For those who don’t know CoBank, it’s a bank that specializes in loans to telecom and electric cooperative but which also has funded numerous rural fiber projects for other borrowers over the years. In August CoBank filed comments In FCC Docket 18-213 in support of expanded use of the Universal Service Fund for rural telemedicine. CoBank is a huge supporter of telemedicine and has made substantial grants to telemedicine projects dealing with diabetes management, opioid abuse, prenatal maternity care, and veteran care.
As part of that filing, CoBank discussed a telemedicine trial they had sponsored in rural Georgia. The trial was conducted in conjunction with Perry Health, a software provider and Navicent Health, a healthcare provider in Macon, Georgia. The trial was for 100 low-income patients with uncontrolled Type 2 diabetes. These patients were on a path towards kidney failure, amputation, loss of vision, and numerous other major related health problems. These are patients who would normally be making numerous emergency room visits and needing other costly medical procedures.
In the trial, the patients were provided with tablets containing Perry Health software that provided for daily interaction between patients and Navicent. Patients were asked to provide daily feedback on how they were sticking to the treatment regimen and provided information like the results of blood sugar tests, the food they ate each day, the amount of daily exercise, etc. The tablet portal also provided for communication from Navicent asking patients how they generally felt and providing recommendations when there was a perceived need.
The results of the trial were hugely positive. In the trial of 100 patents, 75% of the patients in the trial showed a marked improvement in their condition compared to the average diabetes patient. The improvements for these patients equated to reduced health care costs of $3,855 per patient per year through reduced doctor visits and reduced needs to make emergency room visits. The American Diabetes Association says that patients with Type 2 diabetes have 2-3 times the normally expected medical costs, which they estimate totals to $327 billion per year.
Patients in the trial liked the daily interaction which forced them to concentrate on following treatment plans. They felt like their health care provider cared about how they were doing, and that led them to do better. After the trial, Navicent Health expanded the telemedicine plan to hundreds of other patients with Type 2 diabetes, heart failure, and Chronic Obstructive Pulmonary Disease (COPD).
One of the interesting outcomes of the trial was that patents preferred to use cellphones rather than the special tablets. The trial also showed the need for better broadband. One of the challenges of the trial was the effort required by Navicent Health to make sure that a patient had the needed access to broadband. To some degree using cellphones gives patients easier access to broadband. However, there are plenty of rural areas with poor cellular data coverage, and even where patients can use cellular data, the cost of cellular data can be prohibitive if heavily used. Landline broadband is still the preferred connection to take advantage of unlimited WiFi connections to the healthcare portal.
One thing that struck me about this study is that this sounds like it would be equally useful in urban areas. I’ve read that a lot of healthcare costs are due to patients who don’t follow through on a treatment plan after they go home after a procedure. The Navicent Health process could be applied to patients anywhere since the biggest benefit of the trial looks to be due to the daily interface between patient and doctor.
The FCC has already pledged to increase funding for the rural medicine component of the Universal Service Fund. However, that funding is restricted. For example, funding can only be granted to rural non-profit health care providers.
Telemedicine has been picking up steam and is seeing exponential growth. But telemedicine still only represents just a few percentages of rural healthcare visits. The primary barrier seems to be acceptance of the process and the willingness of health care providers to tackle telemedicine.