NEWS A collection of relevant articles providing: Telemedicine trends Industry insights Innovation updates Funding developments Legislation tracking Statutory analysis And more... Industry News Q&A: How retail healthcare, telehealth trends could evolve in 2023 Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, discusses the future of virtual care and how emerging retail players will affect the industry. December 16, 2022 Read More UCHealth slashes code blues up to 70% with telehealth technologies The academic medical center uses tele-sitter and virtual ICU platforms for a program it calls Virtual Deterioration. December 20, 2022 Read More Leveraging Telehealth Platforms to Enhance Provider Workflows, Adoption Implementing a telehealth platform can positively impact provider workflows in numerous ways, including easing administrative burdens, thereby leading to greater provider adoption and satisfaction. December 28, 2022 Read More Telehealth helps stop suicidal ideation for many patients, study finds One person dies from suicide every 11 minutes in the U.S. A new study shows that telemedicine can be used to treat more severe mental illness – contrary to previous thought. December 29, 2022 Read More Telehealth May Be Rural Healthcare’s Lifeline As a new year dawns, it seems like a stock-taking time in U.S. healthcare. Skyrocketing costs, underwater margins, a depleted workforce and sicker patients have most hospitals and systems thinking existential thoughts about 2023, none more so than rural facilities. December 28, 2022 Read More

New ULC Uniform Telehealth Act Highlights Important Policy Considerations & Licensure Trends Center for Connected Health Policy August 2022 The new Uniform Telehealth Act states that services can be provided via telehealth consistent with existing practitioner standards of care and it also establishes a registration process allowing out-of-state providers to deliver services through telehealth to patients in states that choose to adopt the Act. For full post see: https://www.cchpca.org/resources/new-ulc-uniform-telehealth-act-highlights-important-policy-considerations-licensure-trends/ < Previous News Next News >

Principal Deputy Inspector General Grimm on Telehealth By Christi A. Grimm, HHS-OIG Principal Deputy Inspector General February 26, 2021 It has been just over a year into the COVID-19 pandemic and we remember the over 500,000 Americans who have lost their lives due to COVID-19. That figure is a stark reminder of the critical mission of the Department of Health and Human Services. Challenges in responding to the pandemic have been many, thorny and unprecedented. Consequential decisions often were made quickly to respond to the emergency and provide relief in the way of funding, supplies, and reductions in regulatory and procedural burden. This quick response and scope of relief make oversight, enforcement, transparency, program integrity, and accountability all the more important. It has been just over a year into the COVID-19 pandemic and we remember the over 500,000 Americans who have lost their lives due to COVID-19. That figure is a stark reminder of the critical mission of the Department of Health and Human Services. Challenges in responding to the pandemic have been many, thorny and unprecedented. Consequential decisions often were made quickly to respond to the emergency and provide relief in the way of funding, supplies, and reductions in regulatory and procedural burden. This quick response and scope of relief make oversight, enforcement, transparency, program integrity, and accountability all the more important. Early in the pandemic, OIG, along with many others, recognized the value of expanding options for accessing health care services. Telehealth is a prime example. Where telehealth and other remote access technologies were once a matter of convenience, the public health emergency made them a matter of safety for many beneficiaries. In some cases, health care providers needed regulatory flexibility to provide safe and effective care remotely during the ongoing pandemic. In March 2020, we issued policy statements and FAQs in support of increased telehealth flexibilities. A year later, there is a robust national conversation about expanding coverage for telehealth services based on the experience providers and patients have had during the pandemic. For most, telehealth expansion is viewed positively, offering opportunities to increase access to services, decrease burdens for both patients and providers, and enable better care, including enhanced mental health care. A 2019 OIG study found that telehealth can be an important tool to improve patient access to behavioral health services. And as we observed in recent rulemaking, OIG recognizes the promise that telehealth and other digital health technologies have for improving care coordination and health outcomes. It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse, or misuse. OIG is conducting significant oversight work assessing telehealth services during the public health emergency. Once complete, these reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering what telehealth flexibilities should be permanent. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs. We anticipate the first work products to be published later this year. We are aware of concerns raised regarding enforcement actions related to "telefraud" schemes, and it is important to distinguish those schemes from telehealth fraud. In the last few years, OIG has conducted several large investigations of fraud schemes that inappropriately leveraged the reach of telemarketing schemes in combination with unscrupulous doctors conducting sham remote visits to increase the size and scale of the perpetrator's criminal operations. In many cases, the criminals did not bill for the sham telehealth visit. Instead, the perpetrators billed fraudulently for other items or services, like durable medical equipment or genetic tests. We will continue to vigilantly pursue these "telefraud" schemes and monitor the evolution of scams that may relate to telehealth. As our work and the national conversation continues, OIG believes there is a shared goal: ensuring that telehealth delivers quality, convenient care for patients and is not compromised by fraud. As we continue our COVID-19 oversight and enforcement work, we look forward to providing objective, independent information to stakeholders and policymakers. < Previous News Next News >

Citing Medicaid misery, 25 governors push for PHE's end in April Molly Gamble December 21, 2022 In a letter sent to President Joe Biden this week, 25 governors ask for the end of the COVID-19 public health emergency in April. HHS last renewed the federal PHE in October for another increment of 90 days — until January 11 — with the pledge to provide states with 60 days' notice if it decided to terminate the declaration or allow it to expire. Since those 60 days came and went without notice, states are operating under the assumption the PHE will be renewed for another 90 days and expire in April, unless extended again. "We ask that you allow the PHE to expire in April and provide states with much needed certainty well in advance of its expiration," the governors urged Mr. Biden in their Dec. 19 letter. The governors claim the PHE hurts states, largely through the Medicaid flexibilities costing states "hundreds of millions of dollars." Under the continuous coverage requirement of the Families First Coronavirus Response Act, state Medicaid agencies are barred from disenrolling people during the PHE — unless they request it — in exchange for an enhanced federal match. HHS estimates up to 15 million people will be disenrolled from Medicaid and the Children's Health Insurance Program when the PHE ends. "While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily," the governors wrote to Mr. Biden. "Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share." The governors sent their letter a day before Congress released its omnibus spending bill, which contains working language for states to be able to start evaluating Medicaid enrollees' eligibility as of April 1 in a redetermination process that would take place over at least 12 months. The measure also calls for phasing down the enhanced federal Medicaid funding through December 31, 2023, though states would have to meet certain conditions during that period. The American Hospital Association advocated for the latest extension of the PHE in October, noting that the majority of the hospital members it polled said they still depend on the flexibilities provided by the PHE waivers to deliver care. The letter was initiated by Chris Sununu, governor of New Hampshire, and signed by the following: Kay Ivey, Alabama Mike Dunleavy, Alaska Asa Hutchinson, Arkansas Doug Ducey, Arizona Ron DeSantis, Florida Brian Kemp, Georgia Brad Little, Idaho Eric Holcomb, Indiana Kim Reynolds, Iowa Charlie Baker, Massachusetts Tate Reeves, Mississippi Mike Parson, Missouri Greg Gianforte, Montana Pete Ricketts, Nebraska Doug Burgum, North Dakota Mike DeWine, Ohio Kevin Stitt, Oklahoma Henry McMaster, South Carolina Kristi Noem, South Dakota Bill Lee, Tennessee Greg Abbott, Texas Spencer Cox, Utah Glenn Youngkin, Virginia Mark Gordon, Wyoming See original article: https://www.beckershospitalreview.com/finance/citing-medicaid-misery-25-governors-push-for-phes-end-in-april.html?utm_medium=email&utm_content=newsletter < Previous News Next News >

Consumer Survey Data Supports Use of Virtual Visits Center for Connected Health Policy July 2021 The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. The Deloitte Center for Technology, Media & Telecommunications released the second edition of their Connectivity and & Mobile Trends 2021 survey, which gathered information from consumers about their relevant experiences during the pandemic. Using an online methodology of over two thousand consumers surveyed in March 2021, the report looks broadly at how the pandemic has influenced innovation and the “digital home,” including the increase in virtual doctor visits and patient telehealth preferences. In regard to telehealth, they found that over half of Americans had a virtual visit, 80% of those patients were satisfied with their experiences, and 62% were likely to schedule future telehealth visits post-pandemic. Almost 30% of consumers reported assisting someone else in their household with a telehealth visit. The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. While 30% of consumers reported no challenges, others did report they found the lack of human connection challenging, as well as the inability to have their vitals collected which was indicated more frequently among older patients. The report also looked at individual use of “wearables” to advance health and wellness, presuming their ability to support health care providers will continue to grow along with telehealth – although the authors also stated both will likely require the evolution of the regulatory landscape. Interestingly enough, use of wearables was actually found to be mixed during the pandemic and 39% said cost is the primary reason they haven’t bought one. Also, of note for those that had used wearables was that 60% claimed not to be concerned about privacy of their wearable-generated data, which is often raised as one of the main regulatory concerns related to increased innovation in health care. To review additional details about the information gathered, please view the findings in their entirety - https://www2.deloitte.com/content/dam/insights/articles/6978_TMT-Connectivity-and-mobile-trends/DI_TMT-Connectivity-and-mobile-trends.pdf#page=8. < Previous News Next News >

