FLORENCE, S.C. − The Drs. Bruce & Lee Foundation Library will host SC Thrive on the second floor on Thursday July 1; Thursday, July 8; and Thursday, July 15 from 10 a.m. to 3 p.m. to help eligible residents fill out applications for the Emergency Broadband Benefit Program.
The $3.2 billion Emergency Broadband Benefit program provides a discount of up to a $50 per month toward broadband service for eligible households. The benefit also provides up to a $100 per household discount toward a one-time purchase of a computer, laptop, or tablet if the household contributes more than $10 and less than $50 toward the purchase through a participating broadband provider.
A household is eligible if one member of the household meets at least one of the criteria below:
Has an income that is at or below 135% of the Federal Poverty Guidelines or participates in certain assistance programs, such as SNAP, Medicaid or the FCC’s Lifeline program.
Is approved to receive benefits under the free and reduced-price school lunch program or the school breakfast program, including through the USDA Community Eligibility Provision, in the 2019-2020 or 2020-2021 school year.
Received a Federal Pell Grant during the current award year.
Experienced a substantial loss of income through job loss or furlough since February 29, 2020, and the household had a total income in 2020 at or below $99,000 for single filers and $198,000 for joint filers.
Meets the eligibility criteria for a participating provider’s existing low-income or COVID-19 program.
The Emergency Broadband Benefit enrollment began on May 12, 2021. Eligible households can enroll through a participating broadband provider or directly with the Universal Service Administrative Company (USAC) using an online or mail-in application. Additional information about the Emergency Broadband Benefit is available at www.fcc.gov/broadbandbenefit, or by calling 833-511-0311 between 9 a.m. and 9 p.m. any day of the week
The Drs. Bruce & Lee Foundation Library is located at 509 S. Dargan Street in Florence.
BAMBERG, SC—Palmetto Care Connections (PCC), a non-profit telehealth organization, was recently awarded the National Cooperative of Health Networks Association’s (NCHN) 2021 Outstanding Health Network award.
The NCHN Outstanding Health Network of the Year Award recognizes any network or entire network organization that has improved access to health services in its service area and coordination of resources for network members through innovative, comprehensive approaches.
“Palmetto Care Connections was established in 2010 to improve access to care in rural and underserved communities by infusing health care services through telehealth technologies. This was important because of increasing difficulties in recruiting providers of rural areas and the financial challenges facing many small hospitals. Over the years, Palmetto Care Connections has grown into a statewide telehealth network and the resulting scope of activities has continued to expand,” said NCHN Executive Director Linda K. Weiss.
“The leader of the South Carolina broadband consortium, Palmetto Care Connections assists health care providers in receiving broadband savings through the Federal Communication Commission’s Healthcare Connect Fund program. Since 2013, they have helped providers save more than $25 million in broadband costs. The network recently received a $17million FCC commitment to fund broadband for its consortium members over the next three years. These funds represent actual savings for health care providers,” said Weiss.
“Palmetto Care Connections co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, serving as an advocate for rural providers and partnering with organizations to improve health care access and delivery for all South Carolinians,” said Weiss.
“Palmetto Care Connections has been a member of NCHN since its inception and CEO Kathy Schwarting has been an active participant of the Association’s activities and events. On behalf the National Cooperative of Health Networks Association, I congratulate Palmetto Care Connections on receiving the 2021 Outstanding Health Network award,” said Weiss.
Incorporated in 1995, NCHN has developed into a nationally recognized professional membership organization for all types and sizes of health networks across the nation. NCHN is governed by an elected volunteer Board of Directors. Member programs, benefits, and educational offerings are developed and provided by the members through participation on a variety of committees. Each spring, NCHN provides a two and a half-day educational conference for network leaders.
The Substance Abuse and Mental Health Services Administration (SAMHSA) and its National Mental Health and Substance Use Policy Laboratory recently released a new evidence-based resource guide titled, Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders, to support implementation of telehealth across diverse mental health and substance use disorder treatment settings. The guide examines the current telehealth landscape, including evidence on effectiveness and examples of programs that have integrated telehealth modalities (live-video, telephone, and web-based applications) for the treatment of serious mental illness (SMI) and substance use disorders (SUDs). Also included is guidance and resources for evaluating and implementing best practices which are presented across a continuum of services, such as screening and assessment, treatment, medication management, care management, recovery support, and crisis services.
