November 2020

As a reproductive psychiatrist with the Medical University of South Carolina, she knew the stats were dire.

“From 1999 to 2014,” she would later note in a medical study, “the number of pregnant women with opioid use disorder (OUD) in the United States more than quadrupled, increasing  from 1.5 to 6.5 cases per 1,000 hospital births.”

Worse was the fact that only a fraction — fewer than one in four women with the disorder — ever received treatment. It wasn’t hard to imagine where many lived: far-flung rural communities where addiction is compounded with both long-term unemployment and little access to health care.

How to bridge the gap? For Guille, the solution was readily apparent. Since MUSC already had video technology, why not use it to connect doctors with remote patients?

Naturally, there were questions that often greet the use of telehealth, namely whether a doctor could communicate as effectively on video as in person. Guille undertook a year-long academic study, which followed the cases of 98 pregnant women under treatment for opioid addiction. The results, published earlier this year, showed little difference between telehealth and in-person treatment.

Use of telehealth is exploding

Today, telehealth is booming at MUSC and hospitals around the state – largely because of the onslaught of COVID-19.

Through MUSC’s Center for Telehealth, medical professionals come together to reach patients and doctors throughout the Palmetto State

“It’s really an integrated care team,” Guille said. “Obstetricians, nurses, psychiatrists and addiction specialists are all kind of working together to take care of these women.”

MUSC partners in telehealth with Epic, the software firm which maintains the electronic health records for most of the country (some 250 million people) and just over half of South Carolina. The use of video, such as with Epic’s popular MyChart app, has exploded since earlier this year.

“Back in January, we were seeing about 10,000 video visits across our entire Epic community,” said Epic software programmer Taylor Seale in an interview with Statehouse Report. “In April, we saw 2.5 million. Folks got introduced  to telehealth as a means of providing care during COVID, but now that we’re seeing what the tool can do, we’re looking at what it can do in the future.”

Guille said video care hasn’t hindered communication.

“People connect no matter what, right? The more you start talking to someone and the more you know them and the more you engage, the screen just kind of falls away.”

Equally important, telehealth can provide women in remote areas with powerful stabilizing medications like methadone and buprenorphine, which according to Guille increases functioning and makes the patient less likely use opioids or become involved in criminal activity.

Telehealth broadens treatment options in S.C.

Unfortunately for some women in the state, doctors are leery about prescribing these medications to pregnant women.

“I think there are a lot of people, especially in the front line of obstetric practices, that don’t have a lot of training in addiction, and so a lot of these cases are going missed,” Guille said. “The word that needs to get out is that these problems are really common – you should be looking for them in pregnant and postpartum women, and that treatment is accessible and we should be getting people linked to that care.”

There is more to be done in other ways, she said, such as re-examining state and federal laws about prescribing controlled substances via telemedicine or regulations that require a doctor to see a patient first before prescribing medications.

“There were times where we were required to see these women in person first and it delayed care,” she said. “We even had an overdose with a pregnant woman who was trying to access our care but couldn’t get to an in-person appointment. So, we really need to use more of our access capability of being able to connect immediately and being able to get people on treatment when they’re ready.”

New technology will help rural areas, senator says

For lawmakers representing rural South Carolina, the benefits of the new technology are clear.

“Telehealth is going to be the mechanism by which a lot of people receive important facets of their health care,” said Orangeburg Democratic Sen. Brad Hutto, who has already seen two hospitals close in his district.

“In the late 1960s, the heyday of health care in the state was when every little town had a doctor or two, and every county had a hospital,” he said. “Now, small towns are lucky if they have a nurse practitioner or a physician’s assistant. Many small counties don’t have hospitals or won’t have hospitals as we go forward.”

Challenges ahead

Telehealth still has some bugs to work out. Doctors have long had telehealth reimbursement issues with insurance companies, with video visits not quite counting as a real office visit. With COVID, that seems to have changed, as the necessity for more care has meant accepting telehealth for at least the time being.

But the jury is still out.

“The idea of permanently expanding telehealth services covered under Medicare has garnered widespread support,” according to a recent article in MedCity News, “but how private insurers will react is less clear.”

“The way that those changes in reimbursement were framed is that they would be reevaluated or ended at the conclusion of the state of emergency,” said programmer Seale, “which is a little bit of a gray area. We don’t exactly know when that is going to end.”

For Guille, telehealth, has become an effective means of getting help for women in need  — and it’s here to stay.

“If we learned anything from COVID, [it’s that we must have telehealth],” she said. “Otherwise, we would have had no connection in the past seven months. Connection can happen in so many different ways.”

Rodney Welch is a freelance reporter who lives in Elgin.

It’s not breaking news that communicating with the public is vital for the success of your schools. And you know all too well that your relationship with local media can affect the way your community perceives you—and how often your story gets told.

We get it. Sometimes it’s hard to trust that the media has the purest intentions. News is a business, after all, and the most positive things happening on your campuses won’t always strike a reporter as newsworthy material.

