Telehealth Transforming Healthcare in American Samoa

Telehealth has become the fastest growing segment of delivery of healthcare due to COVID-19 and as patients and providers have recognized its far-reaching ability to provide the solutions necessary to significantly bend the cost curve while materially improving quality of life. Telehealth services also include non-clinical telehealth services, such as: Provider training; Administrative meetings; Continuing medical education; Patient education and Public health and health administration.

There are many opportunities for improving health care access in American Samoa where there is a shortage of health care providers. Telehealth provides an opportunity to access specialists and services otherwise not available on island. It also provides much value in cost savings and improved quality of care for follow-up visits.  Potential use of telehealth are endless.  Teleaudiology, speech therapy, maternal child, telepathology, teledendistry, telestroke, to name a few.

A few existing Telehealth Programs in American Samoa:

  • Ongoing Shriners Telehealth Consultations and Referrals: Orthopedic cases, Physical Therapy, Occupational Therapy, Recreational Therapy
  • Pacific Emergency Medical Services for Children: Support for children referral from Pacific Islands to Hawaii (Kapiolani and Shriners).
  • Continuing Medical Education: Ongoing CMEs are being conducted between all DOH clinics including Manu’a Islands. 
  • Regional and national telehealth webinars and educational sessions: American Samoa is a active participant of various regional and national telehealth education groups including those on gastroenterology, geriatrics, asthma, COVID-19 and many more.
  • Telepharmacy with DOH clinics:  Pharmacist can receive medication orders via telephone, text and secured messaging.
  • DOH Services offered via telehealth with off-island specialists: OT, Speech Therapy, Behavioral
  • VA CBOC currently offers and conducts telehealth services for onisland veterans.
  • Teleneurology Network with Queens Medical Hospital: Currently being established between LBJ and Queens Medical Center where a specialist at Queens Medical can consult with doctor at LBJ about stroke cases and other general neurology cases. 

Although the potential value of telehealth is clear in terms of improved access, quality of care, lowered cost, and increased patient satisfaction; telehealth utilization is low.  Key barriers and challenges include: referral process and care coordination; workflow integration; reimbursement, liability, credentialing/licensure, change management, need for new payment structure, and business models. 

  • Referral Process and Care Coordination:  Implement a process for care coordination pre- and post- referral using telehealth. This requires the identification of off-island specialists for pre-care to determine referral and post-referral for ongoing care coordination.
  • Health Information Exchange: Referral also includes the secure exchange of patient information. HIE requires connection into other systems to secure share patient health information required for the care coordination.       
  • Establish a Telehealth Work Group championed by physicians and other healthcare providers to lead territorial coordination for telehealth.  The group can also provide guidance on workflow integration future services. 
  • Reimbursement of Service:  Not all telehealth services are reimbursed. Policies and practices for telehealth reimbursement by Medicare, Medicaid, and private payers are not clear. Providers often do not know if they will get reimbursed for a service because they do not know if the service is covered and or if the service is provided under eligible conditions for payment (e.g., eligible for reimbursement if the patient is in a rural health professional shortage area (HPSA) or not classified as metropolitan statistical area (MSA)).  Further, it is not clear how much a provider will be reimbursed and the reimbursement amount in many cases, specifically from Medicare and Medicaid, is considered very low and often requires subsidization from the health care provider. Generally, this is only feasible and sustainable by government agencies or grant-funded programs.
  • Regulations and Policies: There are currently 25 states and territories with telehealth parity laws for insurance coverage.  These laws indicate that in-person and telehealth service are reimbursed at the same rate. 
  • Medicare and Medicaid Reimbursement:  Since COVID-19, the federal government has expanded funding for telehealth under Medicare and Medicaid.  This needs to be studied and understood on how it would apply to American Samoa.
  • Health Professional Licensure:  An added burden for providers in practicing telehealth across borders, is the need for medical licenses and the processes to obtain licensure in different states.  American Samoa currently does not require local licensure for telehealth.   However, to protect the integrity of and maintaining acceptable standards and protocols licensure and medical certification need to be confirmed. 

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