The report speaks to how telehealth is known to improve access to care during emergencies and in rural and underserved areas, but stresses that implementation should be expanded outside of such situations and integrated into an organization’s standard practices to improve provider and patient communication, satisfaction, timeliness and continuity of care. The authors highlight how this is increasingly important when it comes to mental health issues, which impact millions of Americans that often face unique treatment gaps and barriers. Ultimately, it is suggested that with the right resources and upfront work, the evidence shows telehealth has the capability to address these barriers, improve health outcomes and care coordination, decrease costs and reduce health disparities.
Notable findings related to telehealth use and mental health include:
Telehealth use doubled from 14% to 28% between 2016 and 2019
Telehealth visits for mental health increased 556% between March 11 and April 22, 2020
SUD treatment via telehealth increased from 13.5% to 17.4% between 2016 and 2019
Telehealth use increased 425% for mental health appointments among rural Medicare beneficiaries between 2010 and 2017
The guide presents specific strategies to increase patient access and comfort using telehealth, such as providing devices to those that need them and offering trial sessions to address any technological challenges. It is also suggested that providers first screen patients for their willingness and readiness to receive care via telehealth, as it may not be appropriate for some patients. Additionally, telephone should be encouraged when it reduces prior structural and institutional barriers that have made contacting underserved communities difficult. The guide also offers strategies to increase provider comfort using telehealth, such as:
trainings and designating certain staff to support and evaluate its use
how to create a similar environment to that of an in-person visit for patients
addressing organizational infrastructure issues
Understanding and knowledge of relevant and ever-evolving regulatory and reimbursement policies is included as an important consideration as well, to which the authors offer a variety of tracking resources, including the policy finder tool on CCHP’s new website.
Regardless of where state and federal telehealth policies land, the guide includes a number of telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth. Additional resources can be accessed on the SAMHSA website. For more information read the full SAMHSA resource guide.
With other payers looking at Medicare’s actions on telehealth coverage, a Kaiser Family Foundation brief offers insights on Medicare beneficiaries that support the permanent expansion of connected health services.
– Medicare beneficiaries are using telehealth more often due to extended coverage and access measures introduced during the COVID-19 pandemic, according to a Kaiser Family Foundation brief. And making these measures permanent could further benefit members and influence other payers to follow the same strategy.
Prior to the pandemic, Medicare only covered telehealth services for members living in rural areas, with restrictions on where members could receive services and which providers could deliver them. The Centers for Medicare and Medicaid Services expanded coverage in early 2020 to address the pandemic, and renewed the extension in April 2021, to allow members to access healthcare services while avoiding in-person contact.
For its study, KFF collected telehealth use data from Medicare beneficiaries between summer and fall of 2020. Kaiser researchers noted the increase in use among members, as well as the populations who used telehealth more frequently during the COVID-19 emergency.
Of the Medicare members with an established source of care, almost two-thirds (64 percent) reported that their provider offered telehealth appointments. Before the pandemic, only 18 percent of members could say that. Some beneficiaries reported that they did not know if their provider offered telehealth services, including almost one-third (30 percent) of members living in rural areas.
More than a quarter (27 percent) of Medicare and Medicare Advantage beneficiaries had a telehealth visit with a healthcare professional, according to the survey, which equals 15 million people who used telehealth during the pandemic. Of the members whose established providers offered telehealth, almost half (45 percent) had a telehealth visit.
Telehealth use was higher among beneficiaries under 65 who qualify for Medicare due to a long-term disability, dual eligible beneficiaries, Black and Hispanic beneficiaries, and beneficiaries with six or more chronic conditions, with more than 50 percent of each group reporting using telehealth.
The study also offered evidence supporting continued coverage for audio-only telehealth services, which have been popular during the pandemic.
