health care,
education and
social services

health care,
education  and
social services

Distance is No Longer an Obstacle to Care

AmeriHealth Partnership Enables Mary’s Center to Provide Telemedicine Services.

While telemedicine is not a new service in many parts of rural America, where a scarcity of healthcare providers makes the distance patients must travel to get care an access problem, it is traditionally not the norm in urban areas.  But even in these urban areas, patients face numerous obstacles that make it difficult for them to access necessary healthcare appointments, including transportation barriers or lack of childcare services. Whatever the reason, we know that skipping important healthcare appointments may lead to poor health outcomes.  With this in mind, Mary’s Center is bringing elements of what has worked well in rural areas to population-dense Washington D.C.  By harnessing the power of technology, we are bringing Mary’s Center providers into our participants’ homes to deliver timely and critical healthcare services – that’s urban Telemedicine.

“Telemedicine,” or “Telehealth” as it is sometimes called, is defined in a few ways; Mary’s Center’s follows the D.C. law in defining telemedicine as “the delivery of healthcare services using interactive audio, video, or other electronic media used for diagnosis, consultation, or treatment.” At Mary’s Center communication between providers and patients using audio-only telephones, email or fax messages does not constitute a “telemedicine” encounter. * 

The Mary’s Center Telemedicine Team focuses its efforts primarily on patients who have at least one of the following diagnoses: diabetes, hypertension, asthma and/or congestive heart failure.  We chose these diagnoses because clinical evidence strongly indicates that regular clinician management and follow-up of these diseases results in improved short- and long-term health outcomes.  Based on our providers’ clinical judgment and knowledge of their patients’ unique needs and circumstances, patients with other chronic conditions may be identified as good candidates for telemedicine as well. Conversely, not every patient with one of the four targeted diagnoses is appropriate for Telemedicine, since not every patient’s insurance will pay for Telemedicine visits. The Mary’s Center Telemedicine team will reach out proactively to patients who qualify for the program, and providers will be discussing Telemedicine as an option for future encounters with their patients who qualify.

A Mary’s Center home visitor – who is a certified medical assistant or nurse with experience in direct patient care and home visiting – travels to patients’ homes with a kit full of screening and diagnostic equipment, along with a laptop computer that allows the provider to see and talk to the patient through a secure video teleconferencing platform in real-time.

Other than the setting, the telemedicine visit is very similar to what a patient experiences if they go to the clinic. The home visitor takes vital signs and asks questions about recent health history to update the electronic medical record for the provider’s review and notifies the provider electronically when the patient is ready to be “seen.” The home visitor launches the video teleconferencing software and the patient and provider see and speak with each other on the computer screen. In addition, the home visitor has special equipment – a variety of “scopes” – that allow the provider to examine the patient – just like in the clinic. The provider can, for example, listen to breath and heart sounds, look inside the ears, nose, or throat, take a close look at skin – even though she is in a different building, in a different part of town! All of this is done over a secure internet connection so that we can ensure the privacy and security of patient health information. 

After the provider finishes her examination and discussion, she may order the home visitor to collect a blood or urine sample or perform other diagnostic tests, like checking blood sugar – again, just like in the clinic! The Telemedicine team aims to do as much as possible while in the home, since the whole idea of telemedicine is to make getting healthcare as easy as possible for patients who have access barriers.

Mary's Center Telemedicine program was launched thanks to an early partnership with AmeriHealth, one of D.C.’s Medicaid Managed Care Organizations (MCO). In addition to serving AmeriHealth patients, we will soon bring the program to Trusted enrollees, another Medicaid MCO. As the program grows and shows success, we hope to expand our work to other insurers in the future. 

As we grow and can demonstrate the value of Telemedicine to payers in an urban setting, we expect that many insurance companies will begin to reimburse us for Telemedicine encounters. So even if your insurance company does not reimburse for Telemedicine today, we are hopeful that many more in our community will be served through Telemedicine soon.

For questions about Telemedicine at Mary’s Center, please contact Ellen Evans, clinical director for Telemedicine at ellenevans@maryscenter.org.

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