The changing landscape of telehealth: 4 federal legislative developments Naomi Diaz May 24, 2022 Federal lawmakers have introduced four bills that look to update, continue, renew and expand telehealth access for patients and providers. Below are recent federal developments for policy, regulatory and legal changes related to telehealth during the COVID-19 pandemic, according to JD Supra: HHS' $16.3 million for Title X family planning program: On May 10, HHS announced it will release $16.3 million in grants for family planning groups to expand telehealth services and infrastructure. The funds will be made available through the American Rescue Plan and will be awarded to 31 Title X family planning programs and facilities. Restoring Hope for Mental Health and Well-Being Act: The bill, introduced May 6, would provide grants to schools and emergency departments to scale up or expand pediatric mental health telehealth access. Women's Health Protection Act: Introduced May 4, this bill would protect a provider's ability to provide abortion services via telehealth. Telehealth Extension and Evaluation Act: This bill, introduced April 26, would extend telehealth flexibilities enabled by Medicare for two years following the COVID-19 pandemic. < Previous News Next News >

CMS Releases Final Calendar Year (CY) 2023 Physician Fee Schedule CCHP November 08, 2022 Last week, the Center for Medicare and Medicaid Services (CMS) released the final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS finalized many of their telehealth proposals, which primarily focused on what services will be covered by the program and what will happen immediately following the end of the public health emergency (PHE), including during the 151-day grace period included in the 2022 Budget Act. CMS clarified that the list of services that were temporarily allowed to be delivered via telehealth and reimbursed by Medicare during the PHE, will still be allowed during the 151-day grace period. Additionally, CMS added more of the temporary telehealth PHE list codes to a category of services that would remain through the end of 2023. The rule also reiterates the requirement for an in-person visit in the first 6-months of an initial telehealth mental health visit and every 12 months afterward (with exceptions), and clarifies that won’t be implemented until 152 days after the end of the PHE. They will address the specifics around coding and reporting these types of services through guidance and a sub-regulatory process in the future to ensure a smooth transition after the PHE ends. Stay tuned for an in-depth In Focus write up from CCHP on the 2023 PFS next week, as well as a new factsheet focused on the telehealth elements in the final rule. See original article: https://mailchi.mp/cchpca/its-here-cms-releases-2023-physician-fee-schedule-plus-new-resources-on-telehealth-policy-from-hhs-cchp < Previous News Next News >

Audio-Only Telemedicine In Primary Care: Embraced In The NHS, Second Rate In The US Rebecca Fisher, Urmimala Sarkar, Julia Adler-Milstein December 5, 2022 Use of telemedicine in primary care soared in the first wave of the COVID-19 pandemic and remains well above pre-pandemic levels. In the US, a major enabler of this shift is equal reimbursement across video, audio, and in-person visits. Policy makers must now choose whether to extend these COVID-19-era telemedicine policies. A key decision is whether audio-only telemedicine should be covered and if so, whether it should retain parity with video-based telemedicine. The dominance of video over audio in the US suggests that an appropriate policy strategy would be to not reimburse for audio-only telemedicine or reimburse at markedly lower levels. However, US policy makers would be wise to look internationally first—where experience suggests that audio-only can be an effective and more equitable means of delivering primary care. In the National Health Service (NHS) in England, almost one in three consultations in general practice is audio-only; a figure that has been stable since October 2021. This represents a major rise; pre-pandemic around 10 percent of consults were by phone. Despite efforts from UK policy makers such as fast-tracking funding for online consultation tools, the number of video consults remains stubbornly low, at just 0.4 percent of appointments. This is despite the fact that most NHS primary care practices are video-equipped, and the US and UK populations do not differ significantly in their digital literacy. What Explains The Higher Levels Of Audio-Only Telemedicine In The UK Versus US? There is no evidence that directly answers this important question. We therefore leverage circumstantial considerations to develop three possible explanations. National Policy Given the active efforts of policy makers at the start of the pandemic to expand availability of telemedicine, an initial explanation is that the countries implemented different policies regarding telemedicine provision—with the US pursuing policies that favored video while the UK pursued policies that favored audio. However, we are not aware of any such policy differences. In both countries, policy makers acted swiftly to make it easier for providers to consult using either modality. National guidance issued to practices in England encouraged use of phone and video encounters “tailored to the person, the circumstance and their needs,” but there was no directive to prioritize audio-only above video consulting. In the US, emergency legislation removed barriers to telemedicine consulting, including giving parity of reimbursement across audio and video encounters (theoretically an incentive to drive up audio-only rates). Both countries reduced regulatory barriers to video consultation, allowing providers to use non-medical video call applications such as Skype and Facetime. But neither country mandated—or strongly incentivized—provision of one telemedicine modality over the other. Path Dependence A second explanation is one of path dependence. The idea that faced with the need to act fast and little central planning or coordination, health care delivery organizations disproportionately scaled-up the form of telemedicine that made sense given prior circumstances before the pandemic. In the NHS, the use of audio-only for triage and traditional encounters in general practice was common pre-pandemic. In 2019, 10 percent of encounters in English general practice were by phone, compared to fewer than 1 percent across both telemedicine modalities in the US. The public was also used to receiving health advice by phone—the NHS 111 service is a free phoneline to help people in England access non-emergency medical advice and to link them to local NHS services. Thus, when the pandemic hit, it was easier to act quickly to scale the more familiar modality of audio. In contrast, the US did very little of either modality pre-pandemic, and in an effort to more closely replicate face-to-face care at the start of the pandemic when in-person care was not an option, US practices chose to ramp up video-based telemedicine. Provider Perceptions Of Quality While path dependence emphasizes the concept of choice driven by ease, a third potential explanation is that, instead of prior familiarity driving decisions about modality offerings, these decisions were driven by different perceptions of the strengths and limitations of each modality. In the UK, analysis of why general practitioners hadn’t used video consultations found that despite improvements in functionality and reliability of video consultation tools, practitioners viewed video encounters as logistically more challenging and more cognitively demanding than either face-to-face or telephone consulting. Physicians felt that many presenting problems could be sorted safely by telephone, with in-person assessment required for the remainder. Where problems required visual assessment, physicians preferred a combination of photograph plus telephone consultation (SMS technology is widely embedded in general practice [GP] electronic health records). Consensus from UK physicians seems to be that video provides little benefit over audio-only. Differential uptake of video over audio-consulting suggests that US physicians feel differently; surveys of US physicians have highlighted concerns about the diagnostic accuracy of telephone visits, and their suitability for new patients. The acceptability of different telemedicine modalities to patients is another dimension of quality that could have driven what health care delivery organizations offered. Evidence from the UK suggests that telephone appointments are a popular appointment modality in general practice. Indeed, analysis of 7.5 million patient-initiated requests for care across 146 primary care providers found that telephone consultation was the most popular patient preference, requested by 55 percent of people seeking care, with fewer than 1 percent of requests seeking a video consult. In the US, one trial reports similar patient satisfaction with audio and video consults, but it is possible that US physicians felt that patients expected video consultations and made efforts to oblige. Based on circumstantial evidence, we suspect that path dependence and perceptions of quality worked together to push the countries in different directions. While more conclusive evidence is needed, explanation three raises the more critical question of how to move from perceptions of quality differences to robust evidence that can inform choice of modality. What Is Currently Known About Which Modality Is Better From A Quality Perspective? The clearest evidence on differences between modalities is about access, where audio-only has clear advantages over video consults in promoting equity. People with the greatest need for health care may be least enabled to access it digitally—termed the “digital inverse care law.” In both the US and the UK, digital exclusion is socially patterned. Older people, those in lower-income groups, people with disabilities, or who do not have English as a first language are more likely to be digitally excluded. In the telemedicine context, video visits require digital literacy and access to technology and broadband/data that are not ubiquitous. On the health system side, providing video visits requires health centers and staff to overcome barriers including cost, training, and technology. These barriers may be more likely to occur in safety-net settings. In the US, video visits are more common in people earning above $100,000, White people, younger people, and people with private health insurance. In contrast, users of audio-only telemedicine are more likely to be Black people, older adults, and on Medicaid. With telephony already embedded in health centers and 97 percent of Americans owning cell phones, audio-only telemedicine represents an important means of accessing care for underserved populations. Beyond equitable access, we lack evidence on differences in other dimensions of quality between the two consultation modes, either overall or in specific clinical scenarios. Unfortunately, there is a major obstacle to such evidence generation: In the US, we do not routinely capture the specific telemedicine modality in use and therefore cannot readily compare audio-only to video encounters. Ruth Hailu and colleagues describe the range of interventions—including simplifying coding and adapting electronic health records—required to generate data that would support comparative analysis. However, even with such data available, the choice of modality is non-random, and individuals are likely to receive a blended mix of consultation types during episodes of care. Disentangling the impact of each encounter modality on a range of clinical and patient-reported outcomes would be a substantial research undertaking. Large, diverse population observational studies may be required, alongside a range of qualitative studies of patient and physician experience. Some of this evidence will take years to gather, and decisions on extending coverage beyond the pandemic emergency will likely be required before a full picture is clear. Neither health system can claim an “evidence-based” strategy—and it likely that neither the US nor the NHS has it right yet. So Where Does This Leave Policy Makers? In the UK, there is no urgent policy decision to be made around reimbursement, since all forms of telemedicine are covered by the capitated payment system for general practice. Instead, debate has focused on whether access to in-person appointments is now too limited. This is framed by decreasing public satisfaction with access to general practice, in the context of ongoing and severe shortages of primary care physicians. Despite nudges from policy makers, the pandemic has barely shifted the number of video consultations in general practice, and use of telephone consulting has expanded instead. Ongoing studies will monitor outcomes of this change and may require expansion to help the NHS identify an optimal blend of consulting modes. With UK general practitioners unconvinced of quality benefits of video consultations, it is likely that compelling evidence of their benefit would be required for use to increase. US policy makers face more difficult choices about ongoing reimbursement for audio-only telemedicine. The Consolidated Appropriations Act of 2022 extends certain telehealth coverages for 151 days after the official end of the federal public health emergency, thus going some way to preventing a “telehealth cliff.” But with the World Health Organization recently discussing for the first time the possibility of ending their emergency declaration on COVID-19, decisions about funding for audio-only and/or video will need to be made relatively soon. In the absence of robust evidence, decisions are likely to hinge on perceptions of the quality of different consultation modes. Arguments against payment parity between audio-only and video telehealth are likely to focus on early perceptions that audio is a lower-quality modality or prone to overuse. These arguments and their rebuttals have been clearly described already. However, given the clear evidence of the meaningful benefits for reaching underserved people, the US should extend coverage of audio-only telemedicine for a minimum of five years. During this time, perceptions of quality can be informed by empirical evidence, such that we can either phase out audio-only in an equitable way or give providers more flexibility to combine use of modalities. Even with reimbursement parity, policy makers will need to invest in complementary enablers of equitable telemedicine access through state-level action. As Elaine Khoong writes, avoiding a two-tier system where video encounters are disproportionately available to the wealthy requires policy makers to expand video-visit capacity in the safety net, alongside community-based strategies to improve digital literacy. Given that telehealth does not necessitate the same geographical constraints as in-person care—for example, with respect to physician licensing or online prescribing—amending policies to streamline provision across states is also vital. A Role For Payment Reform? The past two years have shown that telephone and video consultation can be combined to deliver high-quality and efficient care. Going forward, patients are likely to receive a blended mix of appointments across modalities, tailored to clinical need and individual circumstance. In the NHS, capitated payments give clinicians and managers the flexibility to offer a mix of appointment modalities, based on the clinical situation without the need to consider differential reimbursement or administrative burden. In fee-for-service models, differentiating payment levels across telemedicine modalities is likely to increase bureaucracy and risks decreasing efficiency and quality. In the longer run, experience from both systems suggests that we should move away from modality-based reimbursement. In recent testimony to the US Senate’s Committee on Finance, Robert Berenson suggested that fee-for-service is a particularly flawed payment model for telemedicine, and that the Centers for Medicare and Medicaid Services should consider paying for telehealth services in a similar model to the UK: via monthly capitated payments for primary care physicians as part of a hybrid payment model. Capitated payment systems enable physicians to use the encounter modality considered most appropriate for the situation without worrying about how they will be paid (or the patient billed). Berenson’s proposal would allow physicians and patients to tailor the type of telemedicine encounter more precisely to individual patient need and might reduce bureaucracy associated with billing, in turn increasing efficiency. As evidence on the benefits and risks of each modality emerges, such a payment model also allows rapid translation of evidence into practice. Authors’ Note Professor Sarkar holds current research funding from the National Cancer Institute, California Healthcare Foundation, the Food and Drug Administration, HopeLab, and the Commonwealth Fund. She has received prior grant funding from the Gordon and Betty Moore Foundation, the Blue Shield of California Foundation, and the Agency for Healthcare Research and Quality. She received gift funding from The Doctors Company Foundation. She holds contract funding from AppliedVR, InquisitHealth, Somnology, and RecoverX. Professor Sarkar serves as a scientific/expert adviser for nonprofit organizations HealthTech 4 Medicaid (volunteer) and for HopeLab (volunteer). She is a member of the American Medical Association’s Equity and Innovation Advisory Group (honoraria). She is an adviser for Waymark (shares) and for Ceteri Capital I GP, LLC (shares). She has been a clinical adviser for Omada Health (honoraria), and an advisory board member for Doximity (honoraria). See original article: https://www.healthaffairs.org/content/forefront/audio-only-telemedicine-primary-care-embraced-nhs-second-rate-us#.Y45MpkrZubQ.twitter < Previous News Next News >