More than half (56 percent) of Medicare beneficiaries who used telehealth reported using a telephone for their visit. Of those, 65 percent were 75 or older, 61 percent were Hispanic, 65 percent lived in rural areas and 67 percent were dual eligible enrollees.
Audio-only telephone visits are permitted during the public health emergency but will be dropped from coverage once the PHE ends. KFF research indicates that permanent coverage of audio-only telehealth could benefit older beneficiaries, people of color and, beneficiaries living in rural areas, especially since less than half of Black and Hispanic beneficiaries (42 and 34 percent) own a computer.
Under Medicare’s emergency extensions of telehealth coverage, healthcare professionals can provide and get reimbursement for telehealth services; prior to the pandemic, that coverage was limited to telehealth services for patients who’ve been meeting with the provider for at least three years.
CMS has also extended telehealth services to rural health clinics and federally qualified health centers, locations not covered under pre-COVID-19 rules.
CMS has increased telehealth reimbursement rates during the pandemic as well, in some cases offering payment parity – a factor that, if extended, could pull more providers onto the platform. Reimbursement has long been a challenge to telehealth adoption, with providers saying they aren’t being paid enough to try new platforms and payers arguing that they should be able to negotiate their own rates with care providers.
Medicare Advantage plans are more telehealth-friendly, with 98 percent covering connected health services to members even before the pandemic.
Still, the path to increased or even permanent coverage is uneven.
In May 2021, the Government Accountability Office told Congress to hold off on expanding Medicare telehealth coverage past the public health emergency, citing concerns about spending, program integrity, patient health and safety, and equity. The GAO is asking for more evidence showing that telehealth services are cost-effective and produce positive health outcomes for Medicare beneficiaries.
The results from the KFF brief show the impact that expanded telehealth coverage has had on members and how these outcomes could help influence Medicare and other payers’ decisions about telehealth coverage going forward.
Schools and Libraries Will Have 45 Days to Apply for Support to Aid Students Who Fall into the Homework Gap
WASHINGTON, June 15, 2021—Today, FCC Acting Chairwoman Jessica Rosenworcel announced schools and libraries can begin to file applications on June 29 for the newly established $7.17 billion Emergency Connectivity Fund. Schools and libraries can apply for financial support to purchase laptops and tablets, Wi-Fi hotspots, modems, routers, and broadband connections for off-campus use by students, school staff, and library patrons. During this 45-day application filing window, which will run from June 29 to August 13, eligible schools and libraries can submit requests for funding to purchase eligible equipment and services for the 2021-22 school year.
“For too long, the Homework Gap has been a troubling and persistent digital equity problem in the United States,” said Rosenworcel. “With classes themselves moving online and the pandemic requiring us to stay home, we went from having millions of children who couldn’t do online homework assignments to having millions of children who couldn’t do schoolwork at all. In other words, the Homework Gap became a full-fledged learning and education gap.”
“It’s important that we address this issue now, and the Emergency Connectivity Fund gives us the opportunity to do that. As we exit this pandemic, we know that education has been changed. Like so much else in our lives, it has been digitized. That’s why I’m proud that starting in two weeks, schools and libraries across the country will have a terrific opportunity to get broadband service and devices into the hands of students, staff, and library patrons who lack them to connect these learners at home,” said Rosenworcel.
The American Rescue Plan of 2021 established the Emergency Connectivity Fund. The Universal Service Administrative Company will serve as the program’s administrator with FCC oversight. The Fund leverages the processes and structures used in the E-Rate program for the benefit of schools and libraries already familiar with the E-Rate program. You can find more information about the program at www.emergencyconnectivityfund.org or www.fcc.gov/emergency-connectivity-fund and instructions on how to apply at www.emergencyconnectivityfund.org/application-process.Recent estimates suggest there may be as many as 17 million children struggling without the broadband access they need for remote learning. Since her early tenure at the Commission, the Acting Chairwoman has made closing the Homework Gap a priority.
At the height of the COVID-19 pandemic, people were working at home, teaching their children at their kitchen tables, and avoiding various activities including in-person visits with their doctors.
As a result, for a few months at the start of the pandemic, the use of telehealth and telemedicine exploded.