As you know, no matter the story, your obligation is to the public. The media’s biggest concern is holding you to that. This can often make it seem like the press is an opposing force to your schools, only wanting to sell stories or get a good scoop. But this is a huge misconception, and it could be keeping you from sharing the most impactful stories coming out of your district.

“Don’t overthink it,” advises Alia Malik, an education reporter for the San Antonio Express-News. “Don’t think of it as one journalist or one media outlet. When you talk to the media, you’re talking to the public. Treat us with the same respect you would treat them.”

We know you can’t control every piece of news that’s out there about your schools—and that can be scary. What you can control is how you approach and work with the media. By building strong, trusting relationships with local education reporters, you can keep the most accurate stories about your schools in the news cycle and ensure you’re being heard in times of celebration or distress.

Establishing Media Partnerships

Beginning a media strategy can seem daunting. However, education reporters are actually looking for stories to print on schools, and they need credible sources to make their stories stronger. So what can you do to make sure they’re contacting your district?

Jenny LaCoste-Caputo knows a thing or two about building partnerships with the media. Before becoming the Chief of Public Affairs and Communications for Round Rock ISD in Texas, she was an education reporter herself. LaCoste-Caputo’s experience in journalism has helped her build a thriving partnership between her district and local media in the Austin area.

“When I was a reporter, I would often get frustrated with communications folks. I would say, They just don’t understand what we need,” she tells SchoolCEO. “You have to understand, frankly, that journalists are not your PR agency; that’s not their job. Their job is to report the news, to be a watchdog for the public.”
No matter how tempting it may seem, funneling inspiring stories to the media probably won’t get your schools the coverage you’re seeking. They may appreciate a celebratory story here and there, but touting your district’s strengths just isn’t their job—and this false expectation could lead to frustration for everyone.

Instead, make it your goal to build goodwill with local education reporters. When they’re on a deadline, you want them calling your district to ask for quotes and clarification—not asking a neighboring district or publishing a story without your knowledge. If the media knows you’re a good source to work with, you can start reaping the rewards of those partnerships. Once you’ve had a few conversations with your local media outlet, you’ll start to pick up on their needs—which puts you in a perfect position to supply information.

Make the initial connection.

To foster a good relationship with local media, connect with them before there’s a big story—when you don’t need anything at all. Get to know who’s reporting on your schools: not just who they are, but how they work, how they communicate, and what they expect from you and your team.

(Click here to read the full story.)  

Making that initial connection with a reporter doesn’t have to be scary, either. Remember that it not only benefits your schools, but also helps journalists who may be looking for education stories to cover down the line. The reporters we talked to said they appreciated school communications personnel reaching out to them directly—through email, phone call, or even text message.

“You’re almost always better off if you make a personal connection with someone,” says Charles Lussier. He’s been reporting on education for The Advocate in Baton Rouge, Louisiana, for 19 years. “If the goal is to actually get coverage, there needs to be a meeting of the minds. It’s harder and harder because there are fewer and fewer folks like me, and there are more and more schools seeking attention.”

He recommends reaching out to reporters with a simple email introduction. “Sometimes that could just be, Hey, do you have a minute to chat about what may work for you and what won’t?” he advises. “I get a lot of cold call emails where there is no connection made at all. Anybody who covers your schools on a daily or weekly basis is someone you’ll want to get to know.”

According to LaCoste-Caputo, establishing these personal connections should be a priority. “The very first thing you do is start to establish those relationships, calling reporters, telling them a little about yourself,” she says. “Try to set up coffee or lunch with them. Meetings are great—phone calls are fine too. But if you can start building a relationship, that’s always going to be helpful. Someone’s far more likely to pick up the phone or respond to your email if they recognize your name when they see it come across the screen.”

Let them know your “why.”

Even though the media is never going to be your PR agency, articulating your vision for the district can help them tell the complete story of your schools. If a journalist understands your mission, they’ll better understand your choices; they’ll get to know you. Eventually, they might even pick up on some of the words you are using in your marketing and branding—and help tell your district’s story.

For Dr. Shawn Foster, new superintendent of Orangeburg County School District in South Carolina, making a thoughtful connection with local media has allowed him to share his mindset as a school and community leader. “I think it’s important, first of all, that you sit down and explain your philosophy,” he tells us. “As superintendents, we have to make sure people see the big picture in regards to communication, because education is no longer about just reading, writing, and arithmetic. Education is a foundational economic driver for communities. We determine if someone’s going to come live here, if businesses are going to come in—we determine all of those things. So the message about your schools that the media puts out impacts everyone that lives in that community, including that media entity.”

Dr. Foster also stresses that a strong relationship with the media is beneficial in making sure who they’re writing about and reporting on is never forgotten. “We have to tell a story about children,” he says. “That’s the one thing people have to remember when you’re talking about communication in the school aspect—you’re talking about kids. No matter where they go when they leave us, if someone hears something negative about the area they come from, people oftentimes unfairly associate what they heard with those kids. And that’s not fair to them. So it’s extremely important, because a child may have to bear the burden of what we put out into this small world.”

