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TELEHEALTH
fee-for-service to “at risk.” Clinicians
will no longer receive the same payment regardless of the patient outcome. Medicare has developed the Merit-based Incentive Payment System (MIPS) that went into effect July 2017. This system awards “points” based on the physician’s activity in providing information and care in four domains: quality, advancing care information, improvement activities, and resource use. Clinical items that award points to the physician directly related data and disease control; quality of life; self-management programs with a focus on adherence; population health; behavior visits; and cost of medication prescribed. At the end of two years (2019), Medicare will create a “points threshold.” Providers below the threshold will have to return threshold, they will receive a 4 percent bonus. With this behavioral economic model, Medicare hopes to help clinicians adopt practice patterns that promote favorable outcomes related to adherence to treatment. Within the MIPS paradigm, all participants of care (patients, payers, physicians, pharmaceutical industry,
and technology industry) “win” with improved adherence. Enhanced outcomes from adherence may lead to greater adoption of adherence management programs such as the Asthma Adherence Pathway.TM
CONCLUSIONS
Telemedicine enables clinicians to use adherence programs and technology
for managing a large population. Improving patient adherence will serve as a keystone for improving outcomes (disease control, quality of life, and health care resource utilization).
Time Line for Developing the Asthma Adherence Telemedicine Program
The following research activities have
led to the development of an asthma adherence telemedicine program (Asthma Adherence PathwayTM).
1983-1985 Application of theophylline monitoring/behavioral strategies to address non-adherence at Pediatrics Clinic, Medical Center of Delaware.
See – Weinstein AG, Cusky W. Theophylline compliance in asthmatic children. Ann Allergy. 1985;54:19.
Weinstein, AG. Behavioral strategies to promote theophylline compliance in asthmatic children. Ann Allergy. 1985;54:563.
1988-1996 Develop Childhood Asthma Rehabilitation Program (initial inpatient and subsequent outpatient), Alfred I duPont Hospital for Children and apply theophylline monitoring with multiple behavioral strategies (family therapy, self- management, behavioral modification) to improve adherence and psychosomatic symptoms. (See Tables 1 and 2.) The year prior to admission to the inpatient program, the 59 children had a median cost of $10,240: seven hospital days, and four emergency room visits. At all four years of follow-up, the median hospital and ER visits were zero and the cost at the fourth year was below $2,000.
See Weinstein AG, Faust D, Padman R. Family centered short-term rehabilitation for severe childhood asthma. Del Med J. 1991;63:67.
Weinstein AG, Faust D, McKee L, Padman, R. Outcome of short-term hospitalization for severe asthmatic children. J Allerg Clin Immunol. 1992;90:66-75.
Weinstein AG, McKee L, Stapleford J, Faust D. An economic evaluation of short- term inpatient rehabilitation for severe asthmatic children. J Allergy Clin Immunol. 1996;98:264-273.
Weinstein AG, Chenkin C, Faust D. Caring for the severely asthmatic child and family: a family-focused inpatient psycho-educational approach: a case report. Fam Syst Health. 1997;15:175-183.
1998 Develop Asthma Adherence PathwayTM (AAP) Software program for Personal Computer to help asthma patients (adult and child) and clinicians improve asthma control and quality of life 1998-2000.
• DESCRIPTION
- Internet-based adherence disease
management patient questionnaire
- Permits review by patient clinician
- System recommends specific actions
to both patient and clinician based on that patient’s input
• PATIENT INPUTS
- Self-reported adherence
- Barriers: Attitudes/behaviors about
disease management
• PATIENT RECEIVES
- Asthma and adherence education - Written and video to reinforce
physician intervention
• CLINICIANS RECEIVE
- Prior training on how to best use AAP
including instruction in Motivational
Interviewing/Shared Decision Making - AAP provides analysis and recommends Clinical Decision Support interventions
unique to each barrier identified
2000-2002 Blue Cross Blue Shield Asthma Monitoring Project for adults and children with severe asthma
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