Mississippi telehealth, remote monitoring pays dividends for diabetics

Program founder Kristi Henderson may have left for Ascension Health in Texas late last year, but the University of Mississippi Medical Center continues to make significant strides in telehealth.

In fact, the UMMC Center for Telehealth is expanding its service offerings to other states, particularly with remote patient monitoring for people with chronic diseases. That is because the Jackson, Mississippi-based health system has had some impressive early results addressing the state’s stubborn diabetes epidemic this way.

“Why did we get into remote patient monitoring? We [in Mississippi] are really, really good at all the bad things and really, really bad at all the good things,” Michael Adcock, administrator of the Center for Telehealth, said Monday at the Pop Health Forum in Chicago, a conference presented by the Healthcare Information and Management Systems Society (HIMSS).

In other words, the state has a public health crisis, thanks to limited access to healthcare services in many areas and poor nutrition and exercise habits just about everywhere. According to data Adcock presented, Mississippi had the highest percentage of adults diagnosed with diabetes in 2010 and, in 2012, spent $2.74 billion on diabetes-related medical expenses for its nearly 3 million residents.

With strong support from UMMC, Mississippi enacted a law in 2014 requiring insurance parity for both store-and-forward telemedicine and remote patient monitoring. This applies to commercial insurance as well as Medicaid.

As a result of that law, UMMC formed the Mississippi Diabetes Telehealth Network in the poor, underserved Mississippi Delta region in 2014 with locally based wireless carrier C Spire Wireless and with Intel subsidiary Care Innovations. That network is meant to increase access to care, improve patient outcomes and bring care into people’s homes with the help of remote patient monitoring.

The program consists of daily health sessions, personalized interventions, targeted education, health coaching, behavior modification and patient empowerment, explained Adcock, a nurse by training.

UMMC pays service fees to Care Innovations. Reimbursement for remote patient monitoring is set at $16 per day or $480 monthly, per the 2014 state law, regardless if it is through Medicaid or a commercial insurer, Adcock said. (Medicare, administered at the federal level, still has limited reimbursement of telemedicine services.)

Adcock gave an easily relatable example of behavior modification that actually works in the Delta: It’s a normal thing for rural residents to have an extra slice of pecan pie and then lie about it to their caregivers. But a wirelessly connected continuous glucose monitor doesn’t lie, and diabetes patients would rather not let their doctors catch them cheating on their diets, Adcock said.

Adcock reviewed preliminary data, released earlier this year, from a trial of 100 diabetic patients in the Mississippi Delta.

Of this group, medication compliance reached an almost unthinkable level: 96 percent. Mean hemoglobin A1c levels decreased by 1.7 percent and compliance with scheduled health sessions reached 83 percent.

Meanwhile, Adcock said, remote clinicians found nine new cases of diabetic retinopathy that otherwise likely would have gone undetected and untreated. The 100 participants, spread out over most of the eastern part of the state saved a total of 9,454 miles of driving to specialists in Jackson or even Memphis, Tennessee. Plus, not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184.

Those kinds of gains potentially could save Mississippi $180 million per year if 20 percent of the state’s diabetic population took part in a similar remote patient monitoring program, Adcock said.

But an expansion has to be done right. “It’s not as easy to replicate as some people think it is,” said Adcock, who joined UMMC a year ago, three months before Henderson departed.

Henderson created UMMC’s telehealth program in 2003 and vastly ramped it up in the wake of Hurricane Katrina two years later.

Sure, the program has not been without hiccups. The initial rollout of tablet computers with wired connected devices didn’t go so well. Some didn’t hook up the devices properly and others didn’t have Wi-Fi networks at home, so UMMC had to rely on manually reported data.

Diabetics “have an awful tendency for not telling you what’s real,” Adcock noted.

Now, participants receive iPad Mini tablets to patients with a cellular data package from C Spire. Any peripherals now much have Bluetooth to ensure connectivity; the Bluetooth devices Care Innovations supplies capture readings automatically.

As a whole, the Center for Telehealth now handles 100,000 virtual visits per year through 218 service locations in 35 medical specialties. When Adcock took the job a year ago, there were 170 participating sites. “It hasn’t stopped growing,” he said.

This, he said, is the result of the Center for Telehealth designing a telemedicine program outside the constraints of the traditional health system, and always having a clinical purpose behind technology decisions.

“We find a clinical issue and wrap technology around it. We don’t go out just looking for technology,” Adcock told MedCity News.

“You have to put the Triple Aim behind it,” added Matthew Runbaugh, director of national network relations for the Center for Telehealth.

Photo: University of Mississippi Medical Center