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Telehealth’s untapped potential in rural America


Can telehealth solve rural health issues? Maybe. But only with a mindful approach.

We’ve come a long way in medicine over the last decade, but the struggle to merely access quality health services for the 15 to 20 percent of patients who live in rural areas across the United States remains real, leading to frustration and serious health consequences.

In fact, recent studies published in Health Affairs show a growing disparity between rural health and urban health outcomes. While many may not realize it, individuals in rural areas have a 23 percent higher mortality rate than urban residents and a higher incidence of preventable inpatient admissions and emergency department (ED) visits. Data also shows that a lack of specialty-care access accounts for 55 percent of what could be a preventable hospitalization or mortality in rural settings.

These “health deserts” also host a higher percentage of deaths from things like cancer, heart disease, stroke, and chronic lower respiratory disease. And for many-perhaps to no surprise-these same areas account for an estimated 6.5 million individuals suffering from mental health conditions.

This data isn’t all that surprising when one considers the high prevalence of socioeconomic issues also facing many rural residents, including poverty, limited housing, substandard transportation and lack of access to reliable broadband technology. Compounding the issue is the fact that just 11 percent of the physician workforce practices in a rural community, leading to a supply imbalance.

These facts, supported by a multitude of real-life stories, are causing many states across the country to find themselves in the middle of a true healthcare crisis. In Alabama, for example, the distance between hospitals is only increasing. By the numbers, 13 hospitals across the state have closed in the past 10 years, with seven of those being in rural areas, leaving individuals and families at a loss of where to go for care as their options are seemingly reducing.

Telehealth Driving Systemic Change                                                                                                

The good news is, recent surges in telehealth deployments from healthcare organizations around the country are providing a pathway to better and more accessible care, especially for those people in rural areas.

Let’s examine the use case of gestational diabetes. Nationally, 6 to 9 percent of pregnant women develop this condition, which requires careful monitoring during pregnancy to avoid complications such as excessive birth weight (and increased risk of Caesarean births), premature birth, high blood pressure, preeclampsia and stillbirth. Typically, frequent checkups are required to reduce the risk of complications and chronic disease for pregnant women and their babies. However, for women in rural areas, the travel associated with regular visits makes it difficult to keep up with care requirements. At Avera Health, a Sioux Falls, S.D.-based health system with multiple facilities across South Dakota, Minnesota, Iowa, Nebraska and North Dakota, the use of telehealth monitoring, education and intervention for women with gestational diabetes has saved $500 to $1,000 per patient, decreased C-section rates by 20 percent, eliminated hospital stays longer than two days for one-in-four women, and increased vaginal deliveries without complications by nearly 27 percent. One patient who lived 90 minutes from a clinic saved 280 hours in travel time and 12,600 miles during her pregnancy through a combination of remote blood sugar screenings and interactive video visits.

Not only do examples like this prove the value of telehealth, but the industry, which has historically been stymied by reimbursement roadblocks, is today gaining favorable reimbursement tailwinds thanks to new legislation that has started to actually incentivize physicians to leverage telehealth. In fact, several big changes were enacted in 2019, including new Centers for Medicare & Medicaid Services (CMS) policies enabling Medicare Advantage plans to include “additional telehealth services” as part of their basic benefit package beginning in 2020. CMS also made changes to the Medicare Physician Fee Schedule, like the addition of a virtual check-in benefit that enables providers to get reimbursed for consulting with patients to determine whether an in-office visit-or a longer telehealth consultation-is needed.

Supportive reimbursement progress-coupled with the growing awareness and acceptance of telehealth’s value-has seemingly set the stage for big moves in 2020 that will change the paradigm of healthcare overall and certainly for those in rural environments.

Up and Running

Now that telehealth support is building, more rural healthcare providers have the opportunity to design telehealth programs that meets patients’ needs while being supported by payers. Together, we must look at how these programs can be most successful. Ultimately, the greatest impact will be realized when providers can convince their patients and community at large of the benefits of virtual care-to do things like engage a specialist or to simply ensure on-demand access no matter how far a patient may be from a provider.

Here are four best practices to consider when developing a rural telehealth strategy.

1. Put patient engagement first. Going back to the Avera example, when the health system sought to implement a telehealth solution in 2015, it hoped to provide support for multiple use cases beyond urgent care and enable patient access via multiple end-points (e.g., mobile, web, kiosk) to ensure a high-quality online care experience-one that would encourage patient participation and engagement. Putting the patient experience first through telehealth enabled Avera to grow. Since launching AveraNow in the summer of 2015, Avera has seen patient enrollments and visits climb. Meanwhile, the average rating of telehealth physicians providing care through AveraNow is 4.7 on a 5-point scale.

2. Tailor telehealth to patient preferences. The best way to secure buy-in from patients is to design a telehealth program that caters to their specific needs. For example, 67 percent of patients ages 55 and older are willing to try virtual care for chronic care visits, according to American Well’s Telehealth Index: 2019 Consumer Survey. Practices that see a high number of seniors, therefore, need their telehealth platform to support chronic care management. For middle-aged patients, on the other hand, emphasizing the ability of telehealth to support prescription renewals is key, given the fact that 42 percent of consumers ages 45 to 54 who use mobile health apps rely on pharmaceutical apps, according to the same survey.

3. Don’t feel you have to do it alone. If cost is a barrier to implementing telehealth, look for opportunities to partner with health plans that are already using telehealth. More and more health plans are investing in telehealth and encouraging their provider partners to collaborate and use telehealth as part of value-based contracts. When health systems are willing to partner and bring concrete success metrics to demonstrate ROI, health plans are eager to collaborate.  Working directly with a health plan’s telehealth solution also gives providers the opportunity to test the waters before investing in their own technology.  

4. Collaborate with specialists. Patients that require care from a variety of providers are especially challenged in rural areas, especially when providers are not located near one another. Collaborating with specialists to streamline healthcare by offering consultations through a single platform ensures patients get the care they need in a timely, efficient way while dramatically expanding the breadth of services available for in rural areas.

The Future is Bright

Although limited access to high-speed internet has historically presented barriers to telehealth implementation in rural communities, 63 percent of rural areas now have access to high-speed broadband Internet and growing. Meanwhile, 71 percent of rural residents own smartphones that could enable them to log on to a telehealth platform via an app via mobile networks. As a growing number of rural healthcare organizations embrace telehealth, now is the time to consider what is needed to create a telehealth value proposition for rural residents and physicians that improves quality, stretches limited resources and elevates care across the continuum. 

Mike Baird is president, customer solutions, American Well and former CEO, Avizia. Deanna Larson is CEO, Avera eCARE.

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