The Centers for Disease Control and Prevention reported that telehealth visits were up 154% in the last week of March 2020, compared to the same period in 2019.
Today, as more people in the U.S. become vaccinated, it appears that spike in telemedicine use has flattened, but some questions linger: Is interest in telehealth here to stay and will it play a major role in cost containment and service delivery in workers’ compensation?
Statistics support the notion that there is increased acceptance of telehealth. According to McKinsey, 46% of patients say they now use telehealth for some visits, compared to 11% in 2019.
Melissa Burke, vice president, AmTrust Financial Services, Inc.
An increase in telehealth caused by the pandemic was witnessed by David Lupinsky, vice president of digital health and innovation at CorVel.
He said his company reported more telehealth visits in the last two weeks of March 2020 than they had in the previous two years combined.
“It had been going up [in the previous two years], but we saw a huge spike of nearly 500% in March 2020,” he said.
That number has dropped, though it hasn’t gone down to pre-pandemic levels, he said.
His company receives about 100,000 calls a year to its nurse triage hotline, which is staffed by nurses who refer patients to self-care, telehealth or an in-person visit at a medical office or clinic.
About 70% of claims filed at CorVel start with a call to the nurse triage hotline. About 50% of calls are resolved with the nurse recommending self-care for patients, which results in no claim. Of the other half, about 45% are referred to telehealth and 55% end up going into a physical office for a doctor’s visit.
Well-Defined Benefits
In addition to helping to mitigate the spread of disease during a pandemic, Lupinsky said telehealth has a myriad of other advantages for injured workers and employers.
“There are so many other benefits of telehealth,” he said. “There is obviously a return on investment there. It helps reduce the medical spend and improve the speed to get [a patient] to a provider.”
He noted that nurses answer the company’s triage phones within 30 seconds, and a physician will respond to a referral for a virtual telemedicine visit within 10 minutes. A movement in some states to allow doctors to be licensed across state borders also has been a boost for telehealth.
Jennifer Cogbill, vice president of the GBCare Advisor Team at claims service provider Gallagher Bassett, also saw a 15% increase in telehealth-related medical bills in the first 90 days of the pandemic.
That number has since dropped to about 2%.
Like Lupinksy, Cogbill said there are areas in workers’ compensation claims where telehealth is particularly useful, such as triaging patients to determine the type of care they need.
She said she hasn’t seen telehealth used much in workers’ compensation beyond that point-of-injury care and attributes that, in part, to a lack of investment in the technology.
“A lot of providers never invested in the ability to provide a secure connection for a telemedicine visit, although [with the pandemic], we saw providers starting to offer it,” she said.
Cogbill believes telehealth is well-suited for use in ongoing care to monitor a person’s recovery from an injury or minor illness.
“I believe there is a lot of opportunity for telemedicine in follow-up care, but that needs to be promoted by the provider community,” she said. “I think there are some who’ve made that investment and who want to continue to offer that.”
An Innovative Tool
Melissa Burke, vice president at AmTrust Financial Services, Inc., said telehealth is just one way to address patients’ needs.
“It’s another tool in our tool belt,” she said. “It’s about looking at the injury and seeing what makes sense for treating that injury.”
Her company has used national guidelines to train staff on what types of injuries are suited to telehealth.
Like Cogbill, she sees follow-up care as one area where telehealth may be especially useful. Another area is behavioral health.
“We’ve seen an increase in acceptance of telehealth and I think that’s going to continue,” Burke said.
Still another area where telehealth may prove beneficial is in physical therapy that would begin with in-person visits but evolve into virtual visits as a person’s condition improves.
Burke said the pandemic has raised awareness of telehealth, including among her company’s employees.
“Our claim and medical professionals are aware that this service is available and how it can improve the claims process,” she said.
“It can allow employees to be treated at work without having to leave the work site or transition back to work when they do things like tele PT or behavioral health.”
Terri Rhodes, chief executive officer at Disability Management Employer Coalition, agreed that the pandemic has accelerated adoption of telehealth: “In 20/20 hindsight, it wasn’t just that patients weren’t using it,” she said. “Doctors weren’t using it either. So, I think we were all forced into it, and very quickly we had to figure it out.”
