Telehealth and Underserved, Vulnerable Populations: Prisons, Schools, Military, Seniors

Enzyme Health Team June 12, 2019
Telehealth and Underserved, Vulnerable Populations: Prisons, Schools, Military, Seniors

Learn the tremendous impact telemedicine is having on access to healthcare in correctional facilities, in schools, for the military, and for seniors.

Besides simply delivering convenience, telehealth is helping to close the healthcare disparity gap in traditionally underserved and vulnerable patient populations. From cost and time-savings to greater access to care, telemedicine is helping bridge the gap between patients and providers that distance, economic status, and legal status may have prevented in the past.

Here we explore four domains where telehealth is showing the most promise for underserved or vulnerable patient populations: in prisons, in schools, for military personnel, veterans, and their families, and for the elderly.

Telemedicine in Prisons

Telemedicine was first used in prisons in Florida in the late 1980s, but the technology was limited at the time and the program never gained traction. Now, telemedicine is actively being implemented in state prisons across the country to address the challenge of bringing affordable healthcare to this vulnerable population.

Barriers to inmate healthcare

It’s a myth that prisoners receive free medical care. In most states, inmates can receive healthcare services but prisoners are still required to pay a copay. Not only can this deter incarcerated individuals from receiving preventive care, but unmanaged chronic conditions end up costing the system - and the patient - even more. In addition, coordinating prisoner transport for specialty care services is expensive, time-consuming, and logistically complex which can delay care.

Implementing telemedicine in correctional facilities

In New York City, NYC Health + Hospitals has partnered with the city’s 12 jails to improve access to specialty care for inmates. The correctional facility telemedicine program covers specialist services including urology, rheumatology, pulmonary, and gastroenterology, as well as behavioral health, substance abuse, and chronic care management.

And in Texas, the state with the largest inmate population, telemedicine is thought to be a contributor to the state’s relatively low per capita spending on prisoner health.

Benefits of telemedicine in prisons include:

  • Increased safety for care providers

  • Quicker access to care for inmates

  • More cost-effective treatment

  • Time and cost-savings for correctional facilities

  • Access to distant specialists

Used as a supplement for inmate care, rather than a substitution, telemedicine offers access to services and providers that inmates normally wouldn’t have.

Telehealth in Schools

For population health management, bringing care to the places where people need it most is one of the keys to preventing outbreaks of transmittable viruses like the flu. And where better than public schools to stop the spread of infectious illnesses like flu, colds, or strep throat. But with only 40% of elementary schools staffed by a full-time school nurse, providing rapid treatment or diagnosis can be near impossible.

Telemedicine programs in schools are showing promise in facilitating delivery of rapid diagnosis and treatment plans for urgent care needs as well as chronic care management and behavioral health services. For conditions like asthma and diabetes, research has shown telemedicine care management programs in schools improve healthcare outcomes better than controls and are serving as a model for sustainable care management for school children.

Implementing telemedicine in schools

In Rochester, New York, a telemedicine program called Health-e-Access provides healthcare services to all 37 elementary schools in the region. Established in 2001 in just three childcare centers, the program has grown and has provided more than 13,000 telemedicine visits since program initiation. Visits are facilitated by school nurses and mobile telemedicine techs who come on-site and sometimes are conducted with the child’s own pediatrician. Within about an hour, children can be seen by a doctor, prescriptions ordered if necessary, and results sent to the child’s pediatrician - all without mom or dad needing to leave work and head to the doctor’s office.

Telemedicine and the Military

For many years, telemedicine has been used by the military to deliver healthcare services to active- and non-active duty service members as well as their families across the globe. The US Army accounts for nearly 90% of military telehealth visits averaging over 5,000 visits per month across 22 timezones and more than 20 medical specialties.

Recently, the DOD and the VA are expanding their telemedicine programs in an effort to increase access to care and potentially reduce costs. Last year, the VA initiated its Anywhere-to-Anywhere Healthcare program allowing VA-affiliated providers to provide virtual care to veterans across state lines without adhering to telemedicine licensing requirements. And in the past few years, the DOD has removed restrictions on where patients can receive care, opening up home-based telemedicine visits as an option for service members, veterans, and family members.

How the military is using telemedicine outside the US

Beyond providing healthcare services to members within the continental United States, the military has leveraged telehealth technology to provide care to service members and citizens across the globe.

After Hurricane Maria devastated Puerto Rico in 2017, US Army mobile medics leveraged telemedicine to provide on-demand, synchronous critical and specialty care to residents via providers from Fort Sam, Fort Gordon, the Naval Medical Center in San Diego, and the US Naval Ship Comfort.

In Europe, the Landstuhl Regional Medical Center in Germany delivers virtual healthcare to US Army, Navy, and Air Force service members across 20 bases in Italy, Germany, and Turkey. Beginning in 2010 just for behavioral and nutritional health, the program now serves over 40 specialties, has a 98% satisfaction rate, and has saved 1.5 million dollars in travel costs.

Telehealth and the Elderly

Known as the “silver tsunami”, retiring baby boomers entering Medicare are predicted to swell and add additional healthcare needs to an already strained healthcare system. Facing mobility issues, a higher rate of chronic conditions, and lack of transportation, seniors are a prime population group to benefit from the accessibility of telemedicine services.

And seniors aren’t as technologically impaired as many of us think. In fact, a recent AP poll on long-term care found that nearly 9 out of 10 Americans over 40 would be comfortable using at least one type of telemedicine.

Remote patient monitoring tools are especially useful within this patient population as RPM technology can help identify unusual health activity like high blood pressure and healthcare services can be quickly deployed.

The Promise of Telemedicine

Telemedicine’s promise of greater accessibility and cost reduction pales in comparison to the potential impact on telemedicine can have on health outcomes and population health at large. By leveraging technology to deliver care to our most vulnerable and underserved citizens, telemedicine can truly establish its place in modern, patient-centered healthcare delivery.

To get started making an impact and join the telehealth movement, sign up with Enzyme Health and start learning about clinical telehealth positions tailored to you.