CMS Warns Providers to Bill Correctly Center for Connected Health Policy May 2021 OIG is currently conducting several audits on telehealth In mid-April, CMS sent out a Medicare Learning Network (MLN) Connects Newsletter with a reminder to providers to bill correctly for telehealth services. In the short section in their newsletter, CMS cites a 2018 Office of Inspector General (OIG) report that found that there was a significant amount of telehealth claims that were improperly paid, and thus not billed correctly. As the OIG is currently conducting several audits on telehealth, it is possible that they may come to a similar conclusion again. The section also refers providers to several resources to ensure they are billing correctly, including the: Telehealth Services MLN booklet: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf Telehealth Payment Eligibility Analyzer https://data.hrsa.gov/tools/medicare/telehealth List of Covered Telehealth Services https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes For policies specific to the public health emergency (PHE), CCHP also recommends providers review the CMS resources listed in the Federal COVID-19 section in CCHP’s Policy Finder, as there are several telehealth flexibilities currently in place as a result of the PHE. CCHP's Policy Finder: https://www.cchpca.org/federal/?category=covid-19&topic=originating-site < Previous News Next News >

Telehealth and Maternal Mental Health Needs Two recent studies show telehealth can help new and expectant mothers. Psychology Today April 30, 2021 Telehealth measures decreased prenatal distress, pregnancy-related anxiety, and postpartum depression. Telemedicine has skyrocketed since the start of the pandemic. According to The New York Times, just short of May 2020, the Johns Hopkins neurology department was seeing 95 percent of patients virtually. The rise in telemedicine to address maternal mental health has also seen unprecedented growth during the pandemic. Meanwhile, Mental Health America states that the mental health needs of Americans have skyrocketed. Anxiety and depression screenings increased nearly four-fold in 2020, from nearly 2,000 screenings per day to roughly 8,000 per day. Women, and in particular pregnant women, are vulnerable to hormonal fluctuations that make them twice as likely to experience depression during their lifetime compared to men. Research in the past year and a half has shown that telehealth can be substantially as effective as in-person care. (Telehealth, more encompassing than telemedicine but inclusive of it, may include only educational components.) With respect to maternal mental health, there are two studies highlighted herein that demonstrate telehealth's promise when it comes to improving maternal mental health in terms of prenatal distress, pregnancy-related anxiety, and the postpartum period. Of note, one of the studies was conducted prior March 11, 2020, or the official start of the pandemic, which makes it non-COVID-19 related. Maternal mental health, or perinatal mental health, is defined by the Maternal Health Task Force as a woman’s mental health during pregnancy and in the postpartum period. The significance of this period is multifold. It includes increased risk of the following: preterm delivery, low birth weight, impaired postnatal infant growth, insecure infant-mother attachments, and suboptimal breastfeeding practices. The first study published in Midwifery in 2021 supports the use of tele-education in improving prenatal distress and pregnancy-related anxiety. Specifically, the Midwifery study showed that “tele-education offered to the pregnant women on pregnancy and birth planning during COVID-19 decreased their prenatal distress and anxiety levels.” What the pregnant women received were phone calls, text messages, and a digital education pdf file, all of which educated women on a variety of topics, including “general methods of protection from coronavirus, coronavirus prevention methods during pregnancy, coronavirus and delivery process, measures to be taken during the coronavirus pandemic and postpartum process, measures to be taken during the coronavirus pandemic and breastfeeding, and how to manage stress, anxiety, and depression in these processes.” The tele-education included a digital pdf file called the “Booklet for Pregnancy and Birth Planning Education during Coronavirus (COVID-19).” All the of the educational content was developed with suggestions from medical and public health experts. A major takeaway from the above Midwifery study is that tele-education is effective in reducing the fears pregnant women have about giving birth as well as about their babies’ health in the context of a pandemic; in summary, prenatal distress and pregnancy-related anxiety were significantly decreased (p-value <0.05). Significantly lower scores on pregnancy-related anxiety questionnaires developed by van den Bergh (1990) and revised by Huizink et al. (2016) demonstrated the effective role played by tele-education. The second study published in Midwifery in 2021 supports the use of telemedicine interventions in treating postpartum depression symptoms. While the study’s timeframe was not during COVID, the results are helpful in understanding the beneficial role telemedicine has played in the past couple of years. Previous research has shown it can be a challenge for postpartum women to seek care for the “baby blues” or depressive symptoms, either of which could be significant. This may be due to perceived stigma, time, financial constraints, transportation, or childcare concerns. In this study, the telemedicine modalities included: telephone support, mobile applications, social media, and websites. This meta-analysis reviewed at least seven randomized controlled trials that largely used cognitive behavioral therapy (CBT) or psychoeducation to help pregnant women participants. The second Midwifery study concluded that telemedicine interventions “significantly decreased postpartum depression symptoms” and “demonstrated feasibility and acceptability among mothers in the postnatal period.” A major takeaway from the second Midwifery study is that telemedicine appears to be “promising in preventing and improving postpartum depression.” Of note, the study looked at women without a history of mental health conditions. Meanwhile, Hanach et al. highlight the need for larger-scale, future research to figure out the structure, content, and type of providers recommended within future telemedicine interventions. In conclusion, the benefits of telehealth—especially during COVID-19—appear to help women in the prenatal and postpartum phases of pregnancy. While the research is still growing, and quite limited, such positive signs are helpful in understanding the role that technology can play in addressing maternal mental health needs. Future studies that reflect on the benefits of telehealth are vital and will be particularly useful in supporting new and expectant mothers, especially in times of adversity. Source: https://www.psychologytoday.com/ca/blog/healthy-mothers-healthy-families-and-healthier-world/202104/telehealth-and-maternal-mental < Previous News Next News >

