Jana Cason; Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform. Am J Occup Ther 2015;69(2):6902090010. https://doi.org/10.5014/ajot.2015.692003
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© 2021 American Occupational Therapy Association
Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners.
Section 3022 [Medicare shared savings program]: (G) The ACO [Accountable Care Organization] shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.Section 10328 [Improvement in Part D medication therapy management programs]: (i) An annual comprehensive medication review furnished person-to-person or using telehealth technologies (as defined by the Secretary) by a licensed pharmacist or other qualified provider. . . . (ii) Follow-up interventions as warranted based on the findings of the annual medication review or the targeted medication enrollment and which may be provided person-to-person or using telehealth technologies (as defined by the Secretary).Section 10333 [Community-based collaborative care networks]: (E) Expand capacity, including through telehealth, after-hours services or urgent care.Section 10410 [Centers for Excellence for Depression]: (D) use electronic health records and telehealth technology to better coordinate and manage, and improve access to, care, as determined by the coordinating center.
Section 3022 [Medicare shared savings program]: (G) The ACO [Accountable Care Organization] shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.
Section 10328 [Improvement in Part D medication therapy management programs]: (i) An annual comprehensive medication review furnished person-to-person or using telehealth technologies (as defined by the Secretary) by a licensed pharmacist or other qualified provider. . . . (ii) Follow-up interventions as warranted based on the findings of the annual medication review or the targeted medication enrollment and which may be provided person-to-person or using telehealth technologies (as defined by the Secretary).
Section 10333 [Community-based collaborative care networks]: (E) Expand capacity, including through telehealth, after-hours services or urgent care.
Section 10410 [Centers for Excellence for Depression]: (D) use electronic health records and telehealth technology to better coordinate and manage, and improve access to, care, as determined by the coordinating center.
At one extreme, the focus is on health outcomes in populations defined by geography or similar factors. . . . At the other extreme, “population health” refers to accountability for health outcomes in populations defined by health care delivery systems such as health plans or [ACOs]. (p. 2)
The Remote Interventions Improving Specialty Complex Care Model study, funded by CMMI in 2014, will use telehealth technologies for remote patient monitoring to improve access to health care services for people living in underserved areas (CMS, 2014). It is not evident whether occupational therapy will be part of this project, but clearly it should be. Potential roles for occupational therapy in such a model are remote assessment of the physical environment (e.g., fall risk assessment and management); establishment of healthful habits and routines to promote positive health practices, such as medication management; mitigation of behavioral risk factors; patient education and activation for self-management of chronic diseases; and facilitation of improved occupational performance and QoL (AOTA, n.d.-b).
The Avera Virtual Care Center: Improving Care & Reducing Costs for the Vulnerable Elderly Population study will use telehealth technologies to connect an interprofessional geriatric team to more than 30 LTC centers to enhance assessment capability, promote access to care, and improve care transitions.
The University of Illinois CHECK (Coordination of Healthcare for Complex Kids) study will improve access to care for patients where they “live, work, and attend school . . . and will use multiple tools, including technology . . . to build bridges between care sites, care providers, and the family” (CMS, 2014, p. 4).
The San Diego: A Heart Attack and Stroke Free Zone study will use telemonitoring via emerging wireless and other technologies to monitor patient progress in reducing biological risk factors and compliance with a wellness plan. The study incorporates telehealth technologies to improve population health by preventing heart attack and stroke in a high-risk population.
The Rural Clinically Integrated Network to Improve Heart Health and Stroke Survival for Rural Kansas study will use telehealth as a means to provide population health management and care coordination and to prevent stroke.
The VillageCare’s Treatment Adherence Through the Advanced Use of Technology study will promote population health among people living with HIV/AIDS using a variety of telehealth technologies to increase access to services and improve engagement and retention in care.
The University of California San Francisco and University of Nebraska Medical Center study Dementia Care Ecosystem: Using Innovative Technologies to Personalize and Deliver Coordinated Dementia Care is designed to improve population health of people with dementia through telemonitoring using smart phones and sensors to detect and intervene to achieve changes in functional status. This study aims to “improve satisfaction with care, prevent emergency-related health care costs, and keep patients in the home longer” (CMS, 2014, p. 13) and pairs telehealth technologies with health care to achieve the Triple Aim of improved care experience, population health, and affordability of care.
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