Rappahannock native brings at-home care to rural patients
For many older adults in Rappahannock County, getting to a doctor’s office can mean a long drive, limited appointment options and delayed care
Dr. Andrew Kohler believes there’s a better way
Beginning Aug. 1, the Rappahannock native, and his wife, Krista, an emergency medicine doctor, will oversee a pilot program in Virginia as well as several other states that will help people with chronic conditions monitor their health from home using digital devices
The initiative, part of a new Medicare program called ACCESS, is designed to help people monitor and manage chronic conditions, such as high blood pressure, diabetes and obesity. ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions
It’s the kind of program that could be particularly beneficial in aging, rural communities like Rappahannock where medical reh, a telehealth service the Kohlers launched three years ago. This undertaking, however, is tied into the Medicare initiative
Kohler, now Director of Lifestyle Medicine at Yale New Haven Health in Connecticut, grew up here — he’s the son of longtime Realtors Rick and Kaye Kohler — and knows how challenging it can be for local residents to get to doctor appointments or treatments. So the more regularly and closely their conditions can be tracked, he said, the less likely they’ll end up in the hospital
“To me, it’s 80% of what healthcare should be,” he said. “It’s preventive care, teaching people how to maintain their health.”
Kohler has long felt that healthcare in America is skewed in the wrong direction. Instead of focusing on helping people maintain their health, the country’s health insurance programs are largely built around paying for medical tests and other more reactive treatments
“We’ve been missing this low-lying fruit of medicine,”he said. “We just kind of forgot to train residents on this, or even offer it as part of medicine, for the past few, well, 100 years or so.”
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But that is beginning to change with the rollout of the ACCESS program by the Center for Medicare and Medicaid Services
How it works
ACCESS reflects an intended shift in what Medicare covers, with less adherence to a “fee for service” model in the future and more on “outcome-aligned payments” being made to organizations or healthcare services based on improved and measurable health outcomes — such as achieving lower blood pressure levels among people with hypertension
The Kohlers’ program wouldn’t replace a person’s primary care physician, but rather supplement their care with day-to-day advice and monitoring
It will involve providing, free of charge, blood pressure cuffs and digital scales to people who enroll in the program. Their measurements will be tracked remotely by nurses. A Wi-Fi connection isn’t required because such cellular devices have SIM cards that send data straight to a health network
“The blood pressure readings are monitored by a nurse watching a dashboard and there are red flags and yellow flags when you’re outside parameters,” Kohler explained. “Or say your weight’s going up over a period of a few days. That’s going to prompt a call
“The nurse can check in to see if you’re taking your meds. And how they can help,” said Kohler “A lot of this is to prevent exacerbations early, as opposed to someone asking, ‘Do I need to go to the emergency room?’”
A key to the program’s effectiveness, Kohler noted, is how much can be done in collaboration with organizations and individuals in local communities. It’s one thing to have nurses read data and have phone conversations with people. It’s another to have people able to make personal visits and talk with patients in their homes, where they can also determine if the person is living in conditions that could affect their physical and mental health
The paramedicine service that Rappahannock County hopes to launch in the coming months could be an important part of the sort of lifestyle medicine network Kohler wants to create. It would involve trained paramedics who make regular visits to local residents with chronic conditions — often people who rely heavily on emergency services when they have health issues
“We view that paramedicine program as a powerful natural ally,” said Kohler. “There’s massive potential for synergy. Together, our technology and their mobile clinical presence can create a flawless safety net, effectively intercepting health crises right in the living room and keeping people out of emergency departments.”
The pilot will be geared to people with chronic health conditions who have Original Medicare coverage (the red, white and blue card). To determine eligibility, people can go to the websitehttps://us-ltn.com/appointments.htmlor call 571-249-2493
By Randy RielandFoothills Forum Reporter
Randy Rieland is a reporter forFoothills Forum, a nonprofit organization that supports local news in Rappahannock County
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