Effects on Patient Access to Telehealth as Some State Emergencies End Center for Connected Health Policy July 2021 With state of emergency declarations expiring or being lifted in states, there is growing concern patients are being left with reduced access if no permanent telehealth policy changes have been enacted. With state of emergency declarations expiring or being lifted in states, there is growing concern patients are being left with reduced access if no permanent telehealth policy changes have been enacted. According to the National Academy for State Health Policy (NASHP), nearly 20 states no longer are under emergency orders, with many soon to follow. Many states attached telehealth flexibilities to the federal public health emergency (PHE) while others made them contingent on state emergency declarations. Some states have successfully passed legislation to extend certain telehealth flexibilities in advance of state of emergency expirations, such as Connecticut and Delaware. The federal government Emergency Preparedness and Response for Home and Community Based (HCBS) 1915(c) Waivers were often originally tied to state emergencies, but appear to now extend 6 months after the federal PHE ends. Alaska is one of the states no longer under a state of emergency. During the pandemic a local outlet reported thousands of patients were being referred to out-of-state providers, especially in Washington, via telehealth for a variety of reasons including lack of specialty care and long wait times. Once the emergency licensing waivers expired, however, Seattle hospitals were sent rushing to reschedule Alaska patients and resume the more stringent process of becoming licensed in Alaska. According to recent local reports, Florida’s emergency expiration also took away audio-only and the ability to use telehealth to prescribe controlled substances and recertify medical cannabis patients. The Florida Medical Association told the local news outlet they will continue the push to make telehealth changes permanent in the next state legislative session, especially those requiring insurer reimbursement and payment parity, without which they say telehealth will simply no longer be made available to patients. For more information on the status of the emergency orders in each state visit the NASHP website - https://www.nashp.org/governors-prioritize-health-for-all/. < Previous News Next News >

What an eventual end to the PHE would mean for telehealth Andrea Fox October 17, 2022 Among other impacts, ending the PHE would represent access challenges and a loss of Medicaid coverage for millions, and would end medication-assisted treatment for opioid use disorder without an in-person exam. Since the COVID-19 public health emergency was declared in 2020, the Department of Health and Human Services has renewed the legislation every 90 days. Close to the end of the most recent expiration date, October 13, HHS Secretary Xavier Becerra again signed a renewal determination and it was posted without announcement late in the day. There had been no official news, but a lot of hearsay that the PHE would be renewed once more, because the Biden Administration indicated it would give two months' notice before its expiration. There is also the matter that open enrollment begins on November 1, and without the relaxed enrollment provisions for Medicaid that the PHE provides, the national uninsured rate along with health premium costs would certainly rise. But by definition an "emergency" can't last forever. The inevitable end of the PHE could result in the loss of Medicaid to millions when states review enrollee eligibility and in other impacts to healthcare operations. Questions regarding what will happen to telehealth benefits and the continuum of care in the absence of the PHE loom large. There has been extensive support for making the changes that have launched telehealth and provided the opportunity to serve more patients, but some people want to halt the prescribing of controlled substances via telehealth for mental health and substance abuse disorders and see the Ryan Haight Act – the online pharmacy consumer protection act of 2008 – reinstated. What's at stake Despite the Consolidated Appropriations Act of 2022, which provides a 151-day extension on some flexibilities granted during the COVID-19 public health emergency once the PHE ends, providers and other healthcare professionals engaged in telehealth are eager to prepare for the expiration date. There has been mounting pressure from the Republican Party, including a September 19 letter from Sen. Richard Burr, R-N.C., with numerous questions about ending emergency powers after President Joe Biden remarked during his September 60 Minutes appearance that "the pandemic is over." "Without a clear plan to wind down pandemic-era policies, the deficit will continue to balloon and the effectiveness of public health measures will wane as the American people continue to be confused by mixed messages and distrust of federal officials," wrote Burr. Despite economic concerns, ending the legal waivers afforded under the PHE could ricochet, hammering against gains made in increased patient access. Dr. Adrienne Boissy, Qualtrics chief medical officer (and former Cleveland Clinic chief experience officer), notes that patients continue to rely on expanded digital access as mental health effects from the pandemic linger. She says that a reversal would limit digital health access, which an overly burdened and understaffed industry has come to rely on. "The ease and convenience telehealth provides are consistent sources of positive patient experiences, as well as decreased total costs of care and less time away from the workplace," she said in a statement to Healthcare IT News. "Comparing 2016 to 2022, clinicians also report better health outcomes for patients, efficiency and less stress/burnout as major drivers for adopting digital tools, including telehealth," she said. "With the PHE, we saw the industry put patients and their access to care first – no longer hindered by location or demographics. "To revert back to reimbursement models that only support in-person care unravels the gains of meeting people where they are – physically and emotionally," said Boissy. "We can’t turn back now," Boissy said. Brad Kittredge, CEO and cofounder of Brightside Health, adds that the country will be short of psychiatrists – by 14,280 to 31,109 – in just a few years. Ending the PHE presents a reduced ability to serve the growing number of patients in need of or seeking mental healthcare, he said. "While there’s no silver bullet solution, telehealth offers the best and most immediate solution to this growing challenge by increasing patient access to mental health specialists without being limited to geographic regions or facilities," Kittredge explained in a statement sent to HITN. "More significantly, telehealth enables us to use technology and data to help clinicians be more efficient and effective at treating their patients, maximizing the impact they can make," he said. Telehealth in legislative limbo During a recent American Telemedicine Association policy update, the ATA's federal and state-level telehealth policy experts described efforts to develop a consistent regulatory framework so telehealth can be deployed across states, be fully leveraged and address the patchwork of 50 different state requirements. Legislators have also proposed broadening access to telehealth through the Telehealth Benefit Expansion for Workers Act, the Telehealth Extension Act and the Advancing Telehealth Beyond COVID-19 Act of 2021, which was passed by the House of Representatives in July, received in the Senate and referred to the Committee on Finance, where it sits. Also at play are a number of loosened restrictions that opened the gateway to online treatment of certain conditions when uptake surged and access to in-person medical care was restricted. Healthcare organizations and retailers entering the space through mergers and acquisitions with healthcare providers have urged the U.S. Justice Department and the Drug Enforcement Agency to revise telehealth controlled substance rules. The bill H.R. 7666 – the Restoring Hope for Mental Health and Well-Being Act of 2022 – introduced by Rep. Frank Pallone Jr., D-N.J., which was passed in the House, aims to address this hot-button issue for mental telehealth providers. The bill would permanently eliminate the X waiver, currently not required under the PHE. To qualify for the waiver to dispense buprenorphine for maintenance or detoxification treatment, the practitioner must take an eight-hour training and may only treat up to 30 opioid use disorder patients. Dr. Kristin Mack, a physician in Ticonderoga, N.Y., told MedPage Today that she would like to see the X waiver eliminated permanently. According to the story, rural communities are some of the hardest hit by the opiate epidemic. "We work really hard with community resources to provide counseling and things like that. But if I were to tell somebody, 'Oh, you have to go an hour away to a city to get care for this,' and then they need to be seen monthly, it's just not an option," she said. The Restoring Hope for Mental Health and Well-Being Act of 2022 was received in the Senate and was referred to its Committee on Health, Education, Labor and Pensions at the time of reporting. Treating opioid use disorders via telehealth It has been more than 10 years since the Ryan Haight Act mandated that DEA establish a rule ensuring that healthcare providers can successfully prescribe controlled substances via telehealth, but there has been no rule set forward. The SUPPORT Act again mandated the DEA issue rulemaking by October 2019 and the fiscal year 2021 final appropriations report requested that the agency establish these rules, according to the website of Sen. Mark Warner, D-Va. This past year he urged the Biden Administration to finalize regulations that allow doctors to prescribe controlled substances through telehealth. "In practice, the DEA’s failure to address this issue means that a vast majority of healthcare providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need. These restrictions have been temporarily waived during the COVID-19 public health emergency, and I welcome that, but patients and providers need a more permanent and long-term solution to this long-delayed rulemaking," Warner wrote in May 2021. Under the PHE, several virtual behavioral health startups focused on medication-assisted treatment for substance abuse disorder received investment rounds, according to Chris Larson at Behavioral Health Business. According to the story, Doug Nemecek, the chief medical officer of behavioral health for Evernorth, said that not enough people are accessing MAT, and that overdose rates have reached historic highs. "If regulations come back that prevent those companies from being able to deliver care in that way, we’re concerned that it’s going to have a negative impact on patients and our ability to make sure that people have access to the MAT that we want them to have access to," Nemecek said. Evernorth, part of Cigna Corp., is connected to digital MAT companies like Quit Genius. The cofounder of Quit Genius, Dr. Maroof Ahmed, explained in an email to Healthcare IT News that telehealth has filled a void that existed before the PHE. "Telehealth flexibilities and ePrescribing waivers have been crucial in enabling providers to care for patients during the pandemic and have greatly expanded access to care in situations where patients were unable or unwilling to travel to a physical location," he insists. Reinstating Ryan Haight Act requirements also has support Amending the Ryan Haight Act law is an effort largely supported in the healthcare and mental health space. However, Dr. Mimi Winsberg, CMO and the other cofounder of Brightside Health, shared another point of view regarding the dubious practice of prescribing controlled substances without an initial in-person visit. "To count on a public health emergency temporary lifting of laws in order to stimulate growth of your business is perhaps a questionable practice," she told Healthcare IT News, noting that Brightside adhered to not prescribing controlled substances over telemedicine despite the legal waivers. "While a lot of medical visits moved to tele during this sort of difficult part of the pandemic, that now in most specialties, they have gone back to in-person, but what we are seeing in mental health is about 80% have stayed remote," she added. "And so patients are continuing to get their mental healthcare largely through telemedicine." Winsberg entertained the question out loud: "Will they be resistant to in-person appointments if they need certain kinds of prescriptions?" "I don't think they will because we have seen that they're willing to go back to the doctor for other reasons," she added. The net growth of prescription drugs issued – stimulants and other controlled substances – grew during the pandemic, and she says she questions if the growth was largely driven by online practices "that were taking advantage of the lifting of the Ryan Haight Act." Winsberg did acknowledge, however, that an inability to prescribe buprenorphine via telehealth for substance abuse disorder, "is potentially an issue," she said. "These laws exist for a reason, and what we have to balance in medicine is the willingness to help people with the do no harm principle." Establishing systematic monitoring of controlled-substance prescribing via telehealth could be achievable, Winsberg said. "But, we'd like to move towards appropriate prescriptions of controlled substances, and if we can find a way to meaningfully regulate that online, then great," she concluded. Equal treatment for mental health disorders In January, Dr. Robert Field and doctoral candidate Kimberly Williams at Drexel University published a commentary on the National Academy of Medicine website on the long overdue policy update needed to prescribe buprenorphine via telehealth. The authors say that those who need treatment for opioid use disorder should have the same level of telehealth access as others who receive treatment for other medical concerns. They also noted that the DEA has not created a registration process through the online pharmacy consumer protection act, despite Congressional requests and statutory actions. "Doing so would not only ensure increased access to treatment but also set the stage for systematic monitoring of telemedicine and telephone services to confirm they meet the same rigorous standards of care as in-person services. "Such quality assurance efforts could promote the development of best practice guidelines and reduce variations in care as usage of these modalities increases," they argue. For the mental telehealth provider community wondering if the ability to prescribe buprenorphine via telehealth fades away in five months – if the Biden Administration does not intervene and extend the PHE, Congress does not pass legislation and the DEA does not create a registration process for prescribing controlled substances for opioid use disorder via telehealth – the U.S. may face even higher overdose rates. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org Healthcare IT News is a HIMSS publication. See original article: https://www.healthcareitnews.com/news/what-eventual-end-phe-would-mean-telehealth < Previous News Next News >