Other forces boosting telehealth during the pandemic included the federal government, state Medicaid programs and private insurers that expanded coverage for virtual health care services during the crisis.
The U.S. Department of Labor also allowed telemedicine in lieu of in-person treatments under the Family Medical Leave Act.
Looking Ahead
While experts agree that telehealth is useful in some workers’ compensation situations, it still has shortcomings.
Rhodes said a potential disadvantage is that “a medical professional might miss minor signs or symptoms resulting in an inaccurate or incomplete diagnosis, because you really can’t see that person. You can only see what they’re showing you on camera.”
Technology, of course, with its problems of faulty internet connections or dropped calls, can be a deterrent, and some employers are reluctant to adopt the technology.
“We have some clients that really embrace technology and others that are more skeptical,” Cogbill said.
Despite these shortcomings, Rhodes said the need to incorporate telehealth will only grow, because younger workers, who will make up the future workforce, prefer it. “They’re big on self-service portals, online appointment scheduling and accessing mental health through apps,” she said.
“I think there are lessons we can learn from that group in terms of how we shape the future of telehealth and telemedicine.”
Cogbill foresees new technologies like wearables might increase telehealth use as well. A wearable device might be used to monitor an injury or a patient’s recovery remotely, she note
Lupinsky also sees a role for telehealth in reducing risk. He said CorVel is taking a proactive approach to reducing risk by identifying potentially costly claims.
For example, in the case of a patient using opioids, the CorVel team’s telehealth tech system might suggest to a provider they direct that patient to other methods of addressing pain.
“What we want to do is direct patients to other healthier alternatives,” he said.
“We can direct patients to a different mode of care such as cognitive behavior therapy or meditation.”
The pandemic shone a spotlight on telehealth, but the degree to which it will be accepted in workers’ compensation remains to be seen.
Lupinksy, for one, believes it will only grow. “The genie is out of the bottle,” he said. “I think it’s going to be tough to put it back in.” &
Annemarie Mannion is a freelance writer. She can be reached at [email protected].
CHARLESTON, S.C. (June 9, 2021) – A joint MUSC-Clemson panel of judges named the Parent-Child Interaction Therapy (PCIT) telehealth program as the first recipient of the Healthy Me – Healthy SC (HMHSC) grant. The HMHSC grant will provide a $50,000 award to support the Tele-PCIT program’s second year.
“We’re pleased to partner with and support Tele-PCIT, as it provides innovative therapeutic solutions to improve the quality of life for underserved South Carolina children and families,” explained David Sudduth, HMHSC executive director.
This was the inaugural year of the HMHSC grant, a funding opportunity designed to improve the implementation, reach and scaling potential of projects or programs that align with HMHSC’s mission to improve health care access and inequities in rural and underserved communities of South Carolina.
“The Tele-PCIT program application received high marks in each of our scoring categories and had a dual mental health and children’s health focus. We look forward to working with this program as it grows and helps additional families in need,” said Kapri Kreps Rhodes, HMHSC director.
All applications, she explained, needed to align with one of HMHSC’s four focus areas, which include women and children’s health, chronic disease/preventative health care, mental health and cancer. Applications were scored for their innovativeness, impact, scalability and sustainability.
The Tele-PCIT program
Disruptive behavior problems, such as oppositionality, aggression and hyperactivity/impulsivity, are present in 30% to 60% of children with autism spectrum disorder (ASD). PCIT is one of the most well-validated interventions for these types of behavior problems. Despite the initial promise of PCIT for children with ASD, challenges include attrition and limited accessibility.
Telehealth delivery has the potential to address barriers that affect treatment engagement, particularly for underserved populations. The Tele-PCIT program has spent the past year testing its feasibility and preliminary efficacy involving 20 children between the ages of 2 and 6 with ASD and disruptive behavior problems, with a considerable number of families coming from a low socioeconomic status or living in rural areas. The program provides parents with Bluetooth earpieces for the sessions and matches them with a PCIT therapist who then coaches them through 10 live PCIT sessions delivered to them via telehealth in their homes. The program has documented favorable outcomes regarding engagement and child behavior outcomes for families that have completed the program thus far. Its pilot will conclude this fall.
