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• Data Development
• Health Care Reform
• Health Information Technology
• Medicaid and CHIP
• Medicare
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• Payment Policies and Costs
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• State Health Policy

Using Telemedicine to Deliver Services to the Medically Underserved

The serious and costly complications of type 2 diabetes—vision loss, kidney failure, nerve damage, coronary artery disease, cerebrovascular disease, peripheral vascular disease, foot ulcers, lower-extremity amputations, and infections—often can be avoided through case management, monitoring, control of risk factors, and self-care. Unfortunately, geographic, linguistic, or social isolation keeps many patients from obtaining high-quality diabetes care. Isolation also may lessen beneficiaries’ motivation to eat appropriately, exercise, and lose weight as advised by a physician. 

Home telemedicine delivers diagnostic, monitoring, educational, and therapeutic services to health care users through telecommunications technology. It may be a promising way to deliver such services to people living in medically underserved areas and those who are socially isolated.

Mathematica conducted an independent evaluation of a congressionally mandated demonstration (IDEATel, or Informatics for Diabetes Education and Telemedicine) to assess the effects of providing home-based telemedicine services to a large number of eligible Medicare beneficiaries who had diabetes mellitus and lived in medically underserved areas in New York City and upstate New York. The Centers for Medicare & Medicaid Services funded and oversaw the demonstration and evaluation. The demonstration was implemented in two four-year phases, from February 2000 until February 2008.

Although IDEATel had modest effects on clinical outcomes, it did not reduce Medicare use or costs for health services. The costs of the intervention were very high (over $8,000 per person per year) compared to programs with similar-sized clinical impacts. The main driver of these costs was the size of the budget allocated to the demonstration’s operations, compounded with the use of very expensive technology for delivering the intervention. A report to Congress was delivered in spring 2009.

Publications

"Final Report to Congress on the Informatics for Diabetes Education and Telemedicine (IDEATel) Demonstration, Phases I and II" (September 2008)
"Second Interim Report on the Informatics for Diabetes Education and Telemedicine (IDEATel) Demonstration" (June 2005)
"First Interim Report on the Informatics for Diabetes Education and Telemedicine (IDEATel) Demonstration" (July 2002)