Telehealth 2.0: How Providence is taking its platform to the next level Laura Dyrda June 13, 2022 Telehealth became the prevailing mode for medical providers to see patients during the early days of the pandemic, and while use has leveled off in many areas, virtual care has become a permanent part of the healthcare ecosystem. Hospitals and health systems across the U.S. are now building telehealth, remote patient monitoring and hospital-at-home programs as part of their growth strategies. Patients also prefer telehealth as a convenient way to see their clinicians when an in-person visit isn't necessary. Most health systems have built a functioning telehealth program, but what opportunities are there to refine these programs for a better patient and clinician experience? Todd Czartoski, MD, chief medical technology officer at Renton, Wash.-based Providence, joined the Becker's "Digital Health + Health IT" podcast to talk about where the health system's virtual care program is headed. Click here to subscribe to the podcast and keep an eye out for Dr. Czartoski's episode. Note: Response below is edited lightly for clarity. Question: Where do you see telehealth becoming a better tool for clinicians and patients? How is virtual care at Providence evolving? Dr. Todd Czartoski: Over the last two years, our organization has done just over 4 million [telehealth] visits. For perspective, in 2019 we did 67,000 visits, and in one year we were doing 70,000 visits a week in April and May of 2020. That was a huge shift. Now, turning the lights on and being able to walk into the room is one thing, moving furniture around and optimizing the flow is another. A lot of our focus in the last couple years has been improving the experience for the provider, clinic staff and for the patient. We have really gotten it down to where the basic technical components of [telehealth] work pretty darn well, and we don't have a lot of issues with the connectivity piece. We've added interpreter services, and we've added in the ability to talk to more than one person at a time so you can have a family member in a different part of the country join the visit. Those types of things have been important add-ons, in addition to waiting room functionalities where you can add a survey or information tailored to the patient while they're waiting to see their provider in the virtual waiting room. Those are the things you're going to see continuing to evolve and emerge as additional capabilities. The support staff for the physician or provider's clinic also see their function and role evolving. If you think about a traditional clinic, a lot of those roles require putting patients in the room, checking their vitals, ordering labs or getting patients a follow-up appointment. Some of these things still exist, and some are going to be automated or done as part of a telehealth visit. That's where some of the opportunities are arising to continue to optimize the experience for the patients, staff and provider. You're going to see big trends overall here. Telehealth as a video visit, as a functionality, is somewhat limited. What we've learned is that whether you're a behavioral health specialist, a primary care provider or a subspecialty surgeon … all of those specialist visits can be done safely and effectively with telehealth. It's opened the door for looking at what else could we do beyond just a face-to-face visit. Specifically, the door has been opened for home monitoring. We have a remote patient monitoring solution that we built for COVID-19 home monitoring specifically, and because of the success of that, we've monitored over 30,000 patients up to two weeks who either confirmed or were under suspicion of having COVID-19. That opens the door for what we could do in terms of other types of home monitoring for COPD, diabetes, hypertension or whatever the case may be. That's a big area for growth and development. Finally, moving services outside the hospital, hospital-at-home, is a big initiative for us. We've been working on it for a long time and we're seeing some success. We're rapidly deploying that across our ecosystem and a lot of other health systems are as well. It really checks a lot of the boxes for patient experience; our patients absolutely love it. It's bending the cost curve, improving access and helping improve capacity so we don't have to build more super expensive towers and hospitals. Some of the outcomes with hospital-at-home have been shown to be better than traditional hospitalization when it comes to delirium, falls, length of stay and complications. People actually heal better on their own in a comfortable home environment. Those are a few examples of areas that we're going to see growth in our ecosystem. See original article: https://www.beckershospitalreview.com/telehealth/telehealth-2-0-how-providence-is-taking-its-platform-to-the-next-level.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < Previous News Next News >

Packard Foundation COVID-19 Policy Flexibilities Report – Impacts and Recommendations Related to Children and Youth with Special Health Care Needs Center for Connected Health Policy July 2021 Telehealth ensured better access to distant and specialized services, especially for those in rural areas and needing services in nearby states, as well as the potential to reduce disparities and address workforce shortages, such as those related to pediatric specialists. Last month the Lucile Packard Foundation released a report on COVID-19 policy flexibilities that focused on impacts and recommendations related to children and youth with special health care needs (CYSHCN). In addition to analyzing emergency policies, they looked to clinicians, family advocates, and other stakeholders to identify both challenges and opportunities based on their experiences. The number one policy change highlighted by all interviewees was how greater use of telehealth expanded access to care and had significant advantages, particularly for CYSHCN and their families. Telehealth ensured better access to distant and specialized services, especially for those in rural areas and needing services in nearby states, as well as the potential to reduce disparities and address workforce shortages, such as those related to pediatric specialists. Stakeholders also spoke to how telehealth addresses transportation and logistical barriers, mitigating challenges such as traveling long distances, missing work, and bringing other family members along as well as cumbersome medical equipment. The report also noted that the greatest challenges were identified as systemic infrastructure issues affecting broadband access, digital literacy, and lack of interpretation services. Based on their analysis and interviews, the report recommended CMS and state Medicaid programs extend emergency flexibilities on payment parity, audio-only and synchronous reimbursement, as well as remove geographic or rural/urban site restrictions and ease cross-state licensing laws. They also suggested the use of targeted federal funding to reduce disparities and providing grants for telehealth infrastructure and training, as well as increasing flexibility of privacy rules. For state Medicaid programs in particular, they recommended piloting additional modalities for future use such as texting, expanding school-based reimbursement and guidance, and considering reimbursement in childcare settings. The authors heard universally from stakeholders that reimbursement and payment parity requirements were essential to the availability of telehealth. According to their review, 38 states plus DC provided Medicaid payment parity by the end of April 2020, and by September, 17 states enacted laws requiring payment parity from private insurers. In addition, some clinicians reported that telehealth reduced emergency room and inpatient utilization, but because the costs saved were not shared with hospitals, the hospital shut down the program and they are now seeing increased emergency room use and negative health outcomes. For more information, please access the full report at https://www.lpfch.org/sites/default/files/field/publications/covid-19-hma-report_1.pdf. < Previous News Next News >