Building and Maintaining Credibility

Let’s say you’ve put in the work: you’ve reached out to local media, had coffee chats and Zoom calls, exchanged emails and phone numbers. You trust that when a story comes their way, you’ll be the first to know. But how do you maintain that level of credibility when things get chaotic or unpredictable? How can you ensure that you’re still trusted to be a reliable source, no matter the news?

Maintaining your credibility is an essential part of your relationship with the media and the public. “If you’re working with the same school comms directors for any length of time, you have a sense of who’s responsive and who’s capable of getting your questions answered,” Malik tells us. “If you don’t return calls and you’re not interested, that doesn’t let you off the hook. When the school district is not releasing or providing that information, then that becomes part of the story.”

Credibility can also go a long way with the media in times of crisis. We know it can be difficult to be responsive when your priority is the safety and health of your students and staff, so that foundation of trust can go a long way with a journalist. If you know a reporter and they know you, the communication between you will be more timely, efficient, and accurate. The relationship you’ve already built with them saves you drama and stress when your schools need you most.

There are three main tenets to maintaining credibility: be responsive, be prepared, and be transparent.

Be responsive.

Remember that reporters are busy, and they’re often working on a deadline. You don’t have to respond perfectly, but make sure that you respond as soon as possible.

(Click here to read the full story.)

“Reporters are really busy just like we’re all really busy,” LaCoste-Caputo tells us. “So being specific and brief is really important. If you take the time to build those relationships, here’s what’s awesome—on slow news days when they’re looking for something, they’re going to call you up, because they trust your judgment and know you’ll hustle to churn something out quickly.”

Be prepared.

One thing you don’t want slowing you down when dealing with the press is not knowing about state or local laws, especially concerning media relations with the district. “I think comms directors need to have some basic knowledge about public records and open meetings laws in their states,” says Malik. “They shouldn’t have to go to their district’s lawyers every single time there’s a media request.”

This is another reason it’s especially important for a school leader and their communications director to work closely together. “I think the comms person and the super need to have a symbiotic relationship themselves,” Lussier tells us. “The comms directors who are more plugged in are the ones I seek out. Reporters always prefer to talk to people who are in the know.”

(Click here to read the full story.)

Be transparent.

Transparency is the foundation of your credibility, and the experts we spoke with emphasized it repeatedly. “If the media feels like you’re going to hide things from them or answer in a misleading way, they will not trust what you’re sharing with them,” says Kelly Avants, APR, former President of NSPRA and current Chief Communications Officer for California’s Clovis Unified School District. “It’s a huge one—be transparent and be willing to rip off your own Band-Aid.”

In San Antonio, Malik covers education in an area with 17 public school districts and more than 30 private and charter schools. Needless to say, she knows a few things about keeping up healthy relationships with school districts. “Good comms directors tell the truth and are open and transparent,” she says. “I understand they have lots of demands on their time, but I think they should prioritize talking to the media because they view it as talking with the public.”

Being honest and forthright regarding your district is not just a way to build credibility and strengthen your brand—it’s your obligation to the public. “You want to make sure to have an organization that’s doing things the right way,” LaCoste-Caputo says. “But then also share the challenges. People need to understand them. It’s two-fold. You’re building trust for being honest. But primarily, you’re demonstrating your needs so that when there’s a call to action, people feel compelled to answer.”

Pitching Stories

We don’t have to tell you that newsworthy things are happening on your campuses every single day. But without a strategic and thoughtful plan for collecting and sharing these stories, you could be missing out on countless chances to connect with your community and highlight your schools through media coverage.

The media won’t always know what’s going on in your schools unless you tell them. So you also need a plan for taking stories you’ve collected from your schools and pitching them to local education reporters. With an internal story pitching strategy and a plan for pitching to the media, you can be sure the best things happening in your schools don’t go unnoticed.

Create an internal system for pitching stories.

Nobody knows your schools better than the teachers and administrators in your classrooms everyday. But if a class starts a successful fundraiser for a local food bank, would their teacher know how to share that story with the district or media? Does the principal know who to talk to? Should they go to your communications team or directly to the media?

“Our district has some pretty strict protocols in place, and I think for a leader who is learning or rethinking their media strategy, there’s a lot of value in that,” says Avants. At Clovis Unified, she assigns a communications liaison to each one of the district’s more than 50 school sites. This person serves as the district’s eyes and ears on the ground. “They’re tasked with sending information to us,” she explains. “They’re bringing that content to us, and we’re figuring out how to use it—maybe putting out a press release, creating a media event, or simply posting a video on Instagram. We consider ourselves our own newsroom in a sense. We certainly work with the media to tell our story, but it is incumbent on us to tell our own story as well.”

Many journalists don’t like the idea of checking in through the communications office before talking with sources in schools, but Avants says there are good reasons to do this as a district. “I often remind the media that we are sometimes dealing with contentious custodial issues with families who have restraining orders, one parent against the other, etc.,” she says. “We want to be confident that our systems are not going to put a vulnerable child in the line of a camera or a reporter that would be jeopardizing them while they are under our care.”

