Contributor: Modern Medicine Meets House Calls—Caring for the Patient With Diabetes in 2020

Deb Schoenthaler, MS

Deb Schoenthaler is Executive Director of Physician Performance LLC, an organization of 2900 physicians that participates in value-based contracts through the Beth Israel Lahey Health Performance Network. She is an accomplished healthcare executive who has deep experience in Accountable Care Organizations and value-based payment models from both the provider and payer perspective.

Physicians agree that telehealth leads to better and more consistent patient care for patients and their families and provides many more touchpoints for patients with diabetes—all of which should continue after the pandemic in order to provide these patients with the best care going forward.

According to the CDC’s 2020 National Diabetes Statistics Report, approximately 34.2 million Americans—or 1 in 10 adults—have diabetes, and 88 million American adults have prediabetes. With diabetes being a serious complicating comorbidity for coronavirus disease 2019 (COVID-19), managing patients with diabetes during the pandemic has taken on even greater importance, but not without presenting special challenges for health care providers. Members of Physician Performance LLC (PPLLC) in Massachusetts have worked together to care for their patients with diabetes during COVID-19 and have found that the challenges posed by the pandemic have actually created opportunities to care for these patients in new and more effective ways.

PPLLC participating providers Guy A. Navarra, MD, a geriatric and internal medicine physician with Seacoast Medical Associates; pediatric endocrinologist Dr Sanjeev Mehta, MPH, the chief quality officer and interim chief medical officer at the Joslin Diabetes Center; and Dr Saira Naseer, an internal medicine physician with many elderly and diabetic patients, all agree that telemedicine in particular has created marked advantages for caring for patients with diabetes.

The beginning of the pandemic didn’t necessarily look that way, however.

“We had to adapt to a new world, and a new model of how care was delivered,” notes Navarra. At that point, patients had understandably heightened anxiety levels—many “didn’t want to come into the hospital at all. Thank God for telemedicine,” Navarra adds.

Mehta, who galvanized his organization to rethink how they were going to provide care (which was primarily based on face-to-face care prior to the quarantine) notes that while “transitioning from a 99-year-old care model in 48 hours” at the start of the COVID-19 pandemic proved extremely challenging, the results have been more than worth it. Joslin providers can now see patients across the United States and the globe, and telemedicine opened up access to Joslin’s specialty care to patients who live far from health care centers or who could not travel to Joslin.

Telehealth Visits Improve Continuity of Care for Patients With Diabetes

Patients with diabetes often present with a history of health issues and can be a challenging population to treat, especially given the need for multiple visits to a variety of health care specialists and the need to make behavioral changes at home. For instance, physicians did see some understandable weight gain among patients during quarantine—many were not leaving their homes, gyms were closed, and group walking and nutrition programs were on hold. But the more frequent visits that telemedicine allows meant that physicians were able to pick up on this change in activity earlier. Patients also have more consistent access to behavioral health coaching, podiatrists, nutritionists, and other essential tenets of diabetes care.

Navarra agrees: “Continuity of care is especially important in effectively managing diabetes, and telemedicine has made keeping appointments much easier for diabetic patients.” Many diabetic patients need to see their doctor at least 3 or 4 times a year, in addition to having appointments with other specialists for eye exams and other diabetes complications. This can present obvious challenges for patients: having to take a day off from work, find childcare or just find a way to get to the doctor’s office, which may be far from their home or which may require a ride if they do not have a car. All of these challenges are alleviated with telehealth visits, increasing appointment compliance.

Modern Medicine With the Benefits of House Calls

Naseer, who often makes “house calls” to see her patients living in nursing homes or other care facilities, adds that telehealth visits can be “just as effective as in person visits for most appointments.“ She notes that while not everything can be done via telehealth (for example, she cannot feel lymph nodes) most of the needed visits for patients with diabetes can happen virtually.

“We can diagnose the patient, take a good history, and see the patient. While we cannot do a physical exam or an eye test, we can see them breathe and listen to them. My patients love it.” Naseer adds that telehealth visits are especially convenient for her elderly patients, who may not drive,and working parents. She also noted that she is sometimes able to glean more information from patients when they are in a comfortable setting such as their home. Naseer, Mehta and Navarra all agree that telehealth visits improve the continuity of care for the majority of patients, and that while they haven’t replaced all office visits (and sometimes patients who are seen via telehealth will need to come in for follow-up testing) the benefits are important enough that it is essential that insurers continue to reimburse for them just as they would for an office visit.

The physicians agree that telehealth leads to better and more consistent patient care for patients and their families and provides many more touchpoints for patients with diabetes—all of which should continue after the pandemic in order to provide these patients with the best care going forward.