Telemedicine boosts access, decreases inequities in Montana Bill Siwicki October 10, 2022 The University of Montana College of Health has expanded its telehealth offerings across many disciplines to reach more people, especially in tribal communities. Montana has unique challenges in providing healthcare to its widely dispersed population of just over 1 million people. THE PROBLEM Out of 56 counties in Montana, 55 are designated as Health Professional Shortage Areas (HPSAs), limiting access to both urgent and routine medical visits. The cost of travel and long distances between healthcare providers and patients are commonly cited reasons for patients to delay or avoid medical care. The use of telehealth technology can improve healthcare access for Montanans living in rural and tribal communities by providing access to primary care and specialty services. Montana also is home to a significant Native American population, which makes up about 7% of residents. Tribal members experience significant health disparities due partly to inequitable healthcare access. "These pre-existing strains have left many rural and tribal communities particularly vulnerable to broad-reaching impacts of the COVID-19 pandemic," said Erica Woodahl, director of the L.S. Skaggs Institute for Health Innovation and a professor at the Skaggs School of Pharmacy at the University of Montana. "Rural and tribal populations have a higher burden of chronic disease and comorbidities known to increase the risk of morbidity and mortality associated with COVID-19," she continued. "Life expectancy of all Americans has decreased during the two years since the pandemic, but no group more than tribal people whose life expectancy has dropped almost seven years." The pandemic also further reduced access to routine care leading to an increase in preventable complications due to chronic conditions, including emergency room visits, hospitalizations and overall healthcare costs, she added. "Additionally, communities without nearby clinics or hospitals have not had adequate access to coronavirus testing or care, leaving rural and tribal patients vulnerable to the spread of COVID-19," she noted. "This increases pre-existing strains on rural healthcare systems due to provider shortages, limited hospital beds and other resource constraints." PROPOSAL In the telemedicine work of the University of Montana College of Health in Missoula, services would be provided through a centralized hub at the university with synchronous and asynchronous telehealth services provided to rural and tribal communities in partnership with clinics, hospitals and pharmacies across the state. The equipment purchased with help from a grant from the FCC telehealth grant program would allow for the expansion of services within UM's College of Health. "While the initial utility of telehealth technologies to improve care for underserved populations focused on immediate provision of clinical services disrupted by the COVID-19 pandemic, benefits to patients will extend beyond the pandemic to address the challenges of providing healthcare to Montanans," explained Shayna Killam, PharmD, a postdoctoral fellow at the Skaggs School of Pharmacy at the University of Montana. "Telehealth technologies provide clinicians with the tools necessary to bridge the gap in healthcare access and offer quality healthcare to Montana patients," she continued. "Services will specifically target patients living in rural and tribal communities with chronic medical conditions and comorbidities." The organization anticipates a broad reach across Montana, leveraging partnerships with clinical training sites and clinical affiliates to provide centralized telehealth services to a wide range of patients. "Programs in UM's College of Health were awarded $684,593 from the FCC," Killam reported. "Funds were used to purchase telehealth equipment and connected medical devices, providing critical and remote services for patients in Montana." Telehealth equipment will be used by faculty, residents and students affiliated with the University of Montana College of Health. Recipients of funding include the following: Skaggs School of Pharmacy (SSOP). Family Medicine Residency of Western Montana (FMRWM). School of Physical Therapy and Rehabilitation Science (UMPT). School of Speech, Language, Hearing and Occupational Sciences (SLHOS). MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE Pharmacist-driven programs provide services for community-based chronic disease screening, education and management, including management of diabetes, asthma, cardiovascular risk and mental health through point-of-care testing, medication therapy management visits and consultations with telehealth pharmacists. "Connected medical devices and video conferencing hardware will be used to provide routine and urgent care visits with medical residents and providers affiliated with the FMRWM, including diagnostics and monitoring, chronic disease management, prenatal care and mental health services," Woodahl said. "UMPT programs offer home-based visits and services in end-user sites in rural and tribal communities, including remote evaluations enhanced with telehealth technology, such as vestibular function testing and gait monitoring devices, telepresence robots, and video consults with patients and other healthcare professionals," she added. Clinicians and students in SLHOS will conduct telehealth visits via high-quality video and audio equipment, which facilitate effective evaluation and treatment for articulation and voice disorders. USING FCC AWARD FUNDS The University of Montana College of Health was awarded $684,593 from the FCC telehealth grant fund to purchase telemedicine kits to enable critical, remote telehealth services and to provide internet-connected devices for remote patient monitoring services for underserved, rural and tribal populations within the state. "UM's College of Health has used the FCC telehealth award funds to expand telehealth programs offered by the interprofessional disciplines with an overarching goal of increasing healthcare access and addressing inequities in care," Killam explained. "In addition to providing accessible and equitable healthcare, telehealth technologies will be used to train future health professionals," she continued. "Proactive training of our health professions students has the potential to transform the healthcare landscape in Montana and to overcome the challenges presented by traditional models of care." The equipment purchased has empowered physical therapists to engage in remote monitoring of patients as they complete interventions within their home, said Jennifer Bell, PT, clinical associate professor, school of physical therapy and rehabilitation science. "Oftentimes, patients have difficulty with balance and functional mobility within their home," she noted. "By utilizing technology, we are able to see a patient's home environment and support their ability to move around, minimize the risk of falls and complete a home exercise program." Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telemedicine-boosts-access-decreases-inequities-montana?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < Previous News Next News >

A staffing expert shows how telehealth is stepping in to fill the staffing shortage Bill Siwicki December 19, 2022 "As clinicians are passionate about patients receiving quality healthcare delivered in a timely manner, I see telehealth programs being the key to improving patient outcomes and the overall healthcare experience," he says. The staffing shortage is a huge challenge in healthcare today. Another challenge is finding a solution to this vexing problem. But telehealth may be becoming an emerging strategy to help fill in gaps within hospitals and health systems, contended Chris Franklin, president of LocumTenens.com, a self-service job board and a full-service physician and advanced practice recruitment agency working in high-demand medical specialties. Healthcare IT News sat down with Franklin to discuss changes occurring in healthcare staffing, what he calls hybrid staffing strategies, and the results of a new LocumTenens.com survey. Q. Overall, what changes are you seeing occurring in healthcare staffing? A. The changes we've seen in the broader economy regarding contingent employment over the past three years are incredibly impactful on healthcare staffing. There are a few key numbers that tell the story. There currently are 3.5 million fewer workers in the U.S. than there were two years ago. Since February 2020, job openings have gone up by 50%, while total employment in the U.S. has gone slightly down. Because demand is outpacing the available supply, workers are demanding not just increases in pay, but also more choice and control over when, how and where they work. This is incredibly true in healthcare, based on every indicator we watch. New data shows more than 300,000 healthcare workers dropped out of the workforce in the last two years. Physicians report they are choosing early retirement or leaving the full-time practice of medicine for other kinds of work, in and outside of our industry. Nurses on the frontline have made the news due to the difficulties they have experienced, and also because of the freedoms they are newly experiencing due to the uptick in travel nursing. According to a 2021 study from Health Affairs, nearly 100,000 nurses exited the profession last year – most of them under the age of 50. Another 32% of nurses have said they may leave the profession. The Bureau of Labor Statistics estimates we'll need to fill nearly 200,000 nurse vacancies a year until 2030. Patients are sicker than they have ever been. Over the past year, nearly every hospital has seen increases in patient acuity, largely driven by care that was delayed during the [COVID-19] pandemic. And chronic disease and obesity continue to be primary drivers of healthcare consumption in the U.S. Even though it's been on the horizon for years, the impact of a big population of aging baby boomers – the oldest turned 75 this year – is finally here, and demand for healthcare is about to increase dramatically as a result. Burnout also is at an all-time high. A recent survey from MGMA and Jackson Physician Search highlights a sobering pair of statistics: Nearly two-thirds of physicians (65%) report they are experiencing burnout in 2022, up four percentage points from the 2021 study. Of those experiencing burnout, more than one in three physicians (35%) said their levels of burnout significantly increased in 2022. All of this points to a big, industrywide shake-up, and we are seeing first-hand that traditional workforce staffing models are no longer working, especially in healthcare. What's emerging is something very different – hybrid models that anticipate both permanent and contingent workers, an uptick in models that combine site-based care with a robust telehealth presence, an increase in APP staffing overall, and in general, a growing commitment to giving providers access to the kind of work-life balance they are desperately seeking. Q. You say you are seeing a hybrid staffing strategy that includes elements of locum tenens, more advanced practice providers and more telehealth coverage. Please elaborate on this. A. Healthcare leaders are looking for new and creative solutions now more than ever – and all amidst this backdrop of healthcare workforce shortages. We have seen first-hand the impact the gig economy is directly having on the healthcare workforce and know the biggest concerns for healthcare facilities are attracting talent, retaining talent, and avoiding or mitigating burnout. To help clinicians' desire to achieve a more viable work-life balance, healthcare leaders are evolving their hiring models to reflect a new appreciation for the flexibility that hybrid staffing models represent. Solely relying on traditional staffing models and solutions just won't work anymore. Through staffing innovation, hospitals and healthcare organizations are actively seeking options to improve access to care with more sustainable models. Healthcare staffing is complex and there's never a one-size-fits-all solution, but we are seeing an increase in interest in alternative models of staffing, including a growing use of locum tenens staff and improving patient access to care with advanced practice providers (APPs) and telehealth expansion. Awareness of and interest in locum tenens are at an all-time high for both healthcare organizations and clinicians. People are actually taking their own well-being into account in terms of their employment, opting into contingent work as a way to manage their levels of stress and burnout. We had a locum tenens physician tell an audience at a recent conference: "If you have burnout in locums, you are not doing it right." There's no doubt flexibility of locum tenens offers a desirable outcome on what physicians are wanting out of life. According to the recent survey: Nearly 90% of healthcare facilities already use locum tenens staffing. Nearly 57% of facilities that have not used locum tenens staffing in the past are planning to use it in the next year. According to a recent survey we conducted on innovation and flexibility in staffing, when most administrators consider locum tenens, they most commonly think about onsite physician care. Data shows hospitals utilize onsite locum tenens more than three times as often as telehealth, but that is starting to change. Facilities that were previously reliant on onsite are now embracing telehealth. COVID-19 expedited this adoption, as hospitals looked beyond traditional models to meet their patients' needs. In some cases, hospitals are taking a flexible, hybrid approach that integrates telehealth and onsite care, providing the best of both worlds and delivering value to patients. Additionally, the use of APPs in combination with physicians as a strategy is growing, with 73.9% affirmatively responding to the question, "Do you plan to expand APP coverage?" Q. Your company recently did a survey of hospital administrators to get a clearer view of the challenges in today's landscape. What did you learn as it relates to telehealth? A. Our recent survey results – which are detailed in the Innovation & Flexibility: Journey to Sustainable Healthcare Report – revealed that hospital administrators have strong feedback when it comes to managing today's challenging landscape. With regard to how it relates to telehealth, more facilities are using telehealth than ever before. COVID-19 expedited this adoption, but over the coming year, most hospitals expect to expand their use of telehealth even further – there is no turning back. Patients across the board now are more comfortable using telehealth as the COVID-19 pandemic drove a surge in virtual visits, including those who have historically hesitated to use technology. Traditionally, psychiatric services dominated locum tenens telehealth services, with behavioral health accounting for 79% of telehealth services for LocumTenens.com. However, utilization has started to shift as hospitals look at other specialties, including oncology, cardiology and physiatry. By expanding telehealth offerings, facilities can expand access to care and reach more patients in new locations. Over the past year, many facilities have been able to deliver a higher level of specialty care to satellite or remote locations through telehealth. Going forward, better reconciling reimbursements to align with the level of care provided in a telehealth setting will lead to broader adoption. Q. Where do you see the telehealth component of staffing in five years? A. The feedback we have gotten shows that more than half (60%) of those surveyed plan to expand telehealth. Through innovation, healthcare providers will continue to adapt to flexibility and improved access to care. These flexible solutions create a more sustainable model to provide quality care to patients and their communities. As clinicians are passionate about patients receiving quality healthcare delivered in a timely manner, I see telehealth programs being the key to improving patient outcomes and the overall healthcare experience. The beauty of telehealth is that it provides access to a qualified provider at any time. For example, we have a client that provides psychiatric services across the country. During a busy day, a patient presented who was experiencing domestic violence trauma, and she wasn't comfortable talking with a male doctor. The problem was there were only male psychiatrists on call at her presenting hospital. The hospital contacted our team, and we in turn reached out to two privileged and credentialed female providers that weren't on-call that day. Although one was heading out to attend a wedding, she accepted the assignment to immediately provide care for this patient. So, even though this psychiatrist worked five states away from the hospital, she was able to provide care because of the access to telehealth. The result: The patient received the "right care" that she needed at the right time with an experienced provider. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/staffing-expert-shows-how-telehealth-stepping-fill-staffing-shortage < Previous News Next News >