Rosmary Ros-DeMarize, assistant professor in the MUSC Division of Developmental-Behavioral Pediatrics and PI of the Tele-PCIT program, described the vision for the program. “While we know that PCIT has been well-established for young children with disruptive behavior via telehealth, the unique aspect of this program is expanding it to the ASD population, which is often in need of behavioral services. Our focus for the next year will be to reach families of young children with ASD from underserved communities to improve reach and accessibility of behavioral therapies.”
With the funding provided by the HMHSC grant, the Tele-PCIT program will expand its trial for an additional year to include a focus on an additional 20 children from underserved populations in an effort to increase reach and collect further preliminary data necessary for a randomized trial of PCIT within this population.
BAMBERG, SC—Palmetto Care Connections (PCC), a non-profit telehealth organization, recently received a $19,500 Rural Local Initiatives Support Corporation (LISC) grant and an additional $25,000 pledge from S.C. Department on Aging to implement a digital inclusion program for seniors in Allendale, Barnwell, Clarendon, Lower Richland and Williamsburg counties.
“COVID-19 has created an explosion in telehealth services and uncovered a tremendous need for internet access and digital literacy in rural areas,” said PCC Chief Executive Officer Kathy Schwarting. “As PCC surveyed rural health care providers, we confirmed that many of the seniors they serve have difficulty using and understanding technology, and many do not have internet access at home. The goal is to connect seniors not only to telehealth, but also to a variety of quality of life resources, such as special S.C. Arts Commission programs, to combat the social isolation that many seniors have faced during the pandemic.”
The Rural LISC grant and S.C. Department on Aging funding will help up to 100 seniors who live in rural communities, aged 65 and older, with digital literacy training, a free computing device and free cellular service for 12 months. PCC will work with local internet service providers to offer affordable internet packages for seniors and will help program participants apply for internet subsidies through the FCC Lifeline program. In addition, PCC will provide Digital Navigators to provide support and assistance throughout the pilot program.
“For more than 40 years, Rural LISC has proudly worked to connect communities with resources and access to opportunities that everyone deserves,” said Rural LISC Program Officer Christa Vinson. “PCC’s Digital Inclusion pilot program supports the mission of Rural LISC by providing the physical equipment and technical assistance that this segment of the population needs in order to access services and benefit from an increasingly technical society.”
“The South Carolina Department on Aging works with a network of regional and local organizations to develop and manage services that help seniors remain independent in their homes and in their communities. SCDOA is pleased to be a part of the PCC Digital Inclusion pilot program focusing on seniors in five of South Carlina’s rural counties,” said Kay Hightower, SCDOA Senior Consultant, Outreach and Partnership Building.
“It is our hope that this pilot program will be a model of one approach to closing the digital divide in South Carolina,” said Schwarting. “While PCC’s focus has traditionally been on serving rural health care providers with telehealth, broadband and technology resources, we have learned that patients need help in connecting to their health care providers. Residents of rural areas not only need internet access, they need access that is affordable and they need a device and knowledge to connect to resources for a better quality of life.”
“PCC is a member of the Digital Equity workgroup that is facilitated by the S.C. Office of Rural Health. Members include Rural LISC, S.C. Department on Aging, S.C. Arts Council, S.C. Telehealth Alliance, Revolution D and others who want to help close the digital divide in South Carolina. Through this committee we connected with Rural LISC and the S.C. Department on Aging to develop this pilot Digital Inclusion program for seniors in Allendale, Barnwell, Clarendon, Lower Richland and Williamsburg. We are grateful for their support and look forward to making a difference in the lives of some rural seniors,” said Schwarting.
Established in 2010, PCC is a non-profit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas in S.C. PCC hosts the Annual Telehealth Summit of South Carolina presenting state and national best practices and trends, as well as providing networking connections for health care, information technology and broadband professionals. PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, serving as an advocate for rural providers and partnering with organizations to improve health care access and delivery for all South Carolinians.
