The Coronavirus Stimulus -- A Step in the Right Direction

Leslie Krigstein


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But we need a comprehensive strategy centered on remote monitoring and management

The swift action of Congress and the Administration to approve the $2 trillion Coronavirus Stimulus, or CARES Act, will deliver the emergency aid and economic relief Americans need to get through this first phase of the COVID-19 pandemic and its economic shock waves. It provides essential relief for our nation’s overwhelmed hospitals while lifting some regulatory barriers that have stood in the way of people accessing telehealth screening and remote monitoring from the safety of their homes. But while this stimulus is a great step, we need to do more to support the present and future health needs of our most vulnerable populations.

We know that the 147 million Americans living with diabetes and other chronic conditions, while no more susceptible to COVID-19, are at greater risk of complications from the virus, and constitute our vulnerable populations. In New York City, the current US epicenter of the virus, it is reported that people with underlying chronic health conditions account for more than 90 percent of deaths. To mitigate this dire situation, we must do everything possible to keep these people away from hospitals and ERs while delivering the remote monitoring and targeted guidance needed to keep them safe and healthy through the pandemic.

The stimulus plan takes some steps to advance this cause, acknowledging the critical role digital health can and must play in caring for these vulnerable populations. In particular, it removes barriers and expands access to telehealth services, which have emerged as a safe and cost-effective alternative to in-person COVID-19 screening and triage. Relevant provisions in the stimulus bill include:

  • Easing current Medicare telehealth requirements during the COVID-19 emergency period to enable beneficiaries to access telehealth, including in their home, from a wider range of providers.
  • Reauthorizing Health Resources and Services Administration (HRSA) grant programs that promote the use of telehealth technologies.
  • Reauthorizing HRSA grant programs to strengthen rural community health at this time of heightened need. Rural residents are disproportionately older and more likely to have a chronic condition, which could increase their risk for more severe illness if they contract COVID-19.
  • Allowing high-deductible health plans (HDHP) with health savings accounts (HSA) to cover telehealth services prior to a person reaching the deductible.
  • Allowing Federally Qualified Health Centers and Rural Health Clinics to provide and receive Medicare reimbursement for telehealth services during the COVID-19 emergency period.
  • Encouraging the use of telecommunications systems, including remote monitoring, for Medicare Home Health Services during the COVID-19 emergency period.

While these are much-needed and worthy provisions, they are not enough. In the midst of this pandemic, we’ve seen how telehealth can fill a demonstrable need by providing convenient care virtually, limiting trips to clinics and hospitals and reducing risks from exposure. But telehealth alone will not get us the scale, efficacy, and cost-effectiveness we need to keep Americans with chronic conditions safe and healthy through COVID-19 and beyond.

Instead, these times call for a more comprehensive, cost-effective, and tech-first strategy -- what we call Remote Monitoring, Managing, and Testing (RMMT). In this approach, we combine condition-specific data insights with highly and specially trained professionals to deliver an enhanced experience that is available exactly when and where people need it, and more accessible and personalized than simply accessing a doctor remotely. RMMT begins with using remote monitoring to understand the unique and changing health needs of those living with chronic conditions, enabling them to remotely share information with their physician, care team, and family members. From there, we need to give people the tools to manage their conditions, including personalized digital coaching, insights, and 24/7 remote access to certified health coaches, therapists, providers, and behavioral specialists. Finally, as vulnerable populations experience symptoms consistent with COVID-19, we need to ensure we can keep them safely at home until their medical needs dictate otherwise. For those with chronic conditions, this means provisions such as reimbursing for eHbA1c (estimated hemoglobin A1c), a recognized and effective proxy for an in-person blood-draw.

The COVID-19 pandemic presents us with a historic opportunity to reevaluate our health system, and its ability to address the urgent and unique demands of our nation’s most vulnerable citizens. This is clearly an opportunity for telehealth to step up and show how it can help, and the stimulus plan is pivotal in clearing the way for it to do so. But remote monitoring and management are essential components of the comprehensive solution as we look to scale virtual care and provide solutions for people to manage their health outside the physical bounds of our healthcare system. Through thoughtful implementation and a strong clinically backed approach, remote monitoring creates a great experience that makes it easier for people to stay healthy throughout all stages of their care journey. When we look back on this time, we’ll either view the current stimulus as a well-intended, but incomplete fix, or a decisive turning point toward an entirely new standard of care.

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