Comstock's magazine 1218 - December 2018 - Page 53

October 2017, wildfires scorched at least 245,000 acres across Napa, Sonoma, Solano and other counties — displacing doc- tors and nurses, and forcing patients, some with asthma symptoms, into shelters. “That event brought it home for me,” says Dr. Albert Chan, chief of digital patient experience at Sutter Health. “We had one woman who was pregnant and throwing up, but couldn’t get to a doctor because of the fires. But she got referred to an OBGYN through video visits.” In March 2018, Sutter Health deployed its video visits to all Sutter Health patients who use My Health Online, the health network’s online patient portal. Patients log in and the site will ask if you have one of the 18 covered conditions, such as ear problems or a sore throat. In recent years, local tech startups have also emerged to fill the gaps between providers and those who need care. For example, Craig Falk, who operates Craig Cares, a Rose- ville-based home care provider, began SensorSAFE. The startup uses pressure mats and motion sensors in the homes of seniors to provide 24/7 supervision and monitoring. This type of support could be vital in rural areas where caregivers are not available. “Just last week I received a request for an in-home care- giver in the Chester area [in Plumas County],” Falk says. “I spent days working my network of senior and caregiver or- ganizations and could not identify any caregiver services in that area.” At UC Davis, Dr. Jim Marcin, director for the Center for Health and Technology, helps to oversee several telehealth initiatives, including one focused on homecare for those with chronic conditions. Another program connects special- ists to more than 80 remote clinics in Northern California communities without access. “Now it’s more and more about delivering the care to where the patient is,” Marcin says, “whether at home, the workplace, schools and day care centers for children, or long-term care facilities for those requiring care around the clock.” One of the biggest advantages of telehealth is availability. If the patient has a nonemergency question, a phone call or video chat can connect the patient to the provider, bypass- ing the process of an in-person visit, he says. In general, the copay is the same as for seeing a patient in person — depend- ing on where the consultation takes place and the service provided — but in other telehealth cases, there is no copay, Marcin says. In previous decades, only the big health systems had the equipment and ability to communicate electronically, but these days, even the smallest clinics can connect with pa- tients in various places. With smartphone apps, wearable de- vices and health sensors, primary care physicians can track patients with diabetes, hypertension and epilepsy, among other conditions. “Telehealth hopefully helps to prevent hospitalization,” he says. “It’s about being more proactive as opposed to reactive.” THE COST OF CARE In its aims to be proactive, telehealth also presents a financial paradox. For the most part, doctors get paid to treat illnesses and take care of people, not necessarily to keep patients healthy. Take, for example, an endocrinologist — a doctor who treats diseases that affect the glands and hormones, such as diabetes. If the endocrinologist can check insulin with a blood glucose monitoring device, the patient may not need to visit the hospital as often, Marcin says. “We get paid only when we treat patients in a clinic or hos- pital setting and not when we treat the patient when they are at home,” Marcin says, speaking generally. According to the Centers for Medicare & Medicaid Services, the “home” is not included in the list of originating sites, which are locations of a Medicare beneficiary eligible for telehealth services, such as hospitals and rural health clinics. “But it’s a tough sell to insurance companies,” Marcin says. “We’re saying, ‘Hey, pay me to monitor and treat these patients when they’re in their homes, and I’m going to save you money.’ I really believe that we can save the system mon- ey using telemedicine, but health plans are slow to jump into that game without really good data.” Private insurance companies typically follow the lead of federal and state insurances when it comes to adopting health payment protocols, Marcin says. With telehealth, however, many insurers have stepped up to pay for services like remote patient monitoring before federal and state in- surances. That’s never happened before, Marcin says. As fi- nancial incentives align, he adds, more health systems will be able to realize the benefits of care that uses technology to help keep patients out of hospitals. “We have to get out of this volume-based, treat-me-only- when-you’re-sick-and-I’ll-pay-you world,” Marcin says. “Your bottom line will be better if you keep patients healthier.” THE FUTURE OF HEALTH From telepsychiatry sessions to online consultations, ad- vances in technology will continue to create more options for the delivery of health services for underserved communi- ties. UC Davis has started researching the use of automated translation tools to communicate with patients who do not speak English. These and other high-tech tools could bridge the divide in health care, but that also hinges on access to broadband December 2018 | 53