People with intellectual and other developmental disabilities have a higher instance of using the emergency department, but experts say it’s not always the best course of action.
“There are cases were going to a hospital is much more detrimental to an individual with an intellectual and developmental disability than it would be for you or I,” said Diane Marrone, chief of care coordination at Partners Health Plan, a managed care company that exclusively services intellectually disabled patients. “It could just be that one ER visit that could lead to this downward spiral and we don't want that to happen.”
Researchers from St. Michael’s Hospital in Toronto found that patients with developmental disabilities were 1.5 times more likely to go to the emergency department than other patients. Visits due to psychiatric issues were at least double, according to the study. Partners’ data found those patients were three times as likely to be admitted to a hospital.
More digital health companies are directly addressing intellectual disabilities such as autism, with buy in from insurers. Partners Health Plan CEO Kerry Delaney said technology represents an emerging frontier in treating these patients.
“We have just scratched the surface on how technology can be used,” Delaney said. “Quite honestly, the IDD field has been a little bit behind on in use of technological interventions. In the larger healthcare world, everyone started using telemedicine a lot more since COVID. But it was very limited in the IDD world.”
Partners Health Plan and StationMD, a telehealth company that specializes in serving patients with intellectual or developmental disabilities, launched a pilot in early 2020 to reduce emergency department visits. Through this program, the residential or family caregiver works with the telehealth provider to screen for conditions that can be treated at home.
Launching the pilot when telehealth adoption rates were spiking across the country helped Partners Health Plan get off to a strong start, Delaney said. It also kept patients out of urgent care facilities and emergency departments where they might have been exposed to COVID. According to a study in The New England Journal of Medicine, patients with development disabilities were more likely to die of COVID-19 mortality people with congestive heart failure, kidney disease or lung disease.
Two years in, the results of the program have been impressive, said Scott Doolan, AVP health care management.
“In the last two years, we’ve maintained a 93.1% treat-in-place rate. The cost avoidance of the program is around $5.7 million overall,” Doolan said about the health plan’s savings. “Within all of those calls and all of the interactions, we've had zero quality of care issues and zero complaints about the care.”
The doctor treating the patient via telehealth has access to real-time data, Doolan said, which allows them to get a fuller picture than what an emergency physician might see. If a patient can’t be treated at home, the telehealth provider can talk to the emergency physician ahead of time to give them information on the patient.
Unlike other telehealth initiatives, cost and reimbursement are not a barrier, Doolan said. The health plan pays for the per-member, per-month and flat -rate costs, but he said the return on investment is high because of the cost avoidance of going to the emergency department.
Usage of the telehealth program has mostly come from patients in live-in residential facilities, Delaney said she would like to expand that success to IDD patients who aren’t at these facilities. She said the organization is looking at how it can work with its community members better to expand usage among those patients.
“We have more work to do to get people in the community interested in using telemedicine,” Delaney said.