School-Based Telehealth in Line for Double-Barreled Boost

Kids in California schools — particularly those in low-income families and living in medically underserved areas — could be getting more medical attention through school-based telehealth networks, according to a new report from a national children’s advocacy group.

The Children’s Partnership says its report, “School-Based Telehealth: An Innovative Approach To Meet the Health Care Needs of California Children,” is a blueprint for getting care to children who otherwise wouldn’t get it.

“Although it focuses on California, the lessons and recommendations are really applicable in any state, and even at the federal level,” said Jenny Kattlove, director of strategic health initiatives for the Children’s Partnership and principal author of the report.

School-based telehealth services might be in line for a double-barreled boost from broadband expansion plans in the federal stimulus package and new funding in national health reform legislation.

Senate and House reform proposals both include funding for school-based health centers, money that would be “a big-time first and could — especially with the use of telehealth — open a lot of doors that didn’t used to be an option for a lot of kids,” according to Samantha Blackburn, field and technical assistance director for the California School Health Centers Association.

Need for School-Based Care Growing

“There’s no question we’re seeing a growing need in our schools for health care,” Blackburn said. “As increasing numbers of families are losing their primary health insurance, we’re seeing more and more kids with no coverage and those kids and their families are increasingly relying on whatever care they can get through the school.”

In California, Blackburn said, the problem is made worse by a dwindling number of providers willing to see low-income patients.

“We’re seeing fewer and fewer providers who will accept Medi-Cal, so that’s another reason why school-based care is becoming more important,” Blackburn said.

Medi-Cal is California’s Medicaid program.

There are 153 school health centers in California, many of them operating as satellites of community clinics. “And there’s a lot of interest in starting more,” Blackburn said. “So far, telehealth is not playing a big role in most of these school-based centers, but the potential is enormous,” Blackburn said.

‘Wise Use’ of Health IT

The Children’s Partnership telehealth report was timed to take advantage of “an unprecedented interest in and funding for health IT,” Kattlove said.

“We’re really at a unique juncture of technology beginning to offer new ways to deliver health care to more children and governments — federal, state and local — looking seriously at new ways to fund that care,” Kattlove said. “Our goal with this report on California is to shed light on how wise use of health IT can transform the lives of children — a lot of children.”

The report says telehealth can play an especially important role in the treatment of chronic diseases among children, such as asthma, obesity, mental illnesses, and developmental disorders, including autism and attention deficit disorders.

The number of children suffering from chronic illness in the country is estimated to have quadrupled between 1962 and 2005. The current estimate is that 12% to 16% of the country’s kids have a chronic condition, up from an estimate of 3% to 4% in 1962.

The report highlights programs such as the Asthma Telemedicine Program, a pilot project in three San Francisco schools in which medical providers teleconferenced regularly with students suffering from asthma. The project resulted in “significant improvements” in students’ health, according to the report.

Connecting children with health care providers either in person or through technology can help children and their families better manage chronic conditions, the report said.

Funding Might Arrive on Two Fronts

Health care reform legislation in Congress includes funding for school-based health delivery “for the first time ever,” according to Blackburn.

“That would be great, but if we’re going to talk about telehealth in school-based clinics, some new money is going to be absolutely necessary. In addition to acquiring the physical pieces of the puzzle, technology like that only works if you have human resources who know what they’re doing at both ends and currently, we have neither,” Blackburn said.

In addition to reform bills calling for new money that could be used for school-based telehealth, the American Recovery and Reinvestment Act includes $7.2 billion to support broadband deployment, including telemedicine and educational systems. How much of that might be used for school-based telehealth is unclear, but the Children’s Partnership plans to lobby that some of it does.

“We’re really one of the only ones nationally looking into how health IT can specifically affect children’s care,” Kattlove said. “And we’re trying to do it on several fronts ranging from making sure kids don’t get left out of the definition of meaningful use to looking closely at how telemedicine delivered through schools can be a big help.”

The report includes funding recommendations as well as success stories from across the country. For instance, the TeleKidcare project in Kansas lobbied the state to change its Medicaid reimbursement policies to allow for school-based telehealth programs to apply for reimbursement. Other programs in New York, New Mexico, Minnesota and elsewhere are mentioned.

California’s telehealth reimbursement laws allow for payment for remote contact and require insurers to adopt payment policies for telemedicine services. Last year, California changed its Medi-Cal reimbursement policy to allow the provider — the physician’s office, clinic or hospital where the patient is being treated — to bill Medi-Cal for costs associated with telehealth delivery.

The Children’s Partnership telehealth projects are aimed specifically at school-based programs, unlike the California Telehealth Network which hopes to connect more than 300 non-school-based providers in underserved areas to a state- and nationwide broadband telehealth network.

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