Using Telemedicine to Manage Diabetes

With the second highest rate of diabetes diagnoses in the U.S., Mississippi has a plan for delivering world-class disease management to some of its neediest residents…. 

Mississippi, which ranks second after West Virginia in the percentage of residents affected by diabetes, is taking steps to reduce devastating effects on the state economy and the overall health of Mississippians. Nearly 9 percent of Mississippians were diagnosed in 2012 with diabetes, and the $2.7 billion annual cost of diabetes represents nearly 3 percent of the state’s economy (gross state product).

In January, the University of Mississippi Medical Center and three private technology partners announced a plan to help low-income residents manage their diabetes remotely through the use of telemedicine. The goal is to help them keep the disease in check and avoid unnecessary hospitalizations while remaining active and productive.

To make the project possible, Governor Phil Bryant signed a first-of-its-kind law, enacted in March, requiring private insurers, Medicaid and state employee health plans to reimburse medical providers for services dispensed via computer screens and telecommunications at the same rate they would pay for in-person medical care.

The diabetes disease management services offered in the telemedicine project will be free to the poor uninsured participants. But under the new law, the costs of remote monitoring of other participants with insurance coverage or Medicaid will be reimbursed.

As part of the project, health workers will help uninsured participants sign up for coverage. Mississippi has not expanded Medicaid to more low-income adults under the Affordable Care Act, but some participants may qualify for traditional Medicaid or premium tax credits. The diabetes project will run 18 months and interim results will be released during its course.

Mississippi’s telemedicine law goes further than any other state to remove what the telehealth industry considers its biggest impediment – lack of insurance reimbursement.

So far, 20 states and the District of Columbia have required private insurers to pay for some telemedicine services. In addition, most states pay for certain services through Medicaid. But until Mississippi enacted its law, no state had required parity from all insurers for all types of telemedicine services. Tennessee passed a similar law this month.

How will it work? Starting in June, 200 people with diabetes in one of the state’s poorest regions, the Mississippi Delta, will be given internet-capable computer tablets loaded with software provided. The software will enable medical professionals at the University of Mississippi and a hospital in the region, North Sunflower Medical Center, to remotely monitor patients’ test results and symptoms. A third technology partner – will provide technical support for the wireless telecommunications services needed to transmit the medical data.

Local clinicians in Sunflower County are choosing diabetes patients who are the sickest in the community. The idea is to show that even patients with the least-controlled diseases can see improved health outcomes with careful monitoring.

Each patient will be given a baseline exam and a treatment program, which will require them to check glucose levels two to four times daily using a home-testing kit. The results will be transmitted to medical teams at both hospitals. Patients will also check their weight and blood pressure daily and transmit the information.

At the University of Mississippi, the medical team will include a dietitian, a pharmacist, an ophthalmologist, an endocrinologist, a diabetes education expert and a nurse practitioner, who will work with local medical providers at Sunflower Medical Center to provide a full range of specialty care for patients as needed.

By proactively monitoring blood sugar levels and other vital signs, doctors will be able to react before a patient is having more serious problems. Even if there are no unusual fluctuations in a patient’s vital signs, a member of the team will consult with patients daily using video teleconferencing to make sure they are making the lifestyle changes needed to improve their conditions.

Pew Charitable Trusts April 2014