So as you align your district’s media communications, make sure your stakeholders know that there are always extenuating circumstances and events that are beyond anyone’s control. Make sure they know your system is meant to help them communicate their stories, not silence them. “There’s some time lost in unnecessary middleman stuff if there’s restrictions on teachers reaching out to the press,” says Malik. “What I’m concerned about is that people feel like they are able to talk to the press no matter where they fall in the school system—especially students and their families.”

In Orangeburg County, students and families always come first when it comes to communication with the media. For Merry Glenne Piccolino—Orangeburg’s Assistant Superintendent for Communications, Business, and Community Partnerships—that means having a solid system in place that helps find the most impactful stories to share. “Alignment is important to me,” she tells us. “I think about a teacher being an example of a strategic vision for the school district. When you can actually have a human interest story that relates and contributes to the vision and the goals of the school district and shows its employees fulfilling that vision, it’s such a win.”

Learn how to pitch to the media.

So you’ve got your plan in place for gathering story pitches from your schools, but how do you take those ideas and share them with the media? Unfortunately, you can’t just send them anything that comes across your desk—you need to learn more about their needs and what they like to cover. What are they looking for in terms of stories?

(Click here to read the full story.)

Cameron Bell, Executive Director of Media Relations and Public Information for Jeffco Public Schools in Colorado, does research into her district’s local media to learn as much as she can about them. “Get to know publications and outlets,” she advises. “Watch them, read them, follow them on social media—and follow reporters on their own channels as well. Look at what they’re doing so you can also get to know them. That way, you know their voices and what they tend to report on most often. You know what kind of stories they like to tell and seem passionate about.”

Bell also says to be aware that some journalists you work with may not know exactly what they’re looking for. “A lot of reporters who normally cover politics or sports are having to cover things like education because of shortages,” Bell tells us. “A lot of them will say to me, I don’t even know what this means. Can you help me?” If you’re prepared with newsworthy stories and pitches, you can make a reporter’s job a lot easier—and that buys you goodwill and helps you build a stronger connection.

However, the media is always looking for a few common things. “People need to think in terms of what is new, what is a little different,” says Lussier. “They also need to think about the medium. I work at a newspaper. Newspapers aren’t just print entities anymore; we’re news sites. So we’re also trying videos now. The more complete the package on a story you can deliver to someone like me, the more it’s sellable. Especially if it’s visual.”

Education is rife with confusing and complicated rhetoric, so it’s also important to keep that in mind when you’re pitching a story. “The more complex a story, the more human you’ve got to make it,” Lussier advises. “If readers see someone grappling with something in real time and in real circumstances, it’s going to mean more, and it’s going to come alive.”

Knowing what your local media is looking for in terms of education stories will make things a lot less stressful for you, your communications team, and the media. And if everyone’s on the same page, the right stories get told.

Don’t be afraid to nudge reporters.

Depending on your location, you may or may not be dealing with a great number of other schools that want to tell their stories, too. Keeping up your end of the communication bargain may sometimes mean being consistent and assertive in pitching to the media to make sure you’re being heard.

In Jeffco, Bell sends out a weekly newsletter to local media that includes a list of story pitches from schools around the district. “Once I send them out, I post each one on our media relations webpage,” she says. “We give information, but we also pitch fun stories, give construction updates, and things like that.” When directly pitching to a reporter, Bell may use “a blurb-like pitch” or even develop an idea into a story that a reporter can then expand on.

It also never hurts to follow up with a reporter or reach out when something is important or timely. “Definitely nudge me,” Lussier says. “If you really think something is a story, you may have to grab me by the lapel and shake me a little bit and go, This is something and here’s why. Don’t assume that I’m just going to jump to it. If I’ve been doing five other things, it wasn’t even on my radar.”

In terms of how you should nudge or reach out to a reporter, Lussier offers some sound advice. “It’s usually an escalation. If it’s something happening now, give me a call. If it’s something happening tomorrow or the next day, you can start with an email or maybe send a text.” Also remember that reaching out to a reporter who may be too busy for your story isn’t a fruitless endeavor. “If I can’t do it, but I know it’s something big enough, I may be able to find someone else, or we can think about a plan B and circle back,” he says.

When Bad News Strikes

Your schools should be prepared to respond to any kind of story that comes across a reporter’s desk. Sometimes, as you well know, it isn’t good news. So first it’s important to acknowledge and accept that you can’t keep news from reaching your community, no matter what it’s about. Because you serve the public, much like the media, you already know that being transparent and responsive is a top priority. This, in turn, will help you build strong relationships with local education reporters so that when negative things do happen, they call you first.

React thoughtfully and honestly.

As simple as it may seem, being thoughtful goes a long way, and being as honest as possible with the media and public should always be your priority. If there’s a story involving your schools, you want local media to know they can trust you to give them the answers. Bad things happen every day, and you certainly don’t want your reaction to the media to become part of the story.

“Realize that anytime someone has an issue, they’re going to call me,” Lussier tells us. “But if I have a good relationship with a district, I’m not going to pop off with the first tip of the day. I’m going to call them and go, Look, I heard about this. What’s going on here? I’m willing to have a conversation with them on anything people come to me with.”

