Virtual visits with pharmacists may become more common under the federal health care overhaul.
For some seniors, getting out to see a pharmacist can be difficult in good weather and treacherous during Minnesota winters. But it's an essential trip for many; prescription drugs can keep serious illnesses in check, if they're taken as prescribed and managed effectively.
Deloris Breeggemann, 78, is one of those seniors. She's lived in a country house in Jordan, Minn. for nearly 50 years. And along with her husband, she ran a 60-head dairy farm and raised five sons.
Sitting at her kitchen table, Breeggemann is surrounded by the treasures of her past and present: Photographs of her children, grandchildren and great-grandchildren crowd countertops and are tacked to the refrigerator door. It was in this same kitchen less than two years ago she collapsed.
"I got to the table and I felt like I was dying from my feet up," she said. "I started going numb and all of a sudden I couldn't life my arms; I couldn't open my eyes."
Breeggemann suffered a heart attack. On top of heart disease, she also has type 2 diabetes. To manage those two chronic health problems along with other ailments, she takes 18 medicines a day.
But all that chemistry upset her stomach. She remembers how just looking at a week's worth of pills in a pillbox made her so nauseous she couldn't eat.
"I couldn't think about taking them, let alone [their] making me sicker after I took them," she said.
A consultation with a pharmacist from her health system, Fairview Partners, helped Breeggemann address the nausea problem and allowed her to keep taking the medicines.
Ensuring that patients take their medicine correctly can keep chronic health problems from spiraling out of control and into emergency rooms, intensive care units or worse. Reducing preventable hospital re-admissions is a key strategy to containing costs in the federal health care law.
To that end, Fairview Partners, is turning to a variation of telemedicine.
Telemedicine uses technology to connect doctors with patients in remote areas. Fairview Partners is using technology to link patients and providers separated not just by distance, but by difficulty or danger.
While Breeggemann's farmhouse kitchen is cozy and warm, out her window a blanket of fresh snow hides patches of glare ice in the ridges of unpaved roads. Falling and breaking a hip would be devastating for her.
So about year ago, Fairview Partners made it possible to conduct virtual visits with the system's health professionals. At this meeting by webcam, Breeggemann talks with Fairview Partners pharmacist Amy Busker who's only about 20 miles away.
This visit not only gives Breeggemann access to a pharmacist via webcam, but also to a specialist — Busker is a certified Geriatric pharmacist. Over a full hour Busker reviews each medication, checking for adverse drug interactions, side effects and dose adjustments.
The economics behind this kind of program are comparable to the health law's "Shared Savings" program under Medicare.
Fairview Partners gets a lump sum for Breeggemann's care. If Fairview Partners keeps her healthy and reduces her medical costs, the system and her insurance plan share any savings or responsibility for excess spending.
Normally, providers are paid by the number of tests and procedures they perform. Many health experts believe that the "fee for service" system drives up costs unnecessarily.
Fairview Partners' operations director Peg Lusian said virtual visits are benefiting both the health of the 75 patients seeing pharmacists by webcam, and Fairview's finances.
"We've definitely seen cost savings," Lusian said. "We've calculated it to be $1,500 per patient and that's due to the reduction of transportation and ER visits and potential hospitalizations."
If that pattern holds up, many more seniors may be consulting with pharmacists via webcam.
Lusian said while Fairview is largely usin1g pharmacists for the virtual visits, the health system also uses webcam visits with interpreters for non-English speaking patients so that an interpreter doesn't need to travel to a patient's home.