Telemedicine and telehealth canimprove continuity of care for people with chronic illness bysimplifying disease management and making it more accessible andefficient. (Photo: Shutterstock)

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A growing number of self-insured employers are turning totelemedicine–the provision of health care services through remoteconsultation, including video chat or other telecommunications–intheir quest to improve employee access to high quality health careproviders. Often called "remote" or "virtual care," telemedicinehas evolved into a powerful, user-friendly means of providingalmost immediate access to physicians, while lowering costs by60 percent to 70 percent compared withtraditional brick-and-mortar medicine.

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It should come as no surprise then that nearly60 percent of employers now offer virtual care as astandard benefit for employees, owing to its time and costeffectiveness, and high patient satisfaction. Clinical telemedicinecontinues to grow and expand beyond its initial intention oftreating simple, straightforward acute care complaints. We are nowwitnessing the emergence of specialty telemedicine and itsutilization for chronic disease management (CDM) — the mostprevalent and resource-consumptive health conditions.

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Related: Corporate culture, chronic disease and the carecontinuum

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Large employers have been the fastest and most notable adoptersof telemedicine—from 27 percent in 2015 to63 percent in 2017, and 82 percent in 2019. Amongemployers with 50 or more employees that offer telemedicineservices, 48 percent use incentives, such as lowercost-sharing — the share of costs covered by insurance that themember pays out of pocket — to encourage its use.

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Lower cost-sharing incentives for telemedicine use have beensuccessful in increasing the utilization of telemedicine among employees andlowering overall health costs.

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With more employers, brokers, TPAs, payers and theirintermediaries touting the importance of embracing telemedicinegiven its cost savings and time efficiency, specialty telemedicineis expected to become increasingly important for addressingcomplex, chronic diseases, such as diabetes, heart disease,asthma/COPD and others. Specialty telemedicine provides highquality care, better care coordination and communication, andimproved medication/treatment compliance. By addressing clinicalissues early in their course, potentially disastrous complicationscan be avoided, as well as costly visits to the hospital emergencydepartment or urgent care clinic.

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Champions of telemedicine believe that this disruptive servicecan improve the value and efficiency of health care by convenientlymonitoring chronic conditions or triaging and managingnon-emergency situations. Moreover, this clinical service islocation agnostic and can be offered to any patient anywhere,thereby improving access to specialty care in rural communities orareas with limited provider availability.

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Simplifying the managementof chronic illness

The benefits of telemedicine in CDM are evident and have beendemonstrated by multiple studies and reports. Remotely monitoringpatients' physiologic and clinical parameters and addressingabnormalities and patient concerns with continuous clinicalservices, saves money for health care providers, employers,employees and insurance companies.

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Telemedicine is particularly beneficial for hourly employeeswith Minimum Essential Coverage because it allows them to avoid thecost of an expensive ER or urgent care visit.

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A growing number of Americans are suffering from more than onechronic condition, putting pressure on healthcare providers to create care management platforms that addressseveral interconnecting health issues.

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Currently, chronic illnesses account for roughly 75 percent of all physician visits,80 percent of all hospital admissions and90 percent of all prescriptions. These numbers will onlygrow as 50 percent of all Americans are projected tosuffer some form of chronic illness by 2025, ranging from COPD toHIV. The management of these conditions requires continuity ofcare, specifically continuous monitoring and feedback, to ensurethat the patients can avoid the disease- associated morbidity andmortality, thereby improving, or at least maintaining, thepatient's quality of life.

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Telemedicine and telehealth can improve continuity of care forpeople with chronic illness by simplifying disease management andmaking it more accessible and efficient. Patient's care plans canbe streamlined and ordered daily, providing easy access to requiredcare components. Telehealth tools can serve as a source ofinformation and advice for questions that arise. Health informationis easily stored and processed, allowing patients to have constantaccess to their health data. Additionally, care teams cancoordinate care for a shared client using a portal with streamlinedcommunication, rather than relying on traditional health records orcommunication tools, which are often inadequate or incomplete.

Choosing the right telemedicine solution

Look for a partner that includes CDM and a network of medicalexperts for managing chronic conditions, such as heart disease,chronic lung disease, diabetes and chronic kidney disease. Thesolution provider should also have broad and diverse experienceand, for global companies, a telemedicine service with worldwidecapabilities.

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Software and platform

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Today, leading-edge telemedicine companies rely upon advancedanalytics and technology. Some telemedicine companies utilizesophisticated artificial intelligence (AI)-powered software withclinical and telemedicine input to improve outcomes and lower costsfor chronically ill patients. Expanded care platforms can addressgaps in care in conjunction with other technology, ranging fromwireless devices and wearables to mHealth-enabled electronic healthcare record (EHR) platforms.

CDM telemedicine checklist

Personalized care

  • AI-enabled tools
  • Advance alerts
  • App-based platform to drive engagement

Comprehensive care

  • Monitor multiple diseases simultaneously
  • Prevent gaps in care
  • Connect to care providers via telemedicine

Collaborative care

  • Engage caretakers with patients
  • Individualize care plans
  • Personal reminders

The patient experience: Using a CDM telemedicine portal

Typically, patients enroll online or by phone, creating anaccount and completing a short questionnaire regarding medicalhistory, current medical conditions, allergies andmedications—similar to the forms required before a doctor'sappointment. This information should be securely protected,HIPAA-compliant and shared only with the attending doctor forreview before the online consultation.

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With some of the more sophisticated telemedicine programs, userscan go online either via the computer or app to choose from a listof doctors and specialists, schedule an appointment and arrange anappointment reminder. They can also upload photos and files thatmight better inform the doctor's diagnosis and care program.

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Much like any clinical service, a patient who requires aspecialist can be referred either by their primary care physicianor via the telemedicine physician who whose diagnosis is based onmedical history and current symptoms.

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With management of chronic illnesses becoming a focal point ofoverall case management, it's important to look for a telemedicineplatform that provides clinical tools for medical conditionsincluding chronic illnesses. Such tools could include daily careplans, the ability to track and log activities and food intake—muchlike any popular health tracker app—and provide medical alerts tohelp patients remain compliant with their medication and treatmentregimen.

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A person with diabetes, for example, should receive a checklistfor maintaining optimal health based on their condition and pre-setparameters including reminders to check their sugar level and takeinsulin. Severe deviations from the patient's baseline levelsshould trigger an alert to the care team.

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The best CDM telemedicine solutions rely on AI engines that canlearn the patient's tolerances, habits and variances based on theirinput, and run detailed reports and trends that provide a largerpicture of the patient's progress.

The age of "new medicine"

Telemedicine and telehealth provide a breed of "new medicine"and represent a vast improvement over traditional medicine in thedays when patients, particularly those with chronic medicalconditions, would have to constantly visit the doctor's office oraccess emergency help. The great innovation of telemedicine is thatmedical care is decentralized and democratized, easily accessibleand of the highest quality.

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As a 21st century way for physicians to take care ofpatients—and patients to manage their chronic illnesses–CDMtelemedicine harnesses technology to better engage the patient,improve outcomes and, concurrently, enable self-insured employersto provide cost-effective quality care for individuals with chronicconditions.

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Dr. Jonathan Wiesen, M.D., is founder andChief Medical Officer at MediOrbis. 


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