To react to negative stories in a thoughtful, transparent way, be as open as you can be with the media and public about whatever is going on. If there’s been an incident on one of your campuses, or a mistake has been made, your district should be as upfront as possible. “There are going to be negative things that happen,” Piccolino says. “The media needs to know that when we’ve done something wrong, I’m going to own it. I’m not going to sugarcoat it or try to spin the story or anything like that. If a child is hurt or something else has happened that is the fault of an employee, process, or system, I’m going to own it, apologize, and identify how we’re going to do things differently to prevent it from ever happening again.”

Build a bank of good stories.

You can’t keep bad things from happening, but you should always remember that good things are happening, too. Having a system in your schools for gathering those inspiring stories means you’ll be ready to share them when you need to most.

“We’re always trying to build that bank of really good stories,” Piccolino says. “We’re one of the largest employers in the community, and people make mistakes—kids, adults, everybody. Sometimes when things aren’t going so well, we pull a story out of our pocket that is going to change hearts and minds. Those living examples help refocus the community’s mindset on what’s positive and on the intentions of our work. It recenters public interest and attention on something that is positive so that stakeholders can put a small error in perspective while remembering the larger and overwhelmingly positive impact our school system makes.”

(Click here to read the full story.)

By being prepared to share your very best stories, you can ensure that no matter what happens, your schools are being seen, heard, and understood. As the saying goes, If you don’t tell your story, someone else will. After all, it’s the media’s job. But nobody ever said you couldn’t help them along the way.

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COVID-19 brought telehealth into the forefront, and consequently, funding is increasing, restrictions are loosening, and the public’s interest is waxing.

Telehealth was already building acceptance when the pandemic catapulted it into the national spotlight. Now that Pandora’s Box has opened, telehealth is here to stay. And it’s going to evolve. There would be no Netflix without Blockbuster — no iPhone without the first mainframe. All technological innovation triumphs begin with the forerunner. And in that context, telehealth is performing quite well. Imagine what’s in store — more than convenience, telehealth purports to be a crucial part of the 360o customized health care solution.

A short time ago, telehealth was an infrequently used option to traditional health care, a system burdened with fluctuating rules and regulations affecting reimbursement and the variegated, non-eligible costs and services imposed by state and federal laws. Any hope for the swift advancement of telehealth as a practicable alternative to traditional health care was floundering in a hotbed of red tape.

Related: Embracing telehealth benefits in the workplace

However, the onset of COVID-19 brought telehealth into the forefront of health care, and consequently, funding is increasing, restrictions are loosening, and the public’s interest is waxing. This year alone, investor dollars have raised 9.4 billion for digital health, smashing the 2018 record of 8.2 billion, and mega deals are going through the roof. Medicare has also waived many of its restrictions, which prior to the pandemic included physicians receiving either lower reimbursements than in-person visits or no compensation whatsoever. And just this past April, the FCC initiated the COVID-19 Telehealth Program, which gives $200 million in funds to ensure that health care providers have the necessary services and equipment to serve their patients remotely.

Many formerly in-person activities are being re-imagined remotely. Obviously, business meetings and school education, but also music lessons and birthday parties. Surprisingly, people have found that there are distinct and unexpected benefits to distanced activities. Telehealth is similar with 51% of people planning to continue to use telehealth after the pandemic, not just for the convenience of the appointment, but for many little treasures like faster appointment setting, streamlined communications and timely follow-up.

It’s difficult to discount those who suggest the pandemic is responsible for thrusting telehealth into its current predominance. Some experts say that invoking telehealth services into mainstream health care options is long overdue, while others believe that telehealth is untenable, artificially inflated by COVID-19, and its popularity will fade as soon as the pandemic recedes. If nothing else, the pandemic has legitimized this budding service so it can be recognized for what it is — a cutting edge treatment option promising as yet unrealized bonuses.

While COVID-19 may have forced many into using telehealth, by no means was telehealth born out of the pandemic. Case in point: the 12-month period between January 2019-2020 shows telehealth claims increased 43%, and the February 2019-2020 period shows a 121% increase, demonstrating that before the pandemic, telehealth services were already on the rise.

While telehealth is the safer choice amid the pandemic, its pre-COVID rise is due to some of telehealth’s most primary and obvious advantages, including provider support, reassurance, communication and education regarding treatment and medications that is equal to traditional in-office visits. Now, add to these the savings in time, travel, parking, childcare and scheduling conflicts all while receiving care in the comfort and confidential space of one’s home or office. Telehealth saves providers time, too, and allows them to cut costs, meet outcomes and serve patients in remote and rural areas.

Yet, telehealth faces criticism — it is not perfect. It does not allow providers to perform physical exams, which means less information with which to diagnose and medicate, and there are social and technical inequities, e.g., patients who do not have access to computers or reliable Internet. Patients may also not have access to a private area in which to meet; older patients may not have access to the necessary technology or know how to operate it. And truly, some providers and patients adamantly prefer face-to-face appointments.

