Telehealth as a tool to keep people with disabilities out of the hospital
Those with IDD may have trauma relating to hospitals, can be sensitive to change, encounter discrimination or face hurdles with communication – all of which can contribute to adverse experiences in a medical setting.
In other words, said Dr. Stephan Deutsch, chief medical officer at Partners Health Plan, people with IDD can "go downhill with hospital admission."
Based in New York State, Partners Health Plan is a managed care organization that is solely dedicated to providing support and services for persons with intellectual and other developmental disabilities.
For members of these populations, "there are barriers to accessing care across the board," said Courtney Skivington-Wolf, vice president of network development and provider relations at both PHP and its affiliated care coordination organization Care Design NY.
"There's been a lot of work to do in terms of getting these folks access to the care they need," she added.
Historically, "the IDD field has not been on the cutting edge of technology," said PHP CEO Kerry Delaney. "Telehealth has been a known technology – but for IDD [providers] it's brand new," Delaney added.
PHP sought to be an exception. Even before the COVID-19 pandemic, the team had begun to roll out a telehealth program aimed at helping patients access care without having to leave their residences.
The organization worked with StationMD, which uses a video conferencing system to connect patients with board-certified medical professionals who have experience treating vulnerable populations.
"What we put together was a pilot program," said Deutsch. Residential staff members had access to stethoscopes, pulse oximeters and blood pressure monitors, and doctors had patients' detailed history based on claims data.
"Put together, this meant that individuals or caregivers could reach out virtually for non-emergent services – and it meant the approach was very different from traditional telemedicine," he said.
"When the pandemic came along, we were fully geared up," he added.
PHP has seen significant outcomes after implementing its telehealth program, with both hospital admissions and emergency room visits decreasing since 2018. Last year, 91.6% of calls resulted in patients being treated in place, with only 8.4% being transferred to the emergency department.
"The data has been fairly dramatic," said Deutsch.
Looking forward, the PHP team hopes to implement urinary tract infection management into the continuum of at-home care, with staff members being trained in the use of dipsticks. UTIs, which can worsen into serious problems when left untreated, are just one example of issues where, as Deutsch put it, "we think we can be proactive, but it requires backup from telemedicine."
"We're trying to get more creative with the program," added Skivington-Wolf.
Overall, says the team, it's important to think of telehealth as part of holistic care.
"The tech approach has to work hand-in-hand with individualized and customized services and care management," said Delaney. "It's remarkable actually coming from my background seeing what tech is able to do for people with IDD."
"It's been a game changer and one that is so overdue," she added.
Healthcare Everywhere, Every Day
The onset of the COVID-19 crisis a year ago, with its widespread quarantines and lockdowns, offered telemedicine its moment to shine after years of under-fulfilled promise. As states look toward a post-pandemic world it's time to build on that promise.