Telehealth helps stop suicidal ideation for many patients, study finds Bill Siwicki December 29, 2022 One person dies from suicide every 11 minutes in the U.S. A new study shows that telemedicine can be used to treat more severe mental illness – contrary to previous thought. Recently, the Journal of Medical Internet Research published some significant data highlighting the efficacy of psychiatric care delivered through telehealth: Those in the treatment group were 4.3 times more likely to have suicidal ideation remission. This is noteworthy because telehealth has not traditionally been equipped to treat those with the most severe symptoms of mental health due to the oversight necessary to actually provide safe, effective treatment, said Dr. Mimi Winsberg, chief medical officer at Brightside Health, which led the study. We spoke with Winsberg to get an in-depth look at this study and what the results mean for the future of telehealth and mental healthcare. Q. Please talk about your new study that examines the impact of telepsychiatry on reduction in suicidal ideation over time. Who was involved? What kind of care did they receive? What role did technology play? A. The study, which was published in JMIR Formative Research, sought to determine if Brightside Health's telehealth platform, which is equipped with precision prescribing clinical decision support, could successfully reduce suicidal ideation among enrolled patients, versus a control group who tracked their symptoms on the platform without receiving care. Another goal of the study was to describe the symptom clusters of patients who present with suicidal ideation in order to better understand the psychiatric symptoms associated with suicidal feelings. The study was large scale including participants of diverse geography and social demographics. It included a total of 8,581 people who completed a digital intake on the Brightside platform. Of those, 8,366 elected to receive psychiatric care from Brightside, while 215 tracked their symptoms on the platform without receiving care. Those who elected to receive psychiatric care through Brightside received a minimum of 12 weeks of treatment that included video visits with their providers, asynchronous messaging, and a prescription of at least one psychiatric medication. Brightside's technology platform was used to deliver clinically validated measures of depression and anxiety, as well as questions about clinical presentation, medical history and demographics. The proprietary precision-prescribing platform embedded in the tech platform analyzes these data points using an empirically derived algorithm to provide real-time care guidelines and clinical decision support to its providers using a computerized symptom cluster analysis. Q. The study led to some very promising outcomes. Please describe them and the success you achieved with telemedicine. A. The study found that patients enrolled in Brightside Health's telehealth platform had reduced suicidal ideation after 12 weeks of treatment. Patients who received treatment via Brightside Health were also 4.3 times more likely to have remission of their suicidal ideation than the control group who were monitored on the platform but did not receive care. The results demonstrated that a telehealth platform equipped with clinical decision support was an effective intervention for the symptom of suicidal ideation. In addition, we found that suicidal ideation had higher correlations with cognitive symptoms of hopelessness and poor feelings of self-worth, than with the physical symptoms of depression such as disrupted sleep and low energy. Q. Telehealth hasn't traditionally been equipped to treat these kinds of patients. What made the difference here? A. Historically, we have not relied on telehealth solutions to address more serious symptoms of depression. Clinicians are hesitant to treat individuals with suicidal ideation over telehealth because of the perceived risks. However, the results of this study are significant because they demonstrate effectiveness in treating these symptoms through a telehealth platform with clinical decision support, which may help alleviate concerns about the use of telehealth in addressing suicidal ideation. Telehealth can involve more than simply connecting a provider and patient via video camera. The telehealth platform used for the study was equipped with novel features such as remote patient monitoring and clinical decision support. A sophisticated telehealth intervention can assiduously track symptom presentation and outcomes with measurement-based care and offer real-time interventions along with machine learning and algorithmically based clinical decision support to select the best treatment. Q. What does all of this mean for the future of telemedicine and mental health? A. The future of mental health via telemedicine promises more widespread adoption of solutions for the majority of behavioral health conditions, even those with increasing severity of symptoms. We may see telehealth deployed for more serious mental illness, particularly when the telehealth platform can incorporate novel technologies to optimize care delivery. Additionally, as payers and providers collaborate to deliver more effective care, telehealth will likely become more than a means to deliver care, but also a way to enhance care delivery and provide highly effective care to those who need it most with expediency. At Brightside Health, we will continue to research the impact of telehealth treatment across the spectrum of mental health conditions, including those on the higher end of the severity axis. To that end, we are launching Crisis Care, a first of its kind program delivered nationally and over telehealth to treat patients with active suicidal ideation. The program is grounded in the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) framework. This study in JMIR Formative Research laid the foundation for this program, and we are seeing an obvious need for such a national program in the U.S., where one person dies from suicide every 11 minutes. We look forward to furthering this important – and life-saving – work. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telehealth-helps-stop-suicidal-ideation-many-patients-study-finds < Previous News Next News >