Instead of considering telehealth as a replacement for in-person care, most would agree that telehealth and its technology integrations are a welcome complement in the frame of total health care — a vision of minimal but timely intervention, quality monitoring, customized human care, delivered in unison by holistic instead of fragmented disciplines. Telehealth will evolve to meet the growing and complex needs of the future of total care.

In the famous analogy, NASA doesn’t launch its shuttles on a perfect trajectory from the launch pad to the final destination. Rather, it launches a shuttle past the earth’s atmosphere and then adjusts coordinates in flight. Well, telehealth is launched. Now its course will be altered by the millions of patients and providers who have begun to overcome its shortcomings. The pandemic has fueled telehealth’s rise into the stratosphere and revealed its power as a viable alternative, one that has been overshadowed by healthcare’s traditional complacencies. So what does the future of telehealth look like? As we move through this pandemic and into a post-pandemic world, it is likely that telehealth will evolve into something very different than it is today.

Telehealth developed from technological possibilities and, as of late, has been nurtured by necessity — a required, inconceivable, essential circumstance. So, as we’ve required telehealth services to meet our needs through most of 2020, we’ve learned that it will continue to be indispensable, making telehealth an essential service beyond today’s needs and into preventive care; expedient care for triaging new symptoms; mental health management; and close monitoring of chronic conditions. However, the future of telehealth has the potential to also look like this: a 360o care that includes tele-assessment, tele-diagnosis, tele-interactions and tele-monitoring through artificial intelligence that connects a patient’s many providers to a shared knowledge base to ensure better, faster, less-expensive mainstreamed care.

Loraine Daugherty is Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group where she provides analytical decision-making, strategic planning and executive leadership. As CEO, she is focused on developing best practices for organizational processes, performance measurement systems and building IMCS’s infrastructure to maximize the company’s growth. With more than 30 years of industry experience in workers’ compensation, Ms. Daugherty also has professional expertise in Medicaid, Medicare Part B, third-party contracting, administration, client services and operations. 

Read more: 

• Infographic: Telehealth growth amid the COVID pandemic
• Insurers pull the plug on telehealth cost-sharing waivers
• The future of telehealth is hybrid

BlueCross BlueShield of South Carolina announced in a release Monday that they have awarded $11.6 millionin grants to Diabetes Free S.C.

Several healthcare providers in the state have been grant recipients of Diabetes Free S.C., a multi-million dollar project to improve diabetes healthcare.

The grant money will be split between Prisma Health, the Medical University of South Carolina (MUSC), the Alliance for a Healthier Generation and FoodShareSC.

“It’s connecting different health systems across the state to collaborate and provide consistent, standardized care to improve outcomes,” said Hannah White, a Registered Dietitian and Certified Diabetes Educator at Prisma.

According to the American Diabetes Association (ADA), 35% of adults in South Carolina are pre-diabetic and 500,000 South Carolinians are diagnosed with diabetes.

The main objectives for the grant are improving pregnancy outcomes for women with diabetes, reducing diabetes risks in children and diabetes prevention for adults.

At Prisma Health in the Upstate, a group of doctors and experts wrote their grant to focus on improving pregnancy outcomes.

Dr. Megan Shellinger, Maternal Fetal Medicine Specialist and Medical Director of the OB Center for Prisma Health Upstate, helped write the grant at the beginning of the coronavirus pandemic. Her team was awarded $1.5 million of the BlueCross BlueShield grant.

“The benefit of this grant is that they will have all of their care partners in the same clinic,” said Shellinger. “And we’re able to reach patients who haven’t necessarily had access to all of the latest technology and all of the specialists that they need, so this really gives us the opportunity for a holistic care model for these patients.”

Additionally, the cost of care for diabetics in South Carolina can be a barrier for many. In 2017, the ADA reported that the annual cost of care for diabetics in the state was $5.89 billion.

“For some of our patients, insulin is one of the things that they need to survive, so this grant is going to be able to provide that to those patients in need as well as making their lives easier with access to diabetes technology, such as continuous glucose monitors, insulin pumps and those sorts of therapies,” said White.

Part of their diabetes prevention will even include supplying food to patients with food insecurity or without access to healthy options that are essential to preventing and treating Type- 2 diabetes through the FoodShareSC program.

Additionally, Prisma will offer telehealth and virtual medicine to patients with transportation issues and in order to reach more counties, according to Shellinger.

“It will just be such a blessing to our patients because this is what they truly need,” said Shellinger. “They get access to the medications they need the specialists they need, as well as the latest technology, and it will be equal across the state of South Carolina.”

By Kat Jercich

Healthcare lawyer Andrew Selesnick said one key will be to establish a stable, user-friendly platform that can make documentation seamless.

The future potential of telehealth hinges on how it’s reimbursed. Virtual care may be popular among patients, but if providers can’t get paid for their services, it’s unlikely they’ll be able to continue to provide them.

The government has signaled its support for reimbursing some telehealth services, at least in the short term. The Centers for Medicare and Medicaid Services announced earlier this month, for example, that it would add 11 virtual services to its reimbursement list during the COVID-19 public health emergency – following in the footsteps of its earlier flexibilities for virtual care.

