Today’s health systems have set their sights on value-based care, a large component of which is ongoing medication reconciliation and adherence. However, to move the needle on value, they must look for ways to make telemedicine services viable. While telemedicine has far-reaching benefits for many sectors in healthcare, it has a particularly interesting application in rural areas where access to care is a significant challenge. Patients often live hundreds of miles or more from the care they need, and when rural residents can’t access services promptly, they may experience poor outcomes.
For example, a patient who is prescribed medication for congestive heart failure may not refill a prescription because they aren’t willing or able to travel two hours to see the cardiologist for a checkup. Or a patient with diabetes isn’t willing or able to travel that same distance for regular A1C checks, leading to a dangerous spike in their A1C levels. This, in turn, leads to increased hospital admissions, readmissions, and overall higher costs.
As payer coverage of telemedicine expands (Note: 36 states and D.C. have Medicare parity laws for private payer coverage), organizations must explore this technology that can take their patient-centered care models to the next level, improving the quality of the healthcare they provide to rural residents.
Solving Healthcare Challenges in Rural Areas
Though there are many advantages of using telemedicine in all settings, there are critical benefits of telemedicine in rural areas. Telemedicine programs are particularly helpful for providers addressing a variety of challenges facing rural residents. Consider the following:
Lack of access. In rural areas, distance and travel time between patients and providers is a significant barrier. In addition, there may be a shortage of providers in rural areas. The patient-to-primary care physician ratio in rural areas is approximately 40 physicians per 100,000 people. In urban areas, this ratio is about 53 physicians for every 100,000 people. This leads to increased wait times (both for appointments and while in the office) that patients may not be willing to tolerate. When patients need to wait weeks or months for an appointment, they may miss doses of their medication or continue to experience symptoms unnecessarily because they aren’t evaluated and prescribed a medication immediately. By improving access to telemedicine and telehealth programs, organizations can significantly improve outcomes.
Social determinants of health. Telehealth helps address several social determinants of health that affect outcomes. For example, telemedicine services help providers overcome barriers related to geographic location. There are also other benefits of telemedicine in rural areas. For example, telemedicine also addresses economic stability (another social determinant of health) by helping rural residents save money on travel expenses. It also overcomes the challenges residents face in areas where public transportation is sparse (i.e., transportation deserts) and strengthens overall patient engagement.
Medication adherence. It’s critical to monitor patients who are on medications, yet rural residents may not be willing or able to travel long distances regularly for brief check-ins. What ends up happening is that they stop taking the medication when they run out, or they stop taking it once they feel better (and not necessarily for the entire duration of the prescription). Telemedicine programs enable quick check-ins that can greatly improve medication adherence, prevent medication errors, and enhance medication reconciliation.
Who Benefits from Telemedicine in Rural Areas?
Telemedicine and telehealth programs benefit several specific rural populations, including rural residents with disabilities, those struggling with substance use disorders and/or mental health conditions, and those with limited English proficiency. It also helps people who are incarcerated, older adults (including the Medicare population), children, veterans, tribal members, and island populations. Finally, it’s critical for people living in areas affected by natural disasters who require urgent care.
How Telemedicine Programs Help Rural Hospitals and Their Communities
Telemedicine services help providers meet the needs of rural residents by enabling remote consultations, in-home monitoring, outsourced diagnostic analysis, remote specialist consultations, and direct-to-consumer telemedicine (e.g., virtual consultations for urgent care needs).
For example, the University of Virginia Health System uses telemedicine in rural areas of the state to extend specialty care such as behavioral health, diabetes, obstetrics, oncology, and stroke. By using technology, the health system was able to increase its patient satisfaction rates in rural areas by 30%.
The University of Mississippi Medical Center uses telemedicine to extend access to its rural residents, many of whom face hours-long trips to see specialists. “Your care and your treatment shouldn’t be dictated by your ZIP code,” Michael Adcock, executive director at the Center for Telehealth at the University of Mississippi Medical Center, told Modern Healthcare. “We’re not trying to take care of the patients here in Jackson,” he adds. “For patients, not having to leave their home community is a huge deal.”
Intermountain Healthcare is another example of an organization tapping into the benefits of telemedicine in rural areas to positively impact the surrounding rural communities. In this article, Marc Harrison, MD, president and CEO of Intermountain Healthcare, recounts how telemedicine helped one family with a baby born in a rural community who had a hole in his heart. Using telemedicine for a critical care consultation, the baby was able to stay at the facility and avoid a helicopter transfer and seven-hour roundtrip drive for family.
Likewise, Children’s Mercy Kansas City uses telemedicine to extend specialist care to rural areas, enabling children and their families to remain local instead of having to drive hours to see a specialist. Eighty-two percent of parents said their child could see a specialist sooner via telemedicine, thereby improving both access and quality of care.
One recent study found that telemedicine programs even change residents’ perception of their local hospital. They view an organization with telemedicine capabilities as being at the forefront of medical care rather than lagging behind. This perception then filters throughout the community, boosting engagement.
Limitations of Telemedicine in Rural Areas
Although there are challenges related to technical training and equipment, one of the most significant barriers for expanding telemedicine in rural areas is the lack of broadband infrastructure necessary for video consultations in in-home monitoring. According to the latest data from the FCC, 21.3 million Americans lack broadband access, though some experts argue the numbers are even higher. Unfortunately, an unreliable broadband connection often leads to unreliable data.
“With weak connections, video streams for telehealth are blurry, choppy, or just won’t work,” Tony Zhao, CEO of Agora.io, told Becker’s Hospital Review. “Implementing technology that doesn’t rely on the general internet but which relies on an infrastructure that strengthens signals in the most remote areas is crucial.”
One solution is to simplify the federal programs that support the expansion of broadband. Many experts argue that the industry won’t fully reap the benefits of telemedicine in rural areas until connectivity challenges are solved. Resolving these challenges would result in higher-quality care and lower costs.
To learn more about how to optimize medication management under value-based care, watch this free webinar recording.