Can home health visits help keep people out of the ER?
Telemedicine isn’t just for rural areas without a lot of doctors anymore. In the last few years, urban areas all over the country have been exploring how they can connect to patients virtually to improve access to primary care and keep people from calling 911 for non-urgent problems.
In Washington D.C., Mary’s Center, a community health center, is piloting a program to provide primary care virtually to Medicaid patients who can’t make it in to any of their clinics. Sometimes there are mobility or childcare issues, some people may not be able to get time off of work. Others simply don’t want to go.
Dennis Lebron Dolman was in the latter group. He went to a health screening fair over the summer, where Mary’s Center medical assistant Grace Kelly took his blood pressure. It was dangerously high: 180 over 100—stroke-level high. He had no idea it was that bad.
Despite those scary numbers, he didn’t want to go to a doctor and get treatment. So Kelly, who was working at the health fair, talked him into an alternative: she would come to him, with a clinic in a suitcase (a scale, blood pressure monitor, virtual stethoscope), and a laptop to connect virtually with a doctor across town. All of it is paid for by Trusted Health Plan, one of D.C. Medicaid’s managed care organizations, which has partnered with Mary’s Center to cover home visits like this one as part of the pilot program.
Kelly has met with Dolman for several telemedicine appointments over the past few months.
Dolman’s doctor is Gita Agarwal, she’s in an exam room at Mary’s Center in the Adams Morgan neighborhood of Washington, sitting in front of her laptop camera. She can see Dolman and check out all the vitals that Kelly has just entered into his virtual chart.
This sort of exchange aimed at connecting patients with different healthcare providers and services that can help them is the real promise of telemedicine in D.C., according to Erin Holve, the director of healthcare reform and innovation at the D.C. Department of Health Care Finance.
“It’s still early days for telemedicine, but there are lots of reasons to believe that establishing the kind of relationship between a patient and provider and having that continuity of care will ultimately reduce some of the non-emergent visits to the E.R.,” she says.
That’s key for D.C., which has the highest per capita 911 call volume in the country. Mary’s Center pilot program grew out of AmeriHealth, a Medicaid managed care organization in D.C., approaching the health center and wanting to brainstorm how to get the District’s unnecessary emergency visits down. Now, the program has expanded to Medicaid patients like Dolman who have Trusted Health Plan.
The managed care organizations get incentives from the city if they reduce ER overuse. And the D.C. council is considering legislation that would expand reimbursement for these types of visits.
Elsewhere, one of the big barriers to telemedicine has been working across state lines; the doctor has to be licensed in the same state as the patient. By working with local patients who would be eligible to come in to the clinic, Mary’s Center sidesteps that problem.
But the push for telemedicine in the District is about more than just reducing ER visits, Holve says. It’s about improving the health of Medicaid patients in the long run. “That’s really what we’re banking on,” she says. “That we’ll measure improvement in quality of care and that we’ll see an ability for our patients to get healthy and stay healthy.”