This could act as a signal for other payers to do the same, said Andrew Selesnick, a shareholder in Buchalter’s Los Angeles office, in a Healthcare IT News interview. “The government can play a very positive role in telehealth by establishing clear standards and clear reimbursement guidelines,” said Selesnick. If the government, for example, requires documentation for certain services and certain rules around telehealth, “then the payers will be hard pressed to ignore them for a lengthy period of time.”

“If Medicare says you have to cover something – that’s going to be harder” for private payers not to cover it, Selesnick said.

Indeed, private payers have slowly begun to reinstate out-of-pocket costs for telemedicine. UnitedHealth Group and Anthem are saying that some members will be responsible for copays, coinsurance and deductibles for non-COVID-19 virtual visits.

The COVID-19 pandemic has “been a time of tremendous change” with regard to virtual care, said Selesnick.

Given the dozens of changes to policy at the federal level, including allowing providers to practice across state lines and to regard a patient’s home as an originating site, “we’ve probably had more regulatory reform in the last six months than we’ve had in the last six years when it comes to telehealth,” he said. “Many of my clients who weren’t even telehealth providers before have jumped into the fray.”

The providers most focused on the future of reimbursement and telehealth tend to be primary care clinicians, Selesnick said, as well as a “goodly number” of emergency physicians.

“They can do a lot of things, and they’re used to dealing with limited information and making decisions with people they don’t know,” said Selesnick, making them particularly nimble when it comes to virtual care.

“Hospitals and health systems were very active as well, because they had such a huge drop in volume at the early stage of the pandemic,” Selesnick continued, with many of them pivoting to ramp up existing telehealth technology and accommodate patients. “A lot of places saw drops of 30 to 50% in volume, and they have fixed costs – and people still need care.”

When it comes to the future of reimbursement, Selesnick predicted a continuously changing outlook over the next one to two years. “We’re going to see a lot of activity over the next 12 to 24 months, where the landscape shakes out and people have a good understanding of where they stand,” he said. “It’s going to be a struggle.”

So, given that uncertainty, how can providers best prepare?

One way, he said, is having a “stable, user-friendly platform.”

“And I don’t just mean user-friendly for the consumer; I mean for providers as well,” said Selesnick. He described clinicians who can’t easily get into their electronic health records from telehealth platforms and then just not billing for services, rather than jumping through technological hoops.

For providers, he continued, “it’s about clear guidelines” about what telehealth reimbursement requires in terms of documentation and visit length. “You put a lot of hurdles in, you’re going to have diminished use.”

Ultimately, “telehealth is here to stay,” he said. “I think there will be a scale-back in telehealth in terms of what they’re going to pay for, but it’s definitely going to stay.”

Video visits as a form of family visits in the hospital are slated to continue, some experts assert, as a key method for driving patient satisfaction.

Mark E. Dornauer
Robert Bryce

October 28, 2020

The COVID-19 pandemic has led to a surge in demand for everything from hand sanitizer and face masks to lumber and toilet paper. It has also led to the soaring use of telehealth services: Between April 2019 and April 2020, national privately insured telehealth claims’ increased by 8,336 percent (as a proportion of total medical claims). While those ratios eventually tapered in the proceeding months as in-person visits rebounded, there’s no doubt that more patients and providers are relying on telehealth than ever before. But rural Americans are 10 times more likely to lack broadband access than their urban counterparts. In 2018, the Federal Communications Commission (FCC) estimated that one-quarter of rural Americans—and one-third of Americans living on tribal lands—did not have access to broadband (meaning download speeds of at least 25 megabits per second). By contrast, less than 2 percent of urban Americans lacked that same access.

The lack of broadband in rural areas is one of the most striking inequalities in US society. Due to the lack of broadband availability, tens of millions of rural Americans aren’t able to “see” their doctor over the internet in the same way urban Americans can.

Making matters worse, financially strapped rural hospitals are being shuttered by the dozens. An estimated 47 percent of the country’s 1,844 rural hospitals are operating in the red. Since 2005, at least 174 rural hospitals have closed, including 47 since 2018. Fifteen have closed in 2020 alone. A recent analysis found that about 25 percent of rural hospitals are at high risk of closing. More than 80 percent of these at-risk hospitals are considered highly essential to their communities and if shuttered would greatly reduce physical access to care. These closures underscore the importance of telehealth in rural areas.
Rural America Is Becoming More Racially Diverse

The COVID-19 pandemic has not impacted the United States uniformly. Indeed, densely populated urban centers initially bore the brunt of the disease with certain minority populations infected at higher rates. As COVID-19 migrated from big cities to smaller towns, minority populations continued to suffer disproportionately higher infection rates. Even in predominately rural states, such as South Dakota, Asian Americans became infected at rates six times higher than their share of the population. Similarly, in New Mexico, Native Americans accounted for more than half of the COVID-19 confirmed cases but only comprised 11 percent of the population. These trends underscore an important aspect about the demographics of rural America: It is far from monolithic.

