Case Study: A Texas Telemedicine Program Offers Lessons for Governments and Care Delivery Organizations Worldwide

With approximately 60,000 video visits per year, the UTMB in Galveston has one of the world’s largest video visit programs. UTMB’s telemedicine work began with a contract with the state of Texas to provide health services to most Texas prisons. Telemedicine, in the form of video visits combined with the use of cameras and monitoring devices to capture images and vital signs, is used in all prisons for which UTMB is responsible. By enabling patients to be seen remotely, video visits have reduced travel costs and have helped patients obtain easier access to specialist care. In addition, UTMB has collected evidence of high levels of patient satisfaction and improved health outcomes from video visits. UTMB has used its experience in prison telemedicine to offer video visits to other government agencies and employers. This case study can benefit government healthcare agencies that are seeking to improve patient access to healthcare and reduce costs for populations dispersed over large geographic areas or with limited access to specialists. It can also benefit public or private CDOs that are interested in developing videobased telemedicine programs for employers and government agencies.

Introduction
Interest in the potential for telemedicine to improve access to specialist care and reduce travel costs — especially for chronically ill patients who require frequent monitoring — is growing worldwide. Video visits are one of the more mature applications of telemedicine. They are increasingly used for mental health and rehabilitation in the U.S., and are beginning to be used in other countries. Video visits are an important means to reduce costs and improve access to care. They can also facilitate the sharing of expertise between clinicians and can provide an opportunity for CDOs to make money.

In the early 1990s, the state of Texas determined that its prison health system was not delivering adequate healthcare. Moreover, the costs of healthcare had escalated from $2,262 per inmate in 1989 to $2,839 per inmate by 1992, partly due to the growing number of prisoners with chronic health problems. Since 1994, the Texas Department of Criminal Justice (TDCJ) has outsourced prison healthcare to two universities: Texas Tech University Health Sciences Center in Lubbock, and UTMB in Galveston. The universities receive annual capitation fees to cover all medical expenditures for prisoners. UTMB operates medical, dental, mental health, laboratory and pharmacy services in 111 of the state’s prisons, accounting for more than 100,000 inmates, or 78% of the state’s inmate population (Texas Tech serves the remainder). At every prison it serves, UTMB operates primary care ambulatory clinics, which also provide basic dental and mental healthcare services. Some prisons also have basic inpatient facilities. All clinical personnel at the prisons, which includes approximately 120 physicians, are employed by UTMB. For most specialist and inpatient care, patients are transferred to a UTMB hospital in Galveston.


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