A bill to establish Medicare coverage for audio-only telehealth services is now in the House, setting the stage for a debate on whether the telephone is a good healthcare tool.
The debate over whether to allow Medicare coverage for audio-only telehealth services is now before Congress.
US Reps. Jason Smith (R-MO) and Josh Gottheimer (D-NJ) this week introduced the Permanency for Audio-Only Telehealth Act (HR 3447), which would establish coverage for healthcare providers who connect via phone or non-video telehealth platforms with patients who don’t have the resources to use video-based telehealth.
The bill would also remove geographic and originating site restrictions on Medicare coverage, allowing providers to collaborate with patients in their homes.
“The COVID-19 pandemic required the U.S. healthcare system to innovate and embrace every viable method of healthcare delivery. For patients in rural areas back home in Missouri, none have been more beneficial than the expansion of audio-only telehealth,” Smith said in a press release. “This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight.”
Audio-only telehealth is a hot topic right now, with its supporters and opponents. The modality had been largely prohibited or strictly regulated prior to the pandemic, but has seen increased use thanks to emergency measures expanding access to and coverage of telehealth.
But those freedoms will end
Supporters not that many underserved and rural populations don’t have access to broadband resources needed to support audio-visual telemedicine technology, and they may not have the money to buy a smartphone, laptop or computer and Wi-Fi connectivity. In those cases a landline telephone may be the only good contact they have with care providers.
Organizations like the American Medical Association, Medical Group Management Association, Healthcare Leadership Council and Better Medicare Alliance have come out in favor of audio-only telehealth coverage, saying it improves access to care for a significant number of people who haven’t been able to access care.
“During the COVID-19 pandemic, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits,” Andres Gilberg, senior vice president of government affairs for the MGMA, said in the press release. “The need for these services will not disappear upon the conclusion of the COVID-19 public health emergency, but the ability to deliver them to Medicare beneficiaries will without congressional action. Patients should not be penalized for living far away from healthcare facilities or living in areas with inadequate internet access.”
Opponents argue the modality isn’t good enough to establish a doctor-patient relationship or to ensure privacy and security.
Most agree that if the modality is covered, the Centers for Medicare & Medicaid Services would need to develop guidelines as to how the platform can be used by providers, setting strict rules on what services can be provided.
If you’d talked to Brandon Welch in 2013, he probably wouldn’t have expected to be the CEO of a global leader in telemedicine.
Back then, Welch was a University of Utah doctoral student working on a hospital study to make prenatal checkups easier for pregnant women. Virtual visits made sense, but existing HIPAA-compliant platforms were complicated and expensive, so he built his own technology—just for the project.
That led to use in a few more telehealth studies and to the launch of Doxy.me, a startup that offered a basic, secure platform for telehealth visits and a paid version with more features. The business grew through word of mouth, but it wasn’t intended to be a huge moneymaker. At one point, Welch took another job as a professor at the Medical University of South Carolina, while his co-founder Dylan Turner couch-surfed and worked in Salt Lake City coffee shops until the business paid his salary.
The Doxy.me platform, courtesy of Doxy,me
The pandemic created a rush for telehealth services
As you might have guessed, COVID-19 changed everything. Virtually overnight, doctors across the globe scrambled to figure out how to see patients remotely. Today, Doxy.me owns 30 percent of telehealth market share and has revenues in excess of $50 million. But this kind of fast growth was like walking a tightrope. “It was controlled chaos there,” says Welch. “And there were some white-knuckled moments.”
That was the case for many of Utah’s healthcare providers, its small number of telehealth platforms, and the state’s desperate patients. The number of telehealth medical claims in the state jumped 9,614 percent between December 2019 and December 2020, according to the nonprofit FAIR Health. Utahns mostly flocked to the web to see doctors and therapists for mental health, physical therapy, and specialists for respiratory, heart, and soft-tissue diseases.
“We’ve gone from telehealth being a novelty to being an accepted manner of care,” says Kerry Palakanis, director for ConnectCare, the telehealth arm of Intermountain Healthcare. Intermountain pioneered this telehealth platform in 2015 and saw its telemedicine appointments double early in the pandemic. “We were ready,” she says.
