By Chris LaPage
Back to the Future: Telemedicine & Patient-Centered Care
Telemedicine is a technology innovation that has increased access to medical care for rural and underserved populations across the United States over the last two decades. While advancements in technology are typically associated with the future, in many ways telemedicine is a return to the past. Throughout the early and middle 20th Century, patients were traditionally treated in their homes via house calls made by an area doctor. In other words, health care was actually delivered to the patient in an environment where they lived, worked, and studied. With all the advancements of modern medicine, the concept of patient-centered care would not return to the lexicon of the healthcare industry until the Institute of Medicine’s 2001 publication, Crossing the Quality Chasm. Telemedicine enables health care providers the ability to return to their roots. By leveraging video conferencing, these providers can provide primary and specialty therapeutic services to patients and areas of the country that lack medical resources.
The Federal Grants Landscape
The primary issue with implementing a telemedicine program is the high upfront cost associated with equipment and software acquisition, the personnel and resources to maintain the equipment, and the training of health care providers on effective use. Provider training can be especially burdensome. Telemedicine delivery training involves more than simply showing health professionals how to use the technology. Rather, health professionals must also be trained on how to handle the profound changes in the workflow of virtual encounters compared to in-person patient visits.
Fortunately, telemedicine is a prime example of a technology that enables health care access directly, making such initiatives very fundable through grants. As grantseekers peruse the offerings available at the federal level, they will find many grant programs available through agencies such as the U.S. Department of Agriculture (USDA) and the Health Resources and Services Administration (HRSA). Unfortunately, these federal financial resources are finite and grant programs are typically targeted towards populations with the greatest need. In the case of telemedicine, federal funding is primarily aimed at serving rural communities. Urban health care providers often serve as a hub in these arrangements or as the source of the care that is being delivered, however, all services must be delivered to rural areas.
Luckily, there is plenty of good that telemedicine initiatives can still accomplish in urban areas – particularly when it comes to improving access to care for underserved populations, whether they be low-income families, children with special needs, or racial and ethnic minorities. In some instances, telemedicine may be used in urban areas to overcome a specific provider shortage, such as pediatric dentists. While the bulk of federal dollars are targeted at rural areas, the key to success for proposing grant funded, urban-based telemedicine projects is emphasizing the specifically underserved patient population and types of services that are otherwise unavailable. For example, HRSA has a School-Based Health Centers Capital Program (SBHCC) that enables health care facilities to physically or virtually offer their services in school settings. This program is not restricted to rural areas. HRSA also has a program that encourages telemedicine use in effort to improve care for children with epilepsy. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a program due August 13 aimed at leveraging telehealth to improve mental health treatment for children and adolescents. The Centers for Disease Control and Prevention sponsors a program that promotes racial and ethnic approaches to community health (REACH). While it is true that most of the large service-agnostic telemedicine grant programs are aimed at rural areas, as evidenced by the programs just listed, there is funding for urban-based projects. Just remember that urban grantseekers will have the greatest success when searching for opportunities that target specific health service lines and populations.
State & Local Grant Funding
State and locally-sourced grant funding for telemedicine initiatives varies significantly depending on the specific state or target community. Grantseekers should look at the traditional health and human service agencies that would be interested in funding telemedicine within their state to know which, if any, opportunities exist. Similar to the federal landscape, urban-based grantseekers will likely need to carve out specific patient populations or medical services, and target the appropriate state agency. However, it is also wise to broaden one’s search to areas that may not seem intuitive. For instance, Virginia uses its Tobacco Settlement Fund to award grants for telemedicine projects across the state through its Special Projects Program. States and local communities across the country also receive funds through the U.S. Department of Housing and Urban Development’s (HUD) Community Development Block Grant Program (CDBG). CDBG funds are targeted at urban communities and must be used to benefit low and moderate-income populations. If you are in a larger town or county, healthcare facilities may seek CDBG funding directly through their municipality. Smaller communities must leverage CDBG funding through their state housing department. Likewise, healthcare facilities are often a large employer in urban areas and can play a key role in the economic development of a community. As such, healthcare facilities may be able to fund their telemedicine projects through grant programs offered by their state commerce and economic development agency. Healthcare providers in the Appalachian or Delta regions of the United States may also be able to fund their initiatives through grant programs made available by the Appalachian Regional Commission and Delta Regional Authority, respectively.
Foundation Grant Funding
Funding technology-based projects through foundations can sometimes be a difficult task, especially if the link to patients is ancillary or indirect. For instance, many foundations view electronic medical records as “business record keeping” (i.e. a required task of any hospital to be in operation) thus are not interested in funding such initiatives. However, if your reason for maintaining electronic medical records is because you’re trying to implement a patient portal module – which can be used to directly impact patient care – then it is much easier to position your project to foundations as more than requesting support for general operations.
Foundations report annually on the number of people they touch and how the quality of life of these individuals improves because of their funding of specific projects. Fortunately, telemedicine technology can directly impact patient care by improved access and/or quality. As such, a technology-enabled project holds the potential to be highly fundable and of great interest to regional or local foundations provided you’re able to articulate how the technology will help you achieve your goals related to access and quality. Furthermore, since these foundations target particular regions or communities, you are not competing with as large of applicant pool as you may find in the federal space. For these reasons, foundations may be the best and most logical choice for healthcare providers that are seeking funds for their urban telemedicine initiative. The goal will be to tailor your request to the priorities of the foundation. If a foundation has priorities around health care access and low-income children – you may want to tailor your funding request to deliver telemedicine services to the poorest schools and daycare centers. In contrast, if a foundation has a focus on mental health – you may want to propose a tele-psychiatry project to the funder. Since foundation funding levels are typically lower than those seen at the federal level, remember to carve out pieces of your overall project budget that will align best with the specific foundation funder.
Telemedicine is fundamentally changing the way health care is being delivered by improving access to care and doing so in a manner that is convenient to the patient. Fortunately, there are grant programs available to assist providers with developing and expanding such initiatives. While it may seem like most funding is earmarked for rural areas, there is the potential to realize grant dollars for urban-based projects as well. The key is to focus on the specific medical service lines, and vulnerable populations that will be served, as well as conducting a comprehensive funding search across federal, state, local and foundation sources.