As telehealth utilization and policies continue to adjust to ensure patient access to remote care, recent research and resources have been released, which highlight telehealth’s ability to improve chronic illness management and prevention. Addressing the rise in chronic conditions and improving the overall health of Americans has also been a strong focus of the new federal administration, as can be seen through the recent establishment of the Make America Healthy Again Commission and the restructuring of the Department of Health and Human Services (HHS) around the priority of ending chronic illness in America. Telehealth also appears poised to serve a promising role in the process, as covered in the research and resources below, though telehealth policy must be considered carefully to ensure telehealth remains fully accessible.
CHRONIC CONDITION CARE ACROSS MODALITIES
A new JAMA Network study, Variability in Primary Care Telehealth Delivery Methods Across Chronic Conditions, seeks to provide a guide for the most effective uses of telehealth across various conditions. While many studies often look to assess the sociodemographic characteristics associated with telehealth use, the authors of this particular study aimed to also determine the influence of specific clinical conditions and whether certain chronic illnesses are more or less likely to be effectively managed via telehealth.
Using Veterans Health Administration (VHA) data, the study assessed in-person, video, and audio-only primary care encounters across 39 common chronic conditions. Study findings include:
- The top 5 conditions across all modalities: hypertension; hyperlipidemia; diabetes; anxiety, depression, or post-traumatic stress disorder (PTSD); and lower back pain.
- Conditions with the highest percentage of video-based care: HIV/AIDs; migraine; traumatic brain injury; and multiple sclerosis.
- Conditions with the lowest percentage of video-based care: Deafness and hearing impairment; peripheral vascular disease; and ischemic heart disease.
- Telephone care was more common than video across all conditions except migraine encounters.
- Conditions with the highest percentage of telephone care: Spinal cord injury; pneumonia, and mobility impairment.
- Across all chronic conditions, the probability of an encounter occurring in-person was 83.2%, via telephone was 11.1%, and video was 5.8%.
- Three conditions had a higher probability of being conducted via video/telephone telehealth: Heart failure, HIV/AIDs, and mobility impairment.
The authors note that, understandably, many of the conditions that were acute or dependent on physical examination/testing (such as lower back pain, chronic obstructive pulmonary disease, kidney disease and asthma), were less likely to be performed via telehealth. Conversely, conditions associated with physical immobility (such as mobility impairment and dementia), transportation burden, and conditions not as dependent on physical examination, had a higher likelihood of being video-based. Additionally, conditions including Parkinson’s disease and traumatic brain injury had a higher probability of being managed via video rather than telephone, highlighting the value of the visual assessment provided via video telehealth. The study’s discussion also underscores the role that patient characteristics play in many of these findings, and potential limitations of the evaluation related to the focus being solely within the VHA population.
In addition to the population focus, another potential limitation of the study may be the limited telehealth modalities considered, as the VHA evaluation focused only on in-person, video, and audio-only visits. It is possible that policies restricted availability of other modalities, or classify remote evaluations and monitoring, for example, as communication technology-based services (CTBS) codes and separate from telehealth, similar to Medicare. However, with chronic illnesses in particular, effective ongoing care and complication prevention often rely on additional technological modalities outside of just video and telephone visits, such as asynchronous telehealth and remote patient monitoring. For instance, the Department of Health and Human Services (HHS) telehealth website includes a best practice guide for managing chronic conditions through telehealth. The guide clearly notes that telehealth treatment options vary depending on condition as well as modality. Specific benefits are mentioned for video appointments, such as routine check-ins for patients with cancer and diabetes, as well as asynchronous messaging of symptoms and food/exercise logs, and remote patient monitoring of blood pressure and blood sugar levels. Therefore, focusing research around all chronic condition care modalities, including all technological and in-person delivery methods, may be of value. Additionally, it will be important to factor in the role of state and federal policies in the process, to determine the extent that they may either promote or limit access to certain modalities of care being considered.
Best practice guides additionally available through HHS’ telehealth website cover:
Patient-focused resources on using telehealth for chronic conditions are also provided by HHS, as well as patient resources tailored for:
ADDITIONAL RESEARCH & POLICY CONSIDERATIONS
The Community Preventive Services Task Force (CPSTF), which focuses on developing guidance around disease prevention and intervention, offers additional recommendations around utilizing telehealth interventions to improve chronic disease based upon systematic evidence reviews. CPSTF has found that telehealth interventions related to cardiovascular disease issues can improve medication adherence and clinical outcomes (such as blood pressure control), as well as dietary outcomes (such as patients eating healthier foods). In addition to highlighting the value of different telehealth modalities in reducing chronic disease risk factors and managing chronic conditions, such as messaging and monitoring, CPSTF notes that definitions and policies about each modality and what can be covered via telehealth by payers varies widely across jurisdictions, which may limit telehealth delivery for particular patients and conditions (see CCHP’s Policy Finder tool for specific state and modality information). Therefore, while it is important to understand where telehealth may yield the most patient benefit, it is also important to understand how policies may inadvertently limit both the research and benefits if they do not provide enough flexibility around telehealth utilization and accessibility.
CONCLUSION
These research and resources showcase the opportunities and potential that telehealth provides in the management and prevention of chronic conditions. As providers and policymakers assess activities to promote healthy habits and improve health care efficiencies, increasing education around, and allowances of, these tools to better understand the most effective ways to deliver care will be vital to additional advancements in telehealth utilization, public policy and the health of all Americans.
For more information on the recent JAMA study, please review the Variability in Primary Care Telehealth Delivery Methods Across Chronic Conditions article in its entirety. For more information on the CPSTF review, please see their telehealth interventions to improve chronic disease webpage. To access the HHS telehealth resources tailored to addressing chronic diseases, please visit the HHS telehealth website. As always, state and federal policies applicable to care provided via telehealth remain accessible by both topic and jurisdiction in CCHP’s Policy Finder.
