Managing chronic conditions through telehealth
Telehealth treatment options are vast, but they vary depending on the condition and the patient’s needs and abilities.
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There are some instances where patients will need in-person office appointments. Examples include:
- Examination of surgical incisions or permanent ports
- Certain diagnostic or imaging tests, such as biopsies or cardiac imaging
- Suspected infection
- Acute illness or the inability to control the chronic condition through telehealth
Improvements to technology mean there are a lot more options for telehealth care that will benefit both patients and their providers. Patients are more likely to follow their treatment and management plan with routine telehealth follow ups, which gives providers a better look at the patient’s health and well-being.
More frequent check-ins through telehealth, and the possibility of remote patient monitoring, also can help providers catch any complications faster. That could lead to fewer hospitalizations and emergency room visits.
Make an emergency plan
Creating a plan for emergency care is necessary when treating chronically ill patients with telehealth. You may notice that your patient’s remote monitoring devices are picking up alarming data, or that the symptoms they are describing sound like a life-threatening event.
Keep an emergency plan in the patient’s file that includes the following information:
- The patient’s phone number and street address for emergency officials
- The names and numbers of family or close friends of the patient
- The closest hospital or medical facility and the number for air transport helicopters
- An up-to-date list of the patient’s medications and allergies
Telehealth video appointments to manage chronic conditions
Video appointments between providers and patients are the most common type of telehealth. This digital type of “face to face” lets providers see any outwardly physical symptoms. And patients can be comforted by seeing their provider and being able to ask questions.
There are several ways telehealth video appointments can be used to treat and manage chronic conditions, including:
- Follow-up appointments to see how a patient is doing on a new diet, medications, or other modification
- Telebehavioral care and therapy
- Routine check-ins for patients with certain cancers, rheumatological diseases, diabetes, and migraines
- Explanation of test or imaging results
- Explanation of how patients use remote monitoring devices
- Nutrition and fitness counseling
Provider-to-provider telehealth
Providers can also use telehealth to collaborate with other providers involved in the patient’s care. This could be done via video chat, phone conversations, or asynchronous communication. Providers can also use telehealth with other providers for tele-mentoring on new, updated, or complex topics.
The benefits include:
- Collaboration between a patient’s local primary care provider and a specialist that could be in another city, state, or region
- Reduced strain on local providers, especially if they are located in a rural area or a busy urban area with too few providers for their patient load
- The ability for consultations on patient imaging, diagnostic tests, or lab work
- Collaboration between small, local health centers and larger hospitals and universities
Asynchronous telehealth care to reduce patient visits
Patients and providers can share important information without having to set up an appointment. This could include a patient filling out a form to gauge their symptom progression or improvement. It could be messaging updates through a secure portal. The ability to communicate asynchronously with a patient saves time and resources for your practice with fewer phone calls, less paper filing, and fewer appointments to schedule.
Examples of asynchronous telehealth care for chronic conditions include:
- Respiratory-compromised patients sending regular peak flow meter results
- Patients with neurological or rheumatological conditions sending back forms that keep track of symptoms and their severity
- Text messaging with chronically ill patients who do not have access to broadband internet
- Sending X-ray images or lab results through a secure messaging portal
- Patients uploading their food logs if on a specific dietary plan
Did you know?
Asynchronous telehealth, also called “store and forward,” is sometimes covered by Medicaid and Medicare.
Each state has its own Medicaid store and forward billing policies. Check your states policy on National Policy Center - Center for Connected Health Policy.
Federal law limits Medicare’s asynchronous telehealth coverage to certain projects in Alaska and Hawaii. But some asynchronous tasks, including virtual check-ins and questionnaires can be billed to other Medicare codes.
Read more: Medicare Learning Network Fact Sheet: Telehealth Services (PDF) — Centers for Medicare & Medicaid Services
Spotlight
Collaborative for Advancing Rural Excellence and Equity
The Collaborative for Advancing Rural Excellence and Equity (CARE 2) is focused on addressing the impacts of COVID-19 in rural communities, including the effects of "long haul COVID". Covering a rural region spanning Maine, New Hampshire, Vermont, and New York's North Country, the CARE 2 region faces barriers related to workforce shortage, broadband access, and as well as barriers to the consistent use of synchronous virtual consults . Through a partnership with the Northeast Telehealth Resource Center, CARE 2 is providing training on sustainable telehealth modalities including asynchronous telehealth consults to increase collaboration and support care integration between specialists and primary care providers.
Learn more about the Collaborative for Advancing Rural Excellence and Equity
Remote patient monitoring to keep track of symptoms and vital signs
Advancements in technology allow providers and patients the flexibility to monitor their chronic conditions without routine trips into the office. Certain remote patient monitoring is also now covered by Medicare, Medicaid, and many private insurers.
There are guidelines, however, for Medicare coverage. Devices must be FDA-approved and they must be able to automatically transmit data and information to the provider without patient interference.
Many serious chronic illnesses require frequent testing and monitoring to keep the patient stable and feeling well. Remote patient monitoring options for chronically ill patients include:
- Blood sugar levels for diabetes management
- Blood pressure for cardiac patients
- Pulse oximeter readings for patients with respiratory illnesses
- Weight scales for patients being treated for obesity
Specialist telehealth appointments to improve and manage chronic conditions
Patients living with chronic conditions often benefit from evaluations, treatment, and care from providers who specialize in that area of medicine. But there may be several barriers to access for millions of Americans.
Rural or underserved areas may not have the medical facilities or teaching hospitals that attract certain specialists or subspecialists. Some patients may not be able to afford the time off work, gas, or childcare needed to travel to see a specialist. Specialists may also not be covered by the patient’s insurance plan.
Telehealth can help remove some or all of those barriers.
- Patients can find a specialist who will work with the underinsured or uninsured
- Specialists who use telehealth can see patients who may live more than an hour away
- Specialists can see patients over telehealth and then work with the patient’s local provider to manage care and treatment of the condition
- Specialists can order remote patient monitoring and make recommendations to local physicians based on their findings
More resources:
Telehealth Intervention to Improve Chronic Disease - Centers for Disease Control and Prevention (CDC)
Telenutrition for the Prevention and Management of Diabetes (PDF) - Indian Health Service
Telemedicine can revolutionize the treatment of chronic disease - National Institutes of Health
Spotlight
MaineHealth
Maine is the most rural state in America and it has the highest per capita percentage of people living with diabetes. MaineHealth, a not-for-profit health care organization, is using telehealth to increase access to care for people living with diabetes in rural areas.
Patients in this program will be connected through telehealth with specialists and subspecialists who can help them improve their symptoms and manage their diabetes. Primary care providers can use remote patient monitoring to keep track of glucose levels so they have real-time results to evaluate and counsel their patients. Patients will also receive diabetes and nutrition education via telehealth.
This program not only removes barriers to care for rural and underserved patients, it also reduces the strain on rural health care providers.
Read more about MaineHealth’s telehealth services.