While many American urbanites have come to expect the comforts of a nightly dose of Netflix, access to affordable, high speed broadband is not an option for many of their rural counterparts.
More than just late-night impulse buys and binge watching the latest episodes of a favorite TV show, access to broadband also means access to virtual healthcare, known as telehealth.
Such services are critical for rural residents, who often live far from hospitals or clinics and lack access to locally-based specialists. Patients’ ability to communicate with healthcare professionals from home and local doctors’ ability to consult with off-site specialists have the potential to increase both the quality of life for rural residents and the quality of healthcare they receive. These outcomes would help reduce overall costs in thousands of rural communities across the country.
Take, for example, the treatment of Type 2 Diabetes, which accounts for nearly 95 percent of the diabetes population. Type 2 Diabetes can be managed with medical adherence, improved diet and regular exercise. No high tech medical machinery or lab-tests required. However, in order to make these sometimes drastic lifestyle changes, patients need support and they need to have someone around to keep them accountable. That’s where telehealth plays an important role.
In January 2018, CoBank sponsored a pilot program in central Georgia to facilitate the adoption of such technology in rural communities and support Type 2 Diabetes patients. Perry Health, a healthcare software provider, and Navicent Health, a healthcare provider in Macon, Georgia, recruited 100 rural, low-income patients with uncontrolled Type 2 Diabetes. Many already had or were on the path towards kidney failure, amputation and vision loss with a high risk of expensive emergency room visits and hospitalizations.
Each patient received an internet-enabled tablet loaded with Perry Health software that they used to connect with health care teams for clinical support and guidance. They also received a daily interactive care plan structured by the Navicent healthcare team. Patients were responsible for following their daily care plan and logging key health metrics such as blood sugar, diet, medication adherence and daily exercise. This information that was then transferred to their local care team in real-time, altering medical professionals of any patients in need.
The clinical results of this program were strikingly positive. Health improvement in diabetes patients is measured in terms of A1c improvement, a lab test that represents how well a patient is controlling their diabetes. As of March 2019, 75 percent of the individuals who had finished the program had experienced an A1c improvement. The average A1c improvement among those patients was 2.5 percent, an impressive number considering the average baseline A1c at the beginning of the program for all patients was 11.3 percent. (For reference, A1c is measured as a percentage with discrete ranges for disease level: non-diabetes A1c levels are <5.7%; prediabetes is 5.7%-6.4%; diabetes is >6.5%, and uncontrolled diabetes is <9%.)
Throughout their participation, patients also felt more cared for than they had before. One patient offered, “I always felt alone, but this program has made me feel loved for the first time!” Another said, “Having this program feels like having angels looking over me.”
The financial benefits of this program are also stark. The cost of Type 2 Diabetes totaled $327 billion in the U.S. in 2018, according to the American Diabetes Association, and the organization estimates that people with diabetes incur medical expenses approximately 2.3 times higher than those who do not. However, as the Journal for Managed Care and Specialty Pharmacy notes, for every percentage point that A1c is improved among Medicare patients, there is a resulting healthcare cost savings of more than $99-158 per patient per month, translating to approximately $1,542 per patient per year. For patients covered by commercial insurance, the savings is $67-105 per patient per month.
Using the average Medicare savings, the average decrease of 2.5 percent for the patients who experienced an A1c improvement in this program means an estimated reduction in healthcare costs by approximately $3,855 per patient per year.
It’s clear through this pilot that using telehealth to provide a model of continuous care connecting rural patients to their local providers decreases healthcare costs. Most importantly, it improves the quality of life of rural patients, and increases engagement between healthcare providers and their patients.
To expand these benefits, CoBank is sponsoring the Rural Telehealth Initiative (RTI) that will deliver additional pilot programs in other rural communities. RTI is an alliance between CoBank, Perry Health and the WTA Foundation, an affiliate of WTA – Advocates for Rural Broadband, which leverages the relationships with rural broadband providers and their local communities.
For more information about participating in the RTI, please contact Sarah Tyree, Vice President, Policy and Public Affairs, CoBank: styree@cobank.com 202.650.5864.