In fact, rural America is becoming increasingly diverse. In 2010, one in five rural Americans was a person of color or Indigenous individual—up from one in seven in 1990. The 2020 census will likely be even higher. Specifically, recent immigration patterns have changed the racial and ethnic composition of rural regions. In a 2018 Center for American Progress report, a sample of 2,767 rural places witnessed an average population decline of 4 percent through a 12 percent decline in native-born population but a 130 percent growth in immigrant populations. Yet, alarmingly, rural Black, Latino, Asian, and Indigenous adults are also less likely to have a personal doctor and more likely to forgo routine health care visits due to costs, just like their urban peers.

Moreover, rural Americans are statistically poorer than their urban peers   across all racial and ethnic backgrounds. According to the Census Bureau’s 2013–17 five-year estimates from the American Community Survey, poverty rates for mostly rural (16.3 percent) and completely rural (17.2 percent ) counties stood higher than mostly urban counties (14.3 percent). Similarly, in the same survey, predominantly urban counties reported household incomes of $59,970 while mostly and completely rural counties disclosed figures of $47,020 and $44,020, respectively. Arguably, for rural patients, the cost of health care matters nearly as much as the access to it—with telehealth offering a cheaper and more accessible alternative during the COVID-19 pandemic.
A New Deal–Inspired Solution

This rural telehealth crisis must be addressed at the federal level.

In 1930, nine out of ten rural farms and ranches in the country were not connected to the electric grid. Without electricity, rural economies were being left behind. Women and girls were forced to haul water and wash clothes by hand. Factories and big employers congregated in cities where electricity was cheap and abundant.

The New Deal changed that. With the passage of the Public Utility Holding Company Act in 1935 and the Rural Electrification Act of 1936, federal funding allowed cooperatives and other entities to string wires to rural areas. By 1950, about 9 out of 10 rural farms and ranches were connected to the electric grid. Today, that figure is close to 99 percent.

Similar federal action is needed today to solve the rural broadband problem. In 2019, the Pew Research Center found that roughly 63 percent of rural Americans have home broadband internet, still 12 and 14 percentage points lower than their urban and suburban counterparts, respectively.

How much will it cost to bridge the digital divide? Stringing fiber optic cable costs about $20,000 per mile. That’s a lot of money to spend when some rural areas may only have a few houses for every mile of cable. But that’s the very same problem that had to be overcome with rural electrification.

In 2017, Deloitte Consulting put the cost of extending rural broadband at about $40 billion. A 2018 analysis by the National Rural Electric Cooperative Association found that about 6.3 million electric co-op households “totaling 13.4 million people, lack access to adequate, high-speed broadband service.” The association’s cost estimate for addressing the problem was the same as Deloitte’s: about $40 billion.

Politicians are paying attention to the problem. Last year, FCC Chairman Ajit Pai approved $5 billion to improve rural broadband, and later this month the FCC will hold a reverse auction for some $20 billion in grants being made available through the Rural Digital Opportunity Fund. In addition, former Vice President Joe Biden has pledged to spend $20 billion on rural broadband infrastructure and plans to triple the US Department of Agriculture’s Community Connect grants partnering with rural communities across the US.

Whatever the total cost of solving the rural broadband challenge, it is clear that tens of billions of dollars in federal investment is needed.

Critics may claim that the private sector can, and should, solve this problem. But if that were true, it would have already done so. Back in the 1930s, electric companies had the ability—but not the economic incentive—to electrify rural areas. The same holds true today for rural broadband. Today’s lack of rural broadband is a market failure that can only be cured with federal dollars.

Federal investment in rural electrification helped ignite investment across the country. Manufacturers didn’t have to locate near big cities, instead, they could build factories in rural areas where land was cheaper. Electric machinery and refrigeration made farms and ranches more productive. Today, in an era where remote work is increasingly common, rural and urban Americans alike need broadband to stay connected and productive.

Federal investment in rural broadband could help reduce health care costs because it will give patients more options in how and where they seek medical care. Multiple studies have found that as hospitals close, competition declines and prices go up. If telehealth appointments provide a less costly option than in-person visits, then federal spending on rural broadband could ultimately be offset by smaller outlays for Medicare.

To be clear, federal investment in rural broadband should come with some caveats, including some influence with regard to pricing. For instance, broadband prices in a region that has benefited from federal loans should not exceed the prices paid by customers in the two closest exurban areas. Furthermore, to ensure competition, the FCC—along with the respective offices at the Federal Trade Commission and Department of Justice—should monitor and enforce antitrust measures.
An Impact Beyond Telehealth

Rural broadband is not just about telehealth. The pandemic has proven that it is also essential for education and remote work. Microsoft CEO Satya Nadella recently declared that “broadband is a fundamental right.” However, just like in the 1930s with electricity, bringing broadband to rural communities will not happen easily or cheaply. Sustained political support—along with tens of billions of dollars in federal grants and loans—will be needed to bring all of rural America into the 21st century.

Now is the time for a new federal program that will energize rural broadband in the same way that the New Deal brought electricity to rural America and bring rural patients out of the digital dark.
Authors’ Note

The authors are visiting fellows at the Foundation for Research on Equal Opportunity.