This interview with Dr. Peter Antall, President and Medical Director, Amwell Medical Group and Chief Medical Officer with Amwell focuses on telehealth for chronic care management, the patient experience and why Government should focus on the solution.

Telehealth for Diabetes

Diabetes is a monumental dilemma for Healthcare with nine percent of Americans currently affected. The Veterans Affairs system is disproportionately affected with about 24 percent of Veterans impacted. Diabetes is one of Healthcare’s biggest problems and it’s getting worse, not just in the numbers of patients but because those affected are sicker than they used to be and because the growing numbers means we just don’t have enough specialists to treat them.

Telehealth began as a way to make urgent care in the home more widely available, but we see that as the tip of the iceberg. What it really offers is access to care wherever and whenever it is needed for emergent issues and also for things like remote patient monitoring and for specialty services on the subacute side. This technology can help load balance, improve access, and ease in managing case load for those specialists we do have in the field.

Why Should Government Focus on Implementation?

Diabetes is not only a major problem impacting Veterans, but it’s also a key health metric for the Military. Right now, they are falling on par or slightly below par of their performance metrics for diabetes A1c testing. Telehealth can provide an avenue for improving diabetes care for active and retired Military and their families.

Additionally, Government programs can function as payers who need to combine both delivering the best care possible and doing it at a lower cost. Telehealth can do both. We think of telehealth as a point of care and as a technology that allows you to do certain things.

Armed with that, and its mandate as a payer, Government can create more programs to provide access. This can mean helping those with limited mobility or rural access, a way to provide access to specialists and take the burden of travel off all parties involved.

When we think of chronic conditions like diabetes, telehealth provides the opportunity for continuity of care, frequent touchpoints focused on diet, exercise and lifestyle and a programmatic team approach that can help support compliance on the part of the patient. We can also improve coordination of care and offer team-based approaches to care delivery.

We work closely with Avera Health, who has developed an innovative program offering maternal fetal medicine specialists to rural areas to help improve care for gestational diabetes. This program has demonstrated savings of $500 to $1,000 per patient during pregnancy and reduction of C-section rates in these patients by 20 percent.

Then there is the Joslin Diabetes Center that is at the cutting edge in diabetes care, often two or three years ahead of the national model. They have created a virtually-based program called Joslin Home that offers short but frequent telehealth touch points with patients and combines integrated data from the home. Results have shown a notable decrease in HbA1c levels, a decrease in hypertension, and an increase in medication adherence. This is a new model has the potential to revolutionize care delivery for diabetes. And efforts are underway to scale this model more broadly.

The Patient Experience

One of the great successes in telehealth is that patients love this form of care. We have a strict protocol for providers, called Website Manner, that dictates their dress, background, even down to the angle of the camera to ensure an optimal patient experience during a virtual visit. On the patient side, it makes care much more convenient as they can be on their sofas, with their pet at their side, in comfortable clothing and they have been spared travel time and time sitting in a waiting room. There are some limitations of course in that a physical touch exam is not possible, but there is the advantage of the provider being able to see into the home environment, perhaps to identify concerns around social stressors like poverty or the psycho-social environment, providing additional insight beyond what is available in office visits.

Telehealth is a real opportunity for Government to create a patient-centric way of delivering care that solves for geographic and load balancing issues, and that can bring the specific care needed into the home, into long-term care facilities, or anywhere there is a patient who needs it.

About Peter Antall

Dr. Peter Antall is the Chief Medical Officer at Amwell, where he is responsible for clinical direction of the platform, as well as guidance and training for all Amwell’s clients. He is also the founder and President of the Amwell Medical Group, the nation’s first national telehealth medical group, where he manages over 700 clinicians in a variety of disciplines, providing telehealth services in all 50 states. Dr. Antall has developed innovative programs to measure and ensure quality in telehealth, developed a national telehealth credentialing program, and has played an active role in national efforts to modernize telehealth laws and regulations. Dr. Antall has a track record of disruptive innovation in the areas of care delivery, medical management, business development, technology and telehealth. He has built and managed medical practices, founded a hospitalist company, written software for mobile apps and for phone-based triage, and has been actively building telehealth programs since 2009.

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