In rural Mississippi, where almost 65 percent of the state's counties are more than a 40 minute drive from specialty care and 68 percent of the providers are in urban areas even though 64 percent of the patients are in rural areas, telehealth takes on an added importance. 

Michael Adcock, and administrator at the University of Mississippi Medical Center's Center for Telehealth spoke at the Pop Health Forum 2016 in Chicago about how his center uses both site to site telehealth and remote patient monitoring, and shared some early results from a 141-patient remote patient monitoring pilot.

Adcock talked about how, in Mississippi, one of the most important aspects of telehealth programs is to make sure they work with and empower community health providers and don't make them feel threatened. As such, they have site to site telehealth programs and programs that work through employers, but they've steered away from D2C.

"The University of Mississippi can’t handle all the patients coming to our medical center," he said. "I know in the Northeast everybody’s competing for patients. We’ve got all the patients we can handle. We want them to stay in their local communities and be supported there."

One interesting observation Adcock shared was that the video visits offered via employers had the effect of actually decreasing antibiotic prescriptions. 

"Our model is all based on a per member per month, so the employee doesn’t have to pay anything per visit. What we’ve found is it makes them more likely to listen to our advice. [If you have to] take off four hours from work, sit in a waiting room for 3.5 of those hours, go in, see the physician, and be told it’s a virus, you know what they expect when they leave there? A prescription. They expect to walk out of there with something because they’ve spent time and money. But because they’re not spending either of those with us, when we tell them 'It’s a virus, you need to drink water and take some Mucinex', they’re actually willing to listen to it. We’ve seen a huge decrease in antibiotic use because of that."

The remote patient monitoring pilot involved giving patients a tablet and connected devices. Patients checked in with the tablet once a day, took vital sign readings, and participated in an education session. A physician got in touch if they failed to check in or if their vitals fell out of an accepted range.

After the first six months, hemoglobin A1C levels dropped an average of 1.7 percent for the study group. Medication adherence rose from a Mississippi average of 60 percent up to 96 percent, and adherence to the educational sessions hit 83 percent. They detected nine cases of diabetic retinopathy they otherwise would have missed. And participants lost a total of 91 pounds, despite weight loss not being an explicit part of the study.

"One of the families had dinner together every Sunday," Adcock said. "Always pecan pie for dessert. So about three weeks into the study they’re about to sit down and the father says 'I don’t want any pecan pie.' The son says ‘Oh my gosh are you sick, what’s going on?’ The father says ‘If I eat pecan pie, nurse Cindy’s gonna call me.' Behavior modification. We’re not going to get past where we are with patients without modifying their behavior."

In the study, the Center used tablets that connected to the devices via USB. But they've since switched to iPads and Bluetooth-connected devices because they're more reliable and user friendly.

"It was a big 12-inch tablet and everything had to be plugged in," Adcock said. "You’d think that was OK because there’s a red plug on the glucometer and a red hole on the tablet. It doesn’t matter. That’s where we received the majority of our clinical calls was the fact that they couldn’t hook it up. ... What we send out to our patients now are iPads. If they don’t understand it, their grandchildren can tell them how to do it."