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Telehealth and Rural Practices…the Road Less Traveled. Kiki C. Nocella University of Southern California Keck School of Medicine Department of Family Medicine. Rural California. 75% of land mass. 75% i. 75% of land mass and 11% of population live in rural California.
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Telehealth and Rural Practices…the Road Less Traveled Kiki C. Nocella University of Southern California Keck School of Medicine Department of Family Medicine
75% of land mass 75% i 75% of land mass and 11% of population live in rural California 11% of population
State of the Region….2004 • Had a telemedicine unit since 1998 • JPA Collaborative • New TVH built by 2008, seismic retrofit
Support and Success for Telehealth • Blue Cross of California/Wellpoint • Funded through State to develop telehealth network for Healthy Families (SCHIP) and MediCal (Medicaid). • CTEC • California Telemedicine and eHealth Center • UC Davis ….So why wasn’t it working in SE Kern?
What sites do you think of when you think of Telehealth? • Rural hospital? • Rural Health Clinic? • Academic Medical Center? • Physician Office??????
So….what was our process • Community based planning collaborative • Networking outside the rural region • Capacity Building • Lots of data gathering • Lots of key informant interviews • Provider -- Ancillary • Admin -- Office staff
How did we get the docs talking? • Trust building • Listened, and listened, and listened • Maintained confidentiality to a level that was virtually painful • And the ripple effect began – the docs kept talking – to each other and testing the trust
What the docs said (about telehealth) Only possible after much listening and trust building • Show me what is possible in a way I can get my head around – and I’ll run with it from there • Will it take revenue out of my practice? • Will it impact my relationships with my specialists? • My patients better not get billed anything extra (Translation – I don’t want to hear any complaints) • What’s in it for me? (Not said, but always there) • The hospital is just trying to compete with me
OK. Got the docs’ attention….but that’s not all of the challenges
The “Win-Win” is at the center Hospital’s business needs Community’s Health Needs Physician business needs Health Plan Business Needs
So, what was the solution? • Telehealth only part of the equation • System redesign is the approach we’ve embraced
Telehealth Solution • Rural Hospitals and Clinics • Higher cost equipment • Telehealth center that integrates with other programs • Providers (Physicians, PAs, and NPs) • Basic “talking heads” teleconferencing • More as utilization dictates • Via “Integrated Technology Association” Academic Medical Centers and other specialists • Teach them “rural” • Agree to take all patients • Specialties that were not in competition
We’re reforming – but not around the edges! • Infrastructure • Give, give, give and then get a little • Provider leadership team • Population based quality improvement • Start with the basics…playing nice and sharing • Education • Rural residency training • Rural HIT and population health curriculum • E-health alerts • CME/CEU • Some cool pipeline conversations
And reforming • Telehealth – meeting the providers’ needs • “Talking heads” at every provider’s desk • Telehealth – meeting the community’s needs • Diabetic Retinopathy • Women’s health issues • Cardiac issues
And reforming! • Synergistic and overlapping approaches on technologies • PHR • SCDR • Capacity building
Policy suggestions • Focus on the physicians • Count all costs, not just traditional costs • Implement a reimbursement model that does not further fractionate an already fractionated system
“Ultimately, the challenge of health care reform is the challenge of building community”Shortell, 1996
Acknowledgements • Thanks to Michael and Jami for pinch hitting with no notice! • Thanks to AHRQ for giving this community the reason to have this, and other, conversations • Office of Statewide Health Planning and Development – thanks for the maps! • Gregg, Lisa, George, Adil, Atif, Julie, Bill – thanks for your wisdom • Residents of SE Kern – thanks for being so open, willing, and dedicated Wish I were there