On July 10, The Federal Communications Commission (FCC) voted on the adoption of a Notice of Proposed Rulemaking and will move forward with its Connected Care pilot program—an initiative the agency will launch to support the delivery of advanced telehealth solutions to underserved populations.
This initiative will give low-income Americans and veterans—in rural areas—access to high-tech care services from eligible healthcare providers, through broadband technology.
“With advances in telemedicine, healthcare is no longer limited to the confines of traditional brick and mortar healthcare facilities,” says FCC Commissioner Brendan Carr in a press release last month. “With an Internet connection, patients can now access high-quality care right on their smartphones, tablets, or other devices regardless of where they are located.”
Benefits of Connected Care
The FCC expects the program to benefit Americans with a number of medical conditions—cancer, diabetes, opioid dependency, high-risk pregnancies, kidney disease, pediatric heart disease, mental and behavioral health, and stroke—based on proven data from remote monitoring initiatives:
- A study of 20 remote patient monitoring trials found a 20% reduction in all-cause mortality and a 15% reduction in heart failure-related hospitalizations
- The Veterans Health Administration’s (VHA) remote patient monitoring program resulted in a 25% reduction in days of inpatient care and a 19% reduction in hospital admission
- One remote patient monitoring initiative showed a 46% reduction in ER visits, a 53% reduction in hospital admissions, and a 25% shorter length of stay
The agency also expects cost savings, citing examples from connected care investments:
- The Mississippi Delta trial resulted in nearly $700,000 in annual savings due to reductions in hospital readmissions alone. Assuming just 20% of Mississippi’s diabetic population enrolled in this program, Medicaid savings in the state would be $189 million per year.
- The VHA’s remote patient monitoring program cost $1,600 per patient compared to more than $13,000 per patient for VHA’s home-based primary services.
- A telehealth project in the Northeastern U.S. found that every $1 spent on remote monitoring resulted in a $3.30 return in savings.
Connected Care Pilot Program
Commissioner Carr announced the program last year, proposing $100 million, from the FCC’s Universal Service Fund, for the establishment of three-year telehealth pilot projects that will “measure and verify the benefits, costs, and savings associated with connected care deployments.”
He developed the idea for such a program while visiting Mississippi with Senator Roger Wicker (R-Mississippi). During his visit, he saw that the University of Mississippi Medical Center’s remote monitoring pilot program not only improved outcomes for patients with diabetes in the rural Mississippi Delta area, but also reduced costs.
The FCC has now adopted a Notice of Proposed Rulemaking for his proposed program but seeks feedback on several design issues:
- Network equipment approach
- Program structure and duration
- Metrics and data collection
- Budget distribution criteria
- Reimbursement, funding, and cost allocation
- Eligible participants, including providers and patients
This program, using the FCC’s existing Rural Health Care Program authority, will further the agency’s efforts to “connect Americans to health.”
The U.S. Census Bureau notes that about 20% of Americans live in rural areas. Accessing routine care in these areas is a challenge for low-income Americans and veterans alike. There are a few reasons:
- Social determinants of health (SDoH). For many, these barriers impact their ability to receive the care and treatment they need.
- Workplace shortages. The patient-to-primary care physician ratio is 39.8 to 100,000 people, compared to 53.3 physicians per 100,000 in non-rural areas, according to the Centers for Medicare and Medicaid Services (CMS).
- Negative operating margins and hospital closings. CMS notes that nearly 40% of open hospitals are operating on negative margins, and over 100 hospitals have closed since 2010.
Funding Broadband Services to Expand Telehealth Access in Rural Communities
Telehealth has been improving healthcare delivery, but patient connectivity issues affect it in non-urban communities. About 23 million rural Americans lack access to high-speed broadband service, the FCC wrote in its 2016 Broadband Progress Report.
The Connected Care pilot intends to bring change by funding nearly 85% of patient broadband connectivity costs. “If adopted, this pilot program could provide healthcare providers with funding needed to purchase the communications services that will support their connected care efforts and provide valuable data as we consider future policy initiatives,” FCC Chairman Ajit Pai said in a statement.
An important component to expanded telehealth access is: care coordination.
Telehealth technology will equip providers with the ability to share recorded, reported, and transmitted patient health data, including leveraged SDoH data. Care coordinators and interdisciplinary teams, may, in turn, use this information to improve communication and collaboration, between themselves and community-based organizations.
Better communication and collaboration will assist primary care physicians and community care providers in meeting their patients’ medical, behavioral, and social needs—ultimately, improving their care experiences and health outcomes.