Welch, however, was caught off-guard by the sudden demand. Doxy.me had grown to 89,000 users in its first seven years. So on March 1, 2020, Welch was surprised when 100 providers signed up for the service— five times more than normal. He figured it was a fluke, but a friend in the United Kingdom warned Welch that this COVID thing might be a big deal. “We said, no that’s not going to be anything,” Welch recalls.
By the week’s end, Welch realized it was indeed a huge deal. By that point, 600 to 700 providers were signing up per day. The Doxy.me team jumped into action adding three new servers and automated bots to answer customers’ questions. They paused live onboarding sessions and created a YouTube video explaining the platform for new signups. “We used hundreds of support requests to refine the support and answer questions on our website,” Welch says.
Two weeks in, 5,000 people signed up in one day. The next day, 10,000 people signed up. The next day, 20,000 people. Two months into nationwide lockdown, Doxy.me ballooned to 600,000 providers and nearly 1 million sessions a day—up from the pre-pandemic base of 80,000 users and 12,000 daily sessions.
The fast growth blew Welch’s mind, and though it was a blessing, he knew if not handled properly it could crush the company. Doxy.me aggressively recruited at its Salt Lake and Charleston, S.C. offices, ramping up to 120 people from 10 employees the past year.
In those first few months of the pandemic, new recruits—some of these hires had been previously laid off from the restaurant business—holed up in Welch’s living room, building software, fixing bugs and answering support questions, working 12-hour shifts, stopping for dinner, then returning to work from 9 pm to 1 am.
Soon, Welch’s original pursuit of simplicity and easy access to telehealth became a magnet to providers everywhere. Other telehealth platforms might require weeks or months of onboarding before doctors or clinics could start seeing patients online, and video platforms like Zoom weren’t encrypted end-to-end. Doxy.me uses no computer in the middle to transfer information. The site doesn’t collect data and users are anonymous.
About half of Doxy.me’s users subscribed to the free version, which provided a basic room for a doctor and patient. The paid plans offered more perks, such as analytics, branding, billing, multiple rooms, and more. Suddenly, massive hospital networks with thousands of doctors wanted Doxy.me, and the team quickly created a new plan and features that could accommodate them, and also added seven more servers and built a chatbot to more quickly move people through virtual waiting rooms and into doctors’ “examination rooms.”
Brandon Welch, CEO, Doxy,me, courtesy of Doxy.me
The pandemic created demand for (and destigmatized) virtual therapy
While Welch scrambled to deliver on the hospitals and clinic front, entrepreneur Dallen Allred felt a similar surge in visits to his mental health startup Tava Health.
Allred and his wife Cami started Tava Health in 2019 to create a platform that employers could tap so workers could see a therapist or psychiatrist virtually. The couple recognized that Utah ranks among the worst in the US for access to mental health care. In some parts of Utah, patients must drive an hour just to get to a clinic, yet as many as 25.5 percent of the population struggles with mental illness.
Tava’s January 2020 launch proved to be perfect timing. Last summer, 40 percent of US adults reported struggling with mental health or substance abuse, according to the Centers for Disease Control. Virtual visits on Tava Health doubled during its first year of 2020. Yet before the pandemic, doctors and therapists resisted the idea of telehealth for fear of missing the subtle body language cues of patients when face-to-face.
That mindset immediately changed with COVID and has been reinforced ever since. According to Allred, mental health patient outcomes are actually better with telehealth. When a person can meet on their phone or laptop, it takes away the hassle and challenges of attending appointments. No-show rates dropped to five percent with virtual visits, compared to the average 30 percent, he says.
Buoyed by $3 million from investors, Tava Health plans to expand beyond its 100 paying employers this year—most of which are in Utah—and its 100 therapists licensed in 45 states.
Despite the new interest in virtual doctor visits, the sector still faces challenges ahead. The pandemic forced the federal government to fan the flames of telehealth by reducing telehealth regulations, which limited who could be seen, where, for what, and at what cost. Yet those waivers expire at the year’s end.
Now there’s talