The Georgia Health Policy Center recently spoke to Tim Welty, Pharm.D., a professor in the College of Pharmacy and Health Sciences at Drake University (Des Moines, Iowa), and Grant Awes, the chief operating officer of Certintell, about development of a unique telehealth model that provides wraparound services of medication risk assessment, remote patient monitoring, and pharmacist-integrated care.
To date, what has been the biggest accomplishment or win in your telehealth program?
Welty: Our approach to the telehealth grant has been very different than most of the other grantees, in that we have brought together a telehealth company that specializes remote physiologic monitoring (RPM), one that does medication risk assessment (MSR), and trying to reduce side effects and drug interactions by using a pharmacist making recommendations back to the physician. We partnered with rural hospitals and clinics, particularly Critical Access Hospitals, to identify patients in their system that they believe would benefit from the wraparound services that we are providing. So, our accomplishments have been getting all these people working together and we have seen some very impressive results in the outcomes of patients that we are targeting.
What is a tip or early learning that you would share with an organization launching a similar telehealth program?
Welty: We faced challenges around getting people to work together. Some had to do with contracting, as small hospitals and clinics in rural Iowa were not familiar with things like a data use agreement. Anybody trying to replicate what we are doing would need to work hard at helping these smaller communities understand all the contracting and agreements that have to be in place to develop this type of program. We had put a lot of effort early on into workflow — how data and patients flow into our system and feedback into their provider — which we have had to modify that a little bit, but not extensively.
Another challenge is that since we are basically an outside entity to the providers in the clinics, we need to build those personal relationships so that they buy into the program and are willing to refer patients and to respond to the recommendations that we are sending to them. Lastly, providing a multifaceted approach incorporating two services (RPM and MSRs) into one unique health program can be challenging. Ensuring the right team members are in the room to succinctly present the whole program to small hospitals and clinics in rural areas is a must.
We have now reached the point that there is one clinic that has been enrolling patients for a year and a half and they have seen the value of this and have become an advocate in terms of telling other clinics how this benefits their patients.
How do you see participation in the Office for the Advancement of Telehealth’s (OAT’s) grant program as impacting your broader telehealth or health improvement efforts?
Welty: Drake University is not a health care provider. We do have a college of pharmacy and health sciences and we are focused on training students, but also on how to develop new models of care. We see this grant as really taking us to the next level in bringing some partnerships together that allow us to impact and influence patient care.
As a pharmacist, I may be a little biased, but this grant enabled us to incorporate a pharmacy component, which demonstrates the value that a pharmacist has in improving the care of patients. We hope this helps to move forward the integration of pharmacy into the whole health care system because we have already seen positive results on the impact in patient care.
Awes: OAT’s grant program has lowered the barrier for many rural clinics to try innovative services with lower risk for themselves (e.g., costs) and higher rewards for patients (e.g., health outcomes). Without it, many clinics would not be willing to invest the time required to find partners like Drake University and Certintell, let alone implement a countywide health program.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
Welty: The pandemic accelerated understanding of the value the pharmacist brings to the health care system and the engagement of the pharmacy in meeting patient and community needs. Pharmacists were not just providing vaccinations, but in some states, pharmacists were able to do COVID testing and then initiate treatment based upon those test results. So, with this grant, we are trying to build on that demonstrated value of pharmacists and the need to have them integrated into care.
Awes: The pandemic shed a lot of light on the need for telehealth services, and now that social determinants of health are a larger focus for CMS, telehealth services, like RPM, are seen as more relevant for many patients with social barriers to improving health outcomes.
The ending of the public health emergency in May resulted in us having to remind patients there is cost-sharing for many Medicare Part B services, like remote physiologic monitoring. For many of our patients that is an excessive amount of money, and they just cannot face another bill every month. It has negatively impacted our enrollment, but it also opened up a couple of opportunities to look at other ways that we could cover that copayment. It also forced us to look how can we work most more closely with the patient to understand the value to them of the remote patient monitoring and their overall health goals. We are implementing some new approaches, some new marketing, and some new explanations to give to patients to help them understand the value of remote patient monitoring and the medication review in improving their health.