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Telehealth and Rural Practices…the Road Less Traveled

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

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  1. Telehealth and Rural Practices…the Road Less Traveled Kiki C. Nocella University of Southern California Keck School of Medicine Department of Family Medicine

  2. Rural California

  3. 75% of land mass 75% i 75% of land mass and 11% of population live in rural California 11% of population

  4. Tehachapi Valley Healthcare District

  5. State of the Region….2004 • Had a telemedicine unit since 1998 • JPA Collaborative • New TVH built by 2008, seismic retrofit

  6. 98.7% outward migration for inpatient care!

  7. 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?

  8. What sites do you think of when you think of Telehealth? • Rural hospital? • Rural Health Clinic? • Academic Medical Center? • Physician Office??????

  9. 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

  10. 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

  11. 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

  12. OK. Got the docs’ attention….but that’s not all of the challenges

  13. The “Win-Win” is at the center Hospital’s business needs Community’s Health Needs Physician business needs Health Plan Business Needs

  14. So, what was the solution? • Telehealth only part of the equation • System redesign is the approach we’ve embraced

  15. 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

  16. 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

  17. 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

  18. And reforming! • Synergistic and overlapping approaches on technologies • PHR • SCDR • Capacity building

  19. 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

  20. “Ultimately, the challenge of health care reform is the challenge of building community”Shortell, 1996

  21. 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 

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