This notice announces the opportunity to apply for funding under the Evidence Based Telehealth Network Program (EB THNP). The two-fold purpose of this award is (1) to demonstrate how health networks can increase access to health care services utilizing telehealth technologies and (2) to conduct evaluations of those efforts to establish an evidence base for assessing the effectiveness of telehealth care for patients, providers, and payers.
The implementation of telehealth technology is rapidly expanding into health systems.1 HRSA defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Telehealth modalities that support clinical treatment may include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Rising evidence supports that many health conditions can be addressed with a virtual in home visit from a doctor to his or her patient.2 In 2015, the American College of Physicians declared their position and support for Direct-to-Consumer (DTC) considering the patient has an established relationship with the providers, and the care meets in person standards of quality.3
For this NOFO, applicants must propose to provide DTC telehealth services to patients within established telehealth networks. This can be accomplished, in part, by identifying and partnering with local established health care facilities (especially primary care facilities) within the target service area, elevating the trusted patient-provider relationship, access, and quality of care directly to the patient via telehealth. Also, this service will allow for the expansion of access to care in Medically Underserved Areas (MUA) and primary care or mental health defined Health Professional Shortage areas (HPSA). The EB THNP program presents the opportunity for network sites that are currently or have previously utilized telehealth as defined above to efficiently and effectively pilot and/or expand DTC telehealth care. Applicants for this EB THNP Program must utilize synchronous (real-time virtual visits) audio-visual technology and may include remote patient monitoring (RPM) to provide DTC telehealth care to patients (see Appendix). This EB THNP program will expand access to health services in three clinical primary focus areas: (1) Primary Care, (2) Acute Care, and (3) Behavioral Health Care (see Appendix). In addition, applicants have the option to address one of the following secondary focus areas: Maternal Care, Substance Use Disorder, or Chronic Care Management.
Changes to reimbursement policies related to in-home telehealth services and RPM in recent years, particularly in the Medicare program, have laid the framework to enable providers to feasibly integrate these technologies into their practices. For example, even prior to COVID-19, Medicare began to allow beneficiaries to receive telehealth services at home for a limited set of services/conditions including home dialysis and the treatment of a substance use disorder or a co-occurring mental health disorder.4 Home health is also an example of how the Medicare program has expanded the ability of home health agencies (HHAs) to use RPM technologies to augment the health care of the patients they serve. Recently, Medicare explicitly allowed HHAs to provide RPM services to their patients to help foster the adoption of emerging technologies by HHAs and result in more effective care planning.5,6 Such approaches, to the extent that they strengthen rather than supplant existing patterns and systems of care, reinforce the objectives of this funding opportunity. Namely, a key objective of this program is to demonstrate how providers can use DTC telehealth services in a way that enhances the existing health care infrastructure, as opposed to incentivizing care delivery that circumvents and disadvantages providers in local communities, including rural areas.
Applicants are encouraged to include populations that have historically suffered from poorer health outcomes, health disparities, and other inequities, as compared to the rest of the rural population, when addressing health care needs via telehealth. Examples of these populations include, but are not limited to, racial and ethnic minorities, person/persons experiencing homelessness, pregnant women, disabled individuals, youth and adolescents, etc.
Eligible applicants shall be domestic public or private, non-profit or for-profit entities with demonstrated experience utilizing telehealth technologies to serve rural underserved populations. Faith-based, community-based organizations, and federally recognized tribes and tribal organizations are eligible to apply. Services must be provided to rural areas, although the applicant can be located in an urban area.