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issues related to telehealth to local stakeholders, and to coordinate Coalition activities. Conference surveys revealed a strong interest for further training and, in response, PCS developed the Advanced organizations have embarked on implementing telehealth in areas such as remote patient monitoring, telemental health and substance use disorder services, telemedicine for specialty care, and increased use of direct-to-consumer primary care telehealth products being offered to employees and health insurance subscribers in the hope of reducing unnecessary trips to emergency departments.
CHALLENGES
Telehealth is still viewed as relatively new to some Delaware physicians who cannot envision how they can use telehealth in their particular discipline and to some consumers not yet familiar with it. Yet telehealth has been around in other states such as Virginia, Alaska, California, and West Virginia, to name a few, for more than 20 years. The state’s proximity to urban academic medical centers, where many subspecialties and centers of excellence are concentrated, made access to care seem adequate at one time, delaying any obvious need for telehealth. In contrast, variables such as distance, age, lack of mobility or transportation mean today’s Delaware consumers need alternative options to driving out of state for specialized care. The need is there, but demand depends on perspective and buy-in (i.e., doctor, patient, or caregiver).
The Coalition strives to provide outreach to the community, to
physician and consumer buy-in. Where reimbursement was not widely available until passage of HB 69 and Medicaid expansion of physicians to develop telehealth programs. However, as previously noted, lack of Medicare reimbursement for telehealth in Delaware discourages some physicians from adopting telehealth as a service delivery tool. This applies not only to those physicians who strictly treat seniors, but also to clinicians who treat multiple age groups such as primary care and behavioral health professionals because they may not be willing to carve out separate services and billing processes based on payer. To add a positive, albeit complex, note, individuals with both Medicare and Medicaid may be candidates
for certain telehealth services. Delaware Medicaid has indicated it will reimburse for Medicaid-covered services for dually eligible (i.e., with both Medicare and Medicaid) individuals if a proper denial
is obtained from Medicare. Additionally, though HB 69 mandated private insurance parity, large self-insured employers protected
under the Employee Retirement Income Security Act (ERISA) are not required to adhere to state insurance reimbursement mandates.13 Fortunately, many of these large self-insured employers are reportedly following most, if not all, of the elements of the law.
When a law is passed, regulations often follow. A number of
state regulations related to telehealth are in various stages of promulgation from medicine to allied health and even dentistry. Some proposed regulations went through several iterations prior to which commented on several proposed regulations. One of the about regulatory and legislative activity in case members have a stake in the outcome of these policies, prompting some stakeholders to comment at public policy hearings. This activism may have helped to educate some regulatory board members about the the regulatory process.
DELAWARE LANDSCAPE
In addition to the earliest uses of telehealth in Delaware at CCHS and Nemours, and, later, UD NMPCC’s Parkinson’s disease telehealth clinic, the number of use cases is growing. Telepsychiatry has been implemented at organizations such as Beebe Healthcare, Mid-Atlantic Behavioral Health, and Connections. Remote patient monitoring is being used at more home health agencies such as Bayada, along with the integration of video conferencing with specialists during home health visits. Teleneurology has been implemented at CNMRI and Bayhealth conducted a telestroke pilot. And today, Nemours boasts a growing portfolio of dozens of telehealth service lines from emergency room consults to weight management services, behavioral services, and more. Additionally, Project ECHO (Extensions for Community Health Outcomes), a program of combined didactic and case review services for primary care clinicians, has been utilized at one or more community clinics for pain management and medication assisted treatment for opioid addiction.14 Project ECHO, “links expert specialist teams at an academic ‘hub’ with primary care clinicians in local communities — the ‘spokes’ of the model.”14
THE FUTURE
despite limited resources (funds); everyone who worked on the
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