A community health clinic in rural Hertford County launched a telehealth program to fill a local need, but became a national leader in the provision of chronic disease monitoring.
By Amy Adams Ellis
After two bouts with congestive heart failure, Don Craft is finally learning to manage his own health.
Every day after his morning coffee, the elderly Ahoskie native measures his weight and blood pressure at home on wireless monitoring equipment. The readings are sent over a phone line to a computer at Roanoke Chowan Community Health Center, where a nurse is alerted if the readings are outside predetermined parameters. If they are, she’ll call Craft to explore possible reasons, give him some pointers or schedule an appointment with his family doctor.
She calls him weekly, regardless, to evaluate his progress and offer a dose of encouragement.
“It’s made me more conscious, gives me a little more control of my weight and blood pressure, which should keep me from getting into trouble again,” Craft said. “And I have an insight into health care I’d never thought about before: the influence I can have over my own health.
“But the best thing about it?” he said, tapping his walker, “is I don’t have to leave the house.”
Craft is one of a couple of thousand chronic-disease patients statewide who’ve benefited from RCCHC’s remote patient monitoring (RPM) program since 2006. He’s still being monitored today, thanks to revenues generated from RCCHC’s technical assistance and pilot programs for outside groups.
But hundreds of other patients lost their service this past September, when the state Office of Rural Health discontinued its funding for the program, after the legislature eliminated the money for the program.
For seven years now, led by its chief executive officer and telehealth director, Kim Schwartz, RCCHC has been pioneering RPM programs throughout North Carolina, collecting a wealth of experience.
More importantly, Schwartz’s programs have been collecting data that testifies to how such programs meet the national Institute for Healthcare Improvement’s “triple aim”: to increase quality of care, improve the health of populations and reduce costs.
Bolstered by funding from 12 state, federal and private foundations, they’ve impacted 19 of North Carolina’s rural and urban counties with RPM projects. They know their stuff.
Schwartz’s passion for community health brought her from New Mexico, often considered the birthplace of telehealth, to Ahoskie, located in the fourth-poorest congressional district in the nation. Soon after arriving, she procured a grant through the N.C. Health and Wellness Trust Fund to offer RPM to 25 patients to help them better manage chronic diseases like cardiovascular disease, diabetes and hypertension.
A subsequent grant enabled expansion into additional community health centers and hospitals. The Office of Rural Health funded the network the past four years.
“It was showing great promise,” said Schwartz. “Care managers were embedded at each site. We were really broadening our impact and getting phenomenal outcomes. It’s very sad, ridiculous even, that the state chose to discontinue funding.
“The equipment was already paid for. Those centers had adapted to the telehealth culture, and the program was making great strides toward relieving the physical and financial burdens that chronic disease causes in these communities.”
And those strides were, indeed, great. In the initial project, 29 patients completed six months of RPM. Those people averaged a 69 percent reduction in blood glucose levels, an 82.1 percent reduction in systolic blood pressure (the top number measured in a blood pressure reading) and a 92.8 percent reduction in diastolic pressure (the bottom number).
During the six months prior to RPM, 64 participants were hospitalized 199 days, collectively, for the specific chronic diseases they were subsequently monitored for, but they were hospitalized only half as many days for those same diseases during the six months they spent on RPM.
Two years post-RPM, those same patients continued to manage their health conditions more successfully on their own, averaging only 18 hospital bed days every six months.
Those same patients had logged 27 visits to the emergency room in the six months prior to RPM. During their six months of monitoring, that number dropped to only five ER visits. And even two years after the monitoring was done, those same patients averaged only six visits every six months.
Grant administrators calculated that saved a whopping $1.22 million in charges every six months on hospital stays and ER visits combined.
Going out of state
Several years ago, using a grant from the federal Health Resources and Services Administration, Schwartz’s group developed a telehealth network with some Vidant Health hospitals and several primary and specialty clinics throughout North Carolina. Their aim was to prevent chronic-disease patients from rebounding into the hospital.
Over three years and 300-plus participants, glucose readings dropped an average of 6.02 percent and weight dropped 3.5 percent. Patients also saw lower blood pressures.
But changes in the state’s administration this past year and a new emphasis by the General Assembly on cutting budgets added up to loss of support for the project. It only continues because Vidant saw its worth, assuming funding, and even expanding it to all nine hospitals in its organization.
RCCHC was awarded a second round of funding this year through the federal Office of Rural Health Policy to advance RPM. But it won’t happen in North Carolina.
“We really wanted it to be in NC, but we couldn’t get the state to support it,” Schwartz said. “It’s just not a good environment for a federally funded project in our state right now. There’s too much flux. So we went out of state.”
All the way to Oregon, in fact. Two years ago, RCCHC joined the burgeoning Oregon Community Health Information Network (OCHIN), which boasts 60 community health centers nationwide. In a new public-private venture spanning three years, RCCHC aims to do RPM with 500 patients from one of OCHIN’s partners, Mosaic Community Health Center in rural Bend, Oregon.
Mosaic is part of an accountable care organization (ACO), and new federal rules allow RPM as a covered cost for Medicare and Medicaid patients, who receive the service as part of their overall care plan within an ACO. The fact that Oregon lawmakers accepted the federal government’s offer to extend Medicaid coverage to many of their state’s previously ineligible residents only added to the project’s appeal.
We’ll track these 500 patients through the whole system, demonstrate the pre- and post-involvement and distribute that information to all the health care partners involved, so we can prove the value proposition of RPM as a shared-savings component in an ACO model,” Schwartz said.
She said her team is excited about working with a community health center in which every patient has a payer source, as most Oregonians will be insured once the Affordable Care Act is fully implemented.
But fewer patients in North Carolina will reap the benefits of a telehealth initiative originating in the northeast corner of their own state.
Tomorrow: Technology creates new opportunities for care. But will North Carolinians benefit?