. The reverse is now true," according to the Post. "Urban death rates have declined sharply, while rates outside the country’s largest metro areas flattened and then rose." 

A major driver of that stark fact is that "chronic diseases – obesity, liver disease, hypertension, kidney disease and diabetes – [are] on the rise among people 35 to 64," according to the article – which highlights widespread health disparities and social determinant factors such as "inadequate insurance, minimal preventive care, bad diets and a weak economic safety net." 

The article also makes a point to emphasize that the medical workforce in the U.S. is "aging and stretched thin," with the country needing "thousands more primary care doctors." 

As has been shown many times, lack of access to care is a key hurdle to health equity and chronic disease management. But telehealth can help in a significant way.

TimeDoc Health is a vendor of virtual care management, chronic condition management and remote patient monitoring technologies and services. In August, it named Brian Esterly CEO.

Esterly, formerly the chief growth and strategy officer at Centria Healthcare, was hired for his deep experience and acute understanding of provider organizations, combined with his proficiency in leveraging technology to reach vulnerable populations.

Healthcare IT News spoke with him recently to discuss how telehealth and RPM can help with chronic care management – especially as the number of people with chronic diseases grows, the population ages, and the shortage of healthcare workers worsens.

Q. What are the challenges that chronic care management faces today and into the future?

A. The chronic care management segment of the market is experiencing a set of challenges not only prevalent but also significantly impactful in the broader healthcare landscape. These challenges encompass a spectrum of issues that demand our attention today and will continue to shape the landscape of chronic care management in the future.

One of the most prominent challenges is the precarious balance between the escalating demand for chronic care services and the dwindling supply of healthcare providers. This dilemma echoes the broader healthcare scenario, where we witness a simultaneous increase in the prevalence of chronic conditions and an aging population, juxtaposed against a concerning decline in the number of available healthcare professionals.

This challenging dynamic is exemplified by the projection that by the end of this decade approximately 80 million Americans will grapple with three or more chronic conditions. This figure, notably more than double that of the previous decade, underscores the urgency of our mission.

Compounding this challenge is the anticipated shortage of 90,000 physicians within the next decade, which further underscores the imperative for innovative healthcare solutions.

The success of chronic care management pivots on patient behavior change, a transformational process that lies at the core of our mission at TimeDoc. Here, technology and care services offer support to both patients and healthcare providers. However, in an environment teeming with technology-enabled solutions, selecting the precise tools and services that can translate into tangible outcomes becomes an onerous endeavor.

Take, for instance, remote patient monitoring. While it has the potential to continuously track patient status, the challenge lies in identifying and deploying the right combination of technologies and services to achieve the desired outcomes. Our commitment is to navigate this technology landscape strategically, fostering patient engagement and facilitating meaningful behavioral change.

Lastly, and of equal importance, is the imperative to identify and document the impact of our chronic care management initiatives. This assumes heightened significance as healthcare undergoes a transformation, embracing alternative payment models and value-based care.

Our ability to effectively communicate the value of the services we deliver (or the value of any chronic care management program) is pivotal, particularly as these models emphasize outcomes and the quality of care over volume.

Q. How exactly can telemedicine help solve each of these challenges?

A. Telehealth stands as a transformative force in healthcare, advancing the objective of equal access to top-quality care. By harnessing technology to bridge the gaps in access, telehealth empowers patients, mitigates healthcare disparities and fosters an inclusive and patient-centric healthcare system. It transcends conventional limitations and addresses numerous factors contributing to healthcare disparities.

The convenience and accessibility inherent to telehealth are notable. Patients now can schedule virtual visits at their convenience, eliminating the hurdles related to transportation, childcare or work commitments. This newfound ease in seeking care enhances patients' ability to proactively manage their health.

Additionally, telehealth champions the cause of continuity of care, particularly benefiting individuals with chronic conditions or ongoing healthcare needs. Patients can maintain regular contact with their healthcare providers, contributing to improved health outcomes and diminished healthcare disparities.

