TELEHEALTH Digital Health Care

Digital Health Care

A look at growing trends

BY DR. ROBERT KANTOR, MD AND KRISTI HENDERSON

With the COVID-19 pandemic creating necessary constraints on how, when and where people access health care, digital health resources have emerged as an important bridge helping keep health care professionals and their patients stay connected.

One recent analysis estimated by 2027 the digital health market will have grown by nearly 18% a year. This growth projectscts the potential benefit of digital health technology, including its ability to help facilitate more personalized conversations between patients and doctors based on near real-time data. As health care professionals look for ways to expand patient services and grow their practices, leveraging digital health technologies is likely to become increasingly important.

What follows are strategies health care professionals might consider during COVID-19 and beyond.

Integrating Virtual Care

The pandemic is creating a reliance on and awakening of the full potential of virtual care, opening a door to reinvent the model of care moving forward. The key is using digital heath tools to help care professionals reach, engage and build trust with patients in ways that cannot be accomplished with infrequent visits to a doctor’s office. Health care professionals can consider offering a hybrid model of both virtual and in-clinic services that can maximize the patient experience, increase quality, drive affordability and optimize clinic-space utilization.

The use of virtual care resources has surged more than 10-fold compared to before COVID-19 emerged, with more than half of consumers stating that the pandemic has increased their willingness to try virtual care. For many patients, virtual care provides a more convenient way to help connect with care professionals about various health issues, ranging from routine care and urgent health concerns to ongoing chronic condition management, and specialty services. The potential benefits are much broader than improved convenience and access. Virtual care minimizes geographic disparities seen by the 60 million Americans living in rural areas, reduces transportation challenges that are cited as the third most common barrier to care, and can remove a hurdle that makes accessing care difficult for the 40% of Americans who have at least one disability. A digitally-enabled system can minimize these inequities by delivering the right care – at the right time – in any location and ultimately create a better patient experience.

To help make that possible for their practices, health care professionals may want to evaluate offering these services through their own virtual care platform or contracting with a third-party vendor. Creating a virtual care checklist for staff members may also be helpful as this practical tool can support a smoother experience for both patients and staff. In addition, health professionals may want to take the CORE Telehealth Certificate program to ensure they are equipped with the knowledge they need to provide safe and high-quality care through telehealth.

It’s also important to keep in mind that investing in virtual care capabilities can support a practice’s progression through the continuum of value-based care and encourage success in risk-based contracts with health plans. Virtual care tools are becoming increasingly important to close care gaps and improve Healthcare Effectiveness Data and Information Set (HEDIS) scores. By improving patient access to virtual care and through other digital tools like remote monitoring, it may improve health outcomes, better identify and manage chronic conditions, improve satisfaction, enhance connections and relationships and curb costs – all important outcomes in any value-based care program. It is important to note that health plans are now embracing – and reimbursing for – virtual care. Even after COVID19 declines, it will be important for medical practices to continue offering virtual care solutions to help meet patients’ needs and expectations, and to encourage success in risk-based contracts with health plans.

Strides in technology have also made telepharmacy largely indistinguishable from traditional pharmacy. Telepharmacy can be offered through remote dispensing sites, which look and feel like a pharmacy. Prescriptions and patient counseling are overseen by a pharmacist remotely,

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via HIPAA-compliant audio/visual technology. A benefit of telepharmacy Discussing wearables and other emerging technologies with patients – is that it enables quality pharmacy services to be located in remote settings and incorporating them into a holistic treatment regimen – may encourage that otherwise could not support a full-service pharmacy. When quality them to take a more active and data-driven approach to preventing disease pharmacy services are integrated into health care settings, research shows before it starts and treating chronic conditions, if needed. medication adherence rises and hospitalization and emergency services drop. Encourage Whole-Person Health While virtual care has emerged as increasingly

Care professionals, particularly in rural important for medical care, technology is also or underserved communities, should consider changing how people access other types of services evaluating how telepharmacy can help them better serve patients and expand their care team. Leveraging digital health technologies is likely to become that may encourage whole-person health. When counseling patients, consider discussing these Consider Recommending Wearables increasingly important. other types of virtual care resources: Many Americans already rely on smartwatches Behavioral Health. With many people spending and activity trackers to help monitor their daily more time at home due to the COVID-19 pandemic movement and sleep patterns as well as help and some experiencing the stress of job loss or illness, support their efforts to improve their well-being. behavioral health issues may be more widespread. With wearables now part of our day-to-day lives, In fact, 53% of American adults reported that their some people are also becoming comfortable using them as a resource to mental health has been negatively impacted due to worry and stress related to promote wellness and help manage certain chronic conditions, including COVID-19, contributing to difficulty sleeping, poor eating habits and increases to use personal data to make more informed decisions about their care and in alcohol use. To help address these trends, virtual care has emerged as a secure daily habits. To that end, care professionals can recommend that patients and private way to connect with a qualified behavioral health care provider. check with their health plan for incentive-based well-being programs, which Through a behavioral telehealth visit that may be available through health are offered by many employers and some Medicare Advantage plans. Some plans, patients may have a real-time, audio- and video-enabled session with a programs provide wearables to eligible participants at no additional cost, behavioral health care provider, potentially including psychiatrists, psychologists, enabling them to earn financial incentives such as deducible credits by meeting certain daily activity targets. Digital Health Care to page 264

For people with type 2 diabetes, continuous glucose monitors (CGM) are another potential resource. By transmitting data about glucose levels to the patient’s smartphone or other digital device in near real-time, the patient and their care provider may be able to more easily identify relationships between ENGAN ASSOCIATES eating, exercise and blood sugar that may be difficult to observe with only test strips and a glucose meter. Some health plans across the country are starting to provide CGMs at no additional cost to members as a digital therapeutic, helping to make this technology more affordable for patients. The growing use Creating Healing Environments of CGMs is especially important amid the pandemic, as people with diabetes are at a greater risk of complications from COVID-19. Importantly, research shows for 40 Years people with existing diabetes whose blood sugar is well controlled may require fewer medical interventions and are more likely to recover from COVID-19.

In the future, other types of wearables and patient monitoring initiatives may also make a difference in the management of chronic conditions, such as heart failure. By leveraging blood pressure cuffs, scales and pulse oximeters to measure blood-oxygen levels, pulse rate and perfusion index, care professionals may increasingly be able to identify potentially serious changes and more quickly intervene, which may help to avert complications and possible hospitalizations. Likewise, some physicians are starting to recommend “smart inhalers,” which use Bluetooth® technology and mobile apps to send near real-time data back to patients and health care professionals to help them monitor medication usage patterns. In fact, a recent Northwestern study in Pediatrics found that the use of sensor-based inhaler monitoring may help improve asthma symptom control and caregiver quality of life. Additionally, to help people with asthma, physicians can consider suggesting other connected devices to measure indoor air quality, offering near real-time “We wouldn’t hesitate to work with Engan Associates again.” (Matt Reinertson, Heartland Orthopedic Specialists) feedback to help people reduce exposure to potential irritants.

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3Digital Health Care from page 24

important to remember that good oral health is a first line of defense to behavioral nurse practitioners and behavioral master’s-level clinicians. Virtual help the body protect itself from infections, systemic inflammation and behavioral health care professionals may be able to help members with various various types of disease such as diabetes and heart disease. For primary care conditions – including depression, bipolar disease, physicians, consider discussing the importance of neurodevelopment disorders, anxiety and substance dental care, and teledentisry, with your patients. use issues – and produce improved health outcomes, Eye Health. Research shows eye health contributes at the same cost, as in-person office visits. to overall health, as comprehensive eye exams may Dental Health. With dental care ranking among help with the detection and management of certain the most avoidable reasons for emergency room Dome physicians are starting to chronic conditions, including diabetes, heart disease visits, teledentistry may help patients make more recommend “smart inhalers”. and high blood pressure. informed decisions about when and where to To help improve eye care, some vision plans go for care. Through teledentistry capabilities, are enabling access to virtual care for eye exams, patients may have access to at-home telephone and using the same clinical standards, eye care provider video consultations for advice regarding dental reimbursement and coverage policies as in-person concerns, as well as help with decisions on an appointments. Virtual care can enable remote eye care professionals to appropriate setting for in-person dental care, if needed. While dental practices complete eye exams in a traditional in-person setting staffed by a licensed continue to provide routine care with appropriate COVID-19 precautions, technician. This may be a useful option when eye care professionals are virtual care resources – along with at-home hygiene habits such as brushing not available in person, especially for people with certain chronic health twice a day and daily flossing – continue to take on added importance in conditions that may require frequent eye care. For added convenience for helping people maintain proper oral health and reduce the risk of exposure routine eye care needs, patients may also consider online resources that at in-person visits. When a potential dental emergency occurs, teledentistry enable them to order prescription eyewear and contact lenses, in some cases can help evaluate the severity of the situation and guide people to their for little or no out-of-pocket costs through vision plans. own dentist, a local dentist with availability or a primary care physician. And while some people often focus primarily on their physical health, it is Hearing Health. Hearing health is also connected to overall well-being, as people with hearing loss who obtain treatment experience lower risk of depression, dementia and diminished risk of falls. Health care professionals can play a role in detecting hearing loss, including by in-person testing or by suggesting the use of publicly available online screening resources. If additional hearing care is needed, consumers can then obtain an in-person hearing test from a local, licensed hearing health professional to generate an audiogram, which may be used to purchase customprogrammed hearing aids delivered directly to the person’s home. While home-delivered hearing aids have been previously available, new resources are offering a “direct delivery with virtual care” model. Through these initiatives, people may be able to have hearing aids customized and adjusted (as necessary) through a virtual experience. This new model can reduce the need for in-person appointments for hearing aid adjustments and support, offering greater convenience and affordability compared to traditional models.

Helping physicians communicate Considering these emerging technologies – and discussing them with your patients and your health plans – may help encourage improved health with physicians for over 30 years. outcomes, curb costs and help your practices grow. Moving forward, we anticipate people to increasingly embrace a digital-first mindset, likely

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Kristi Henderson, is Senior Vice President, Center for Digital Health and Innovation, Optum. For more information, please go to uhcprovider.com