Florida Retirement Community Adopts Telehealth as Linchpin of ACO

“Picture it: Florida, 2012. An elderly diabetic woman turns on her computer and has an online visit with her doctor to check on her blood glucose readings.” Sophia Petrillo, Estelle Getty’s character on Golden Girls, probably would have never fathomed telling this story; however, this story, unlike many of her native Sicilian tall tales, will be coming true. The Villages, the country’s largest senior residential community in the U.S., in partnership with University of South Florida (USF) Health and Boston, Mass.-based American Well, have launched an e-visit telehealth platform to begin its journey toward accountable and patient-centered care.The web-based e-visit will specifically target the 90,000 residents of The Villages retirement community in central Florida to increase access to primary and specialty care, including post-operative care, diabetes care, cardiovascular health, dermatology, mental health, and urology. This service will allow seniors and healthcare providers to have live and clinically meaningful online visits through video, secure text chat, or phone. The physician documentation from the conversation will then be transmitted to an electronic health record (EHR) to be a part of the patient record.The goal is to utilize the e-visit to reduce hospital admissions, readmission rates, and pharmacy costs, while allowing Medicare beneficiaries to remain in their homes rather than long-term care settings.“People make decisions whether or not to go to the doctor’s office based on cost, how long they are going to have to wait, on transportation, and then sometimes that decision not to go creates an emergency room visit or a readmission,” says Stephen K. Klasko, M.D., dean of the USF Health Morsani College of Medicine and CEO, USF Health. “So having that intermediate step where you can talk to a nurse or doctor and get some good information is a great advance to make healthcare more patient-centric and reduce costs.”

Stephen K. Klasko, M.D.The e-visit program is seen as a central primary care tool for The Villages Health system’s accountable care organization (ACO) initiative. “With the way that we’re working on The Villages accountable care organization, it will be the patient-centered medical homes, it will be the University [USF Health] as the specialist, it will be a private-label insurance company,” says Klasko. “It will be accountable care in the way of if we save $3 million, $1 million will go back to the insurance company, $1 million will go to the docs, and $1 million will go back into the community.”The e-visit partnership with American Well was signed last month and the infrastructure work and staffing will be completed this fall. The Villages Health system is currently interviewing a handful of insurers to partner with for its ACO initiative. The next step of the initiative will be developing a home health component, and the third stage will involve setting up biometric monitoring and allowing patients to send high-definition photos (i.e. a rash) to their specialists via the telehealth platform.The common myth that seniors do not embrace technology is something that Klasko seeks to dispel through this ACO initiative. According to a recent study from the Pew Internet & American Life Project, more than half of adults age 65 and older are online, compared to just 15 percent in April 2000. Among Internet users ages 65 and older, 70 percent use the Internet on a typical day.USF Health recently received back 32,000 paper and online responses from its own public health survey that will give its researchers a baseline of health of the population, which will then provide information to make interventions to solve specific health problems. Some early findings show that the Villages have 2,800 clubs, many of them health-related (i.e. The Airheads club for chronic obstructive pulmonary disease (COPD) patients). Klasko says this shows great community health awareness, which can serve The Villages Health system’s ACO purposes well.“The American Well relationship allows us for the first time to really be partners with the patients in healthcare,” concludes Klasko. “It allows [physicians] to get into the patients’ home at a level that we couldn’t before.”