Q. What do CMOs, CMIOs, CIOs and other leaders need to know about virtual care when it comes to starting an effort using technology to help handle the increasing number of patients requiring chronic care?

A. For healthcare leaders venturing into technology-driven chronic care management, several vital considerations should guide their path.

Embarking on a virtual care journey for chronic care management demands a holistic approach: recognizing transformative potential, building a robust technological foundation, fostering collaboration, promoting patient engagement and prioritizing data-driven quality improvement.

First, these leaders must recognize the profound transformation that virtual care represents. It's more than adopting technology; it's a fundamental shift in healthcare delivery, extending beyond episodic visits to continuous patient engagement.

Building a robust technology infrastructure is crucial. This involves selecting the right telehealth platforms and ensuring seamless integration with existing electronic health records and healthcare systems, emphasizing interoperability.

Collaborative partnerships across organizational divisions and with vendors are vital. These partnerships facilitate necessary engagement between healthcare providers and patients, unlocking the potential of chronic care management programs.

Lastly, a commitment to outcomes measurement and quality improvement is essential. Leveraging data analytics to track the impact of virtual care on patient outcomes, costs and satisfaction informs and enhances care strategies.

Q. Please describe in detail an example of a patient receiving chronic care management via your company's telemedicine and the outcomes achieved.

A. Patient success stories are at the core of our mission and we share them daily on our internal chat channels. Here is an example of a recent patient story that truly underscores why our teams are so passionate about what we do.

Last month, during a care call with a patient, a concerning health issue came to light that highlighted the critical role we play in patient care and advocacy through chronic care management and remote patient monitoring.

During the call, the patient casually mentioned his heart rate had been consistently abnormally low, and his blood pressure had dropped significantly. Sensing the urgency of the situation, our care coordinator wasted no time and proactively inquired about the specific readings.

To our alarm, the patient revealed his heart rate was consistently in the 40-50 beats per minute range, and his blood pressure had dipped as low as 60/40.

Recognizing the severity of the situation, our care coordinator immediately sprang into action. They promptly reached out to the patient's cardiologist, conveying the urgency of the matter and securing an appointment for the very next morning.

Upon evaluation, the patient underwent a stress test followed by a heart catheterization procedure. Shockingly, the heart catheterization revealed a total occlusion, a critical blockage in one of the coronary arteries. Thanks to the swift intervention facilitated by our care coordinator, the cardiologist promptly adjusted the patient's medication regimen and emphasized the importance of closely monitoring heart rate and blood pressure.

In our recent care call with the patient, our care coordinator took the opportunity to educate him about the parameters for abnormal heart rate and blood pressure readings. Together, they established a clear plan that, if readings fall outside the set parameters, the patient will promptly contact the cardiologist for further evaluation and intervention.

This patient success story highlights how a proactive approach can make a profound difference in our patients' lives. It also underscores the critical importance of routine care calls and patient advocacy in ensuring potential health issues are identified and addressed promptly, ultimately leading to improved patient outcomes and wellbeing.

As an organization we track these patient stories as well as the impact of our support on our clients' objectives. In fact, we recently conducted a collaborative initiative with StayWell Health, a federally qualified health center multispecialty practice based in Connecticut, where we found our programs to have a significant impact on their clinical quality measures.

Notably, patients engaged in the chronic care management program were found to be 40% more compliant with diabetic eye exams and showed a 12% improvement in A1c control. This same patient population demonstrated 22% and 21% greater compliance with colorectal cancer and breast cancer screenings, respectively.

This is particularly noteworthy because many patients in lower socioeconomic populations face challenges related to transportation and other social determinants that hinder access to quality care.

Overall, this collaboration exemplifies how innovative telemedicine solutions can positively impact patient outcomes, enhance engagement and optimize healthcare delivery, even for patients facing social determinants of health challenges.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
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