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80% of older adults have at least one chronic disease, 77% have at least two, supporting the urgent need to increase telemedicine and digital monitoring adoption.
Since patients with chronic medical conditions are among the largest consumers of healthcare costs, telemedicine and telehealth solutions have emerged as potential cost-effective solutions to improve their management.
Approximately 80% of older adults have at least one chronic disease, and 77% have at least two, hence the urgent need to enhance and support the adoption of telemedicine and digital monitoring among Medicaid and Medicare Advantage (MA) patients. The Center for Medicare and Medicaid Services (CMS) has slowly come around to this realization, and cloud-based telehealth-based remote monitoring programs for managing chronic diseases are now reimbursable by CMS.
An Association of American Medical Colleges (AAMC) report in 2020 estimated a physician shortage in the United States of over 100,000 providers, distributed relatively evenly between primary and specialty doctors. Compounding the challenge of the physician shortage is the increased burden of chronic medical conditions.
For example, a Milken Institute report indicated that the U.S. health care costs for chronic diseases such as heart disease, cancer, diabetes, and Alzheimer’s disease totaled $1.1 trillion in 2016. When lost economic productivity is included, the total economic impact was $3.7 trillion. This is equivalent to nearly 20 percent of the U.S. gross domestic product.
Telemedicine and telehealth have been associated with improvements in patient’s HbA1c (17%, over 50% of patients)and 70% improvement in cholesterol management, important biomarkers for metabolic/chronic disease management. Telemedicine was also associated with significantly decreased wait times and improved visit attendance for patients with chronic conditions. This improved care led to 75% fewer hospitalizations and cost savings of almost $45,000 per patient per year.
Furthermore, managing a patient’s chronic condition from a distance reduces the need for office visits and in-person consultations, thereby mitigating viral transmission. Healthcare for the elderly and patients with chronic illnesses is being transformed to a virtual, home-based enterprise: a recent study indicated that a majority of MA participants used telemedicine services during the COVID pandemic, with over 90% satisfaction with the experience.
Telehealth and digital technologies are not only being used to help patients achieve long-term self-management of their chronic diseases, they can also facilitate collaboration among providers—an essential component in the management of patients with complicated chronic disease and comorbidities. This approach enhances symptom management and provides a channel to assess and improve patient compliance and adherence to prescribed regimens of care.
With around 57 million Americans currently living in a rural area, many patients across the country lack adequate access to healthcare facilities and are forced to travel long distances to see their primary care provider or specialist. Individuals suffering from chronic diseases may face additional unique challenges such as a lack of mobility or difficulties sitting in a vehicle over long periods of time. Telemedicine resolves many of these issues, including the elimination of travel expenses, allowing patients to interact with specialty physicians or other providers from the comfort of their own home.
As patients living with chronic conditions will benefit from lifestyle modifications, such as dietary changes, smoking cessation, and increased physical fitness, specialty telehealth consultations are critical to monitoring these changes. Digital devices, such as Bluetooth-enabled scales, blood pressure cuffs, and glucometers can monitor disease progression or regression. Physicians can also utilize mobile devices and live video and audio to quickly remind patients to take their medication, eat healthy, or find ways to stay active.
Inpatient hospitalizations are among the most expensive component of managing patients with chronic diseases. By providing specialists the ability to remotely monitor a patient’s condition, treatment and management can be delivered in a timely and effective manner. This decreases care costs, promotes better care coordination, and reduces stress levels for both patients and families. Physicians can therefore utilize telemedicine to quickly respond to questions regarding medications or treatments and intervene on acute conditions that arise to reduce preventable hospital admissions.
Undoubtedly, there is perhaps no more compelling benefit of telemedicine for chronic disease management than patient and provider safety, which has gained such importance during the COVID-19 pandemic. Specialty telemedicine in particular has been hailed as an imperative for CDM since it provides high quality care while still maintaining appropriate distancing measures, necessary to prevent viral transmission.
This is particularly relevant for MA beneficiaries whose underlying comorbid medical conditions place them at high risk for severe COVID-19 sequelae, yet simultaneously also necessitate relatively frequent medical consultations.