United States: Mississippi Advances With Telehealth, Shows Promise For Improved Diabetes Disease Management

Rightly or wrongly, Mississippi is not generally regarded as a leader in health. The state, which opted out of the Affordable Care Act (ACA) Medicaid expansion, consistently ranks in the bottom two states for most health indicators: infant mortality and low birth weight, obesity, cancer deaths, and diabetes outcomes.  Mississippi, however, is making significant efforts to be  a leader in telehealth. In 2014, the state initiated The Diabetes Telehealth Network, the first program of its kind to provide remote diabetes management and specialty care to rural, medically underserved populations in the Mississippi Delta through internet-capable computer tablets. Mississippi's telehealth model is gaining national attention for its promise of significant cost-savings by preventing complications and hospital admissions while reducing the demand for expensive specialty services.

Diabetes Care in the US: A Costly Burden

In 2012, the American Diabetic Association (ADA) estimated total medical spending on diabetes at $245 billion, a 40% increase since 2007. Diabetes care consumes one in every five dollars spent on healthcare in the US, primarily through hospital and nursing home care, outpatient services, and medications.

About 29.1 million Americans, or 7% of the population, have type 2 diabetes. According to the CDC, current trends indicate as many as 1 in 3 adults in the U.S. could have type 2 diabetes by year 2050.

Mississippi Implements The Diabetes Telehealth Network

In 2012, Mississippi spent $2.7 billion on diabetes care, almost 3% of the state's GDP. In an effort to address its growing diabetes crisis, Mississippi implemented The Diabetes Telehealth Network, a pilot program that provides remote diabetes care to rural, medically underserved populations in the Mississippi Delta, a historically impoverished region where about 12% of adults have been diagnosed with type 2 diabetes. The telehealth program, which began in June of 2014, aims to reduce costs of care and improve patient outcomes through timely access to care and improved disease management to keep patients out of the hospital and avoid disease-related complications (e.g. blindness, amputations, kidney failure, stroke). The program's 200 enrollees receive 18 months of remote comprehensive specialty care through internet-capable computer tablets.

The University of Mississippi Medical Center (UMMC) runs the pilot in collaboration with Mississippi Governor Phil Bryant, North Sunflower Medical Center (NSMC), and three private technology partners. The tablet is powered by Intel-GE Care Innovations and GE Healthcare and is equipped with a high-speed mobile broadband communications network provided by C Spire.

How Does the Program Work?

Participants receive daily video consultations from clinicians at UMMC, including nurses, dieticians, diabetes educators, pharmacists, endocrinologists and ophthalmologists, who work in conjunction with local providers at NSMC. The tablet requires participants to record daily health data such as weight, blood pressure, and glucose levels using an at-home testing kit. The data is transmitted to both medical centers, allowing clinicians to remotely monitor results and symptoms and alter treatment regimes (e.g. changes to diet or medication).

The tablet also delivers daily interactive lessons for participants to learn about their disease and provides individualized guidance to resolve disease management issues.

Reducing Medical Costs and Improving Health Outcomes

The Diabetes Telehealth Network promises significant cost savings by reducing hospital admissions and in-person physician visits for specialty and routine care. In its first year, the pilot saved $339,000 in Medicaid spending and avoided an estimated 10,000 miles of travel. Prior to enrollment, participants traveled hours to receive care at UMMC, the only hospital in the state equipped to provide specialty services.

The telehealth program has also demonstrated early success in clinical outcomes. The first 100 patients had zero hospital readmissions and an average medication compliance of 96% — much higher than the s estimated 50% nationwide compliance rate. Through remote monitoring, clinicians also uncovered 18 cases of diabetic retinopathy, a diabetes complication that can lead to blindness.

Telehealth Model is Replicable, yet Legislative Barriers Remain

Despite gaining national recognition for its cost-effective diabetes care, implementation of telehealth programs like the pilot are limited by a lack of insurance reimbursement. To ensure the Diabetes Telehealth Network's viability, Mississippi Governor Phil Bryant signed an unprecedented law (enacted March 2014) that requires private insurers, Medicaid, and state employee health plan to reimburse medical providers for telehealth services at the same rate as in-person visits.

By securing reimbursement parity, the legislation opened doors for telehealth services to expand across the state and provide remote care for other chronic conditions, emergency services, psychiatric care, and neonatal care. Since Mississippi passed the law, 20 states have followed suit with telehealth parity legislation.

The pilot's leaders are confident states can easily replicate the telehealth model, especially considering the program was able to succeed in one of the most resource-scarce regions of the country.

According to Dr. Kristi Henderson, Chief Telehealth & Innovation Officer at UMMC, "If we can do it in Mississippi, where chronic disease is at its worst, where poverty is at its worst, and where transportation and workforce issues are at their worst, we can make it work anywhere."

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