Are Amazon, Walmart, CVS & Dollar Store Taking Over Healthcare? Dr. Maheu, Telehealth.org August 2021 Amazon, Walmart, CVS, and Dollar General are making notable strides toward increasing their healthcare footprints, positioning themselves to create a seismic shift in healthcare. Telehealth.org has been reporting such efforts for the last several years, and this week offers you an update on the latest developments on amazon care, Walmart care clinic, CVS health, and Dollar General. Amazon Care Introduced in 2019, Amazon Care launched a pilot study for employees in Seattle, quickly followed by an expansion into Washington State. Amazon Care is now expanding nationwide. In addition to developing connections with other companies, the service appears most focused on expanding into underserved rural areas. The pivotal issue to consider as Amazon grows its healthcare footprint is that Amazon currently dominates two digital areas lacking in the industry: optimizing the delivery of digital customer experiences and excelling at the automation of services. Walmart Care Clinic In 2019, Walmart announced the first of its many health centers, called Walmart Care Clinic, with these offerings: primary care, labs, X-ray and EKG, counseling, dental, optical, hearing, community health (nutritional services, fitness), and health insurance education as well as enrollment, in a growing number of their facilities. Walmart has since been keeping itself involved in telehealth developments through mergers and acquisitions. Walmart, the largest in-person retail company in the United States, recently purchased MeMD, described as an “on-demand, multispecialty telehealth provider.” As a complementary addition to the already existing Walmart health centers, MeMD will enable Walmart to provide digital behavioral, primary, and urgent care services. Walmart has also begun a collaboration with Ro, a pharmacy services telehealth app. The relationship will also Ro to sell its health and wellness products in Walmart locations while further increasing Walmart’s digital service offerings. CVS Health Although CVS and Walmart had previously worked together to deliver care through Walmart’s pharmacies, CVS Health announced in January 2019 that Walmart opted to leave the CVS Caremark pharmacy benefit management commercial and Managed Medicaid retail pharmacy networks. That same year, CVS purchased Aetna for $69 billion in cash and stock. The merger brought one of the largest providers of pharmacy services together with the third-largest US-based health insurer. The successful merger formed a healthcare giant with more than $245 billion in annual revenue. Since then, CVS Health has steadily grown its healthcare footprint and, just last week launched a new health care benefit called Aetna Virtual Primary Care. The announcement reads: Offered through the CVS Health Aetna medical insurance subsidiary, Aetna Virtual Primary Care offers members access to a diverse panel of board-certified physicians and coordinated care from a consistent team of specialists based on their health needs. Members will have a continuous relationship with a virtual care physician, beginning from their first 30-45 minute comprehensive primary care visit and extending to every visit thereafter. Existing Aetna virtual care offerings include mental health counseling, dermatology services, and 24/7 urgent care. Dan Finke, executive VP, CVS Health, and President, Aetna, explained, “The future of digital health solutions is rapidly unfolding.” He added, “Aetna Virtual Primary Care is a first-of-its-kind health care solution that provides a simple, affordable, convenient way for eligible members to receive quality primary care from a physician-led care team that knows them and is accessible from virtually anywhere.” As described in his profile, Mr. Finke “is passionate about addressing mental health stigma. He is also deeply committed to attaining health equity for all Americans by engaging public and private stakeholders to address social determinants of health through analytics-based approaches that offer new insight and opportunities into health care disparities.” Dollar General Dollar General is a smaller company, but it has an enviable foothold in rural America. Their stores are well known and trusted. Therefore, they can offer care to patients who live in areas where primary care, behavioral and other specialists are difficult to access. While analysts doubt that Dollar General would follow Walmart’s lead and build primary-care clinics, telehealth solutions are easily within their reach. Dollar General differs from Amazon due to limited floor space, small parking lots, leased rather than owned retail space, and a lack of infrastructure for filling prescriptions. However, these limited abilities did not prevent Dollar General from serving as a site for COVID-19 testing in some states. Dollar General has already partnered with Higi, a blood-pressure machine company that can be seen in some Dollar general stores. Babylon Health is a telehealth provider that has invested in Higi. Given its rural presence, Dollar General may be positioning itself for acquisition by one of the larger publicly traded telehealth companies. In July 2021, the company issued a press released stating: With 75% of the U.S. population living within approximately five miles of one of Dollar General’s 17,000+ stores, the Company recognizes the unique access it provides to rural communities often underserved by other retailers as well as the existing healthcare ecosystem. The Company’s commitment to expanding its health offerings is underpinned by its existing infrastructure, robust supply chain, and current complementary health and nutrition assortment. < Previous News Next News >

Amazon Launches Messaging-Based Virtual Care Service Anuja Vaidya November 15, 2022 Called Amazon Clinic, the new service enables healthcare consumers to connect with clinicians via a message-based portal and receive care for common medical conditions like acne and UTIs. A few months after announcing plans to shutter its telehealth business, Amazon has launched a new virtual care clinic. Called Amazon Clinic, the message-based service is currently available in 32 states. It offers virtual care for more than 20 common medical conditions, including acne, cold sores, seasonal allergies, and urinary tract infections. The service also provides access to birth control services. Healthcare consumers can choose to receive care from a network of telehealth providers, including SteadyMD and Health Tap. After selecting a provider, the consumer completes an intake questionnaire. They are then connected with a clinician via a message-based portal. Once the consultation is over, the clinician sends a treatment plan to the patient through the portal. Clinicians can also send needed prescriptions to a preferred pharmacy or Amazon's online pharmacy. The service further allows users to exchange messages with the selected clinician for up to two weeks after the initial consultation. READ MORE: National Telehealth Use Appears to be Stabilizing "We believe that improving both the occasional and ongoing engagement experience is necessary to making care dramatically better," Nworah Ayogu, MD, chief medical officer and general manager at Amazon Clinic, wrote in a company blog post. "We also believe that customers should have the agency to choose what works best for them. Amazon Clinic is just one of the ways we're working to empower people to take control of their health by providing access to convenient, affordable care in partnership with trusted providers." Amazon Clinic costs will vary by provider. Prices will be disclosed upfront, and according to the 'frequently asked questions' section of the blog post, the prices are "equivalent or less than the average copay." The service does not yet accept health insurance, but consumers can use flexible spending and health savings accounts to make payments. They can also use their insurance to pay for medications. Amazon plans to expand the virtual care clinic to additional states in the coming months. The news comes on the heels of the technology giant announcing that it will close its Amazon Care business by the end of the year. Amazon Care included both telehealth and in-person care and was positioned as an employer-focused service. Initially open to only Amazon employees in the Seattle area, the company began offering the service to other businesses in 2021 and even signed deals to extend it to Silicon Labs, TrueBlue, and Whole Foods Market employees earlier this year. But leaders decided to shut down Amazon Care because it was "not a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term," Amazon Health Services Senior Vice President Neil Lindsay said in an internal company memo. READ MORE: Telehealth Patient Satisfaction On Par with In-Person Care During Pandemic Unlike Amazon Care, it appears that Amazon Clinic will operate as a connector, enabling consumers to gain access to telehealth provided by established virtual care companies. "By abandoning Amazon Care in favor of Amazon Clinic, Amazon is doubling down on what they are good at — going directly to the consumer," said Allison Oakes, PhD, director of research at market research firm Trilliant Health, in an email. "Capitalizing on what they are good at, it seems like Amazon will create a marketplace for providers and patients to connect, rather than employing their own network of doctors. This will allow them to keep their costs low and scale quickly. It will be interesting to learn more about the economics of a marketplace model, which traditionally are based upon allocating revenue between the provider of the good or service and the operator of the marketplace. Given long-standing prohibitions against fee-splitting, it will be interesting to understand Amazon's economic upside." Further, because of the current cash-only payment model, Amazon Clinic may only attract relatively young and healthy patients, which is unlikely to improve population health, Oakes added. The shuttering of Amazon Care and launch of Amazon Clinic follow the company's purchase of One Medical. This may point to Amazon's growing focus on a hybrid care strategy overall. "It is interesting that Amazon Clinic is doubling down on virtual-only care, despite the fact that telehealth visits have declined by 37 percent from Q2 2020 to Q1 2022," Oakes said. "They may see Amazon Clinic as the 'digital front door' for One Medical patient acquisition." READ MORE: Patients Prefer Telehealth for Primary Care, Mental Health Needs Today's announcement appears to bolster that idea, with Ayogu noting in the blog post that if healthcare consumers are seeking virtual care for a condition that may be better treated in person, the service will let them know before they are connected to a telehealth provider. "Virtual care isn't right for every problem," he wrote. Editor's note: The article was updated at 2:50 om ET with comments from Trilliant Health's Dr. Allison Oakes. See original article: https://mhealthintelligence.com/news/amazon-launches-messaging-based-virtual-care-service < Previous News Next News >

Building Lasting Tele-Behavioral Health Programs to Address Patient Needs Kat Jercich, Healthcare IT News. August 2021 In a HIMSS21 Global Conference Digital session, two experts discuss what it's taken for the University of Rochester to spin up a virtual behavioral health program over the past nine years. Telehealth during the COVID-19 pandemic has allowed many patients – especially those in under-resourced areas – unprecedented access to behavioral healthcare. But as Michael Hasselberg, senior director of digital health at the University of Rochester, discussed with Cleveland Clinic Director of Design and Best Practices Julie Rish during a HIMSS21 Global Conference Digital session, such programs have required being nimble and adaptable in the face of changing needs. Hasselberg outlined the results of a tele-behavioral health model in effect at the University of Rochester, explaining that it grew from a pilot program aimed at primary care doctors to a full-scale initiative in nearly a decade. But the pandemic, he says, ramped up demand – and the supply had to change in response. "Like every health system in the entire country, overnight you had to flip the switch on, and essentially totally pivot to telemedicine," he said. Having the infrastructure and years of experience allowed the team to shift within about a week to providing behavioral health services nearly entirely virtually. Even as vaccines have become more readily available, Hasselberg estimates that about 60% of the team's ambulatory services are being provided via telemedicine. Interestingly, considering reports from other parts of the country, Hasselberg said the team has not encountered patient difficulties with broadband access, even in rural areas – thanks in part to state government efforts to ensure connectivity throughout the region. But one challenge, he said, has been gaining community trust and support. "Learning to build those community partnerships, identify how the stakeholders are, doing focus groups … has allowed us to be successful," he said. For other organizations looking to replicate the university's success, he said, start by reaching out to providers already in place. "Build that partnership there. Find out where their struggles may be, where the gaps may be, how you can join forces to fill those gaps and truly partner," he advised. He also suggests approaching the programs as iterative – being agile and flexible, and not allowing perfect to be the enemy of good. "Just get something out there: See what works and what doesn't work, and continue to build off of that," he said. It's also vital to remember that not every service can be done via telehealth, he said. Having a support network to assist patients with technology is enormously helpful. Rish noted that it's not just about access alone. It's also about comfort and about trust. "Having somebody from your team who can get to the community, who can be onsite – that's really important," said Hasselberg. Hasselberg said it's been useful to examine who can most benefit from telehealth because of transportation hurdles or other barriers to in-person care. "Finding parking at an academic medical center is not an easy thing to do!" he laughed. By merging that information with electronic health record data, he said, the team can get specific about how best to target services. As far as care delivery predictions, Hasselberg said he saw telemedicine as the "tip of the iceberg." "I think the future of behavioral health will be an a la carte array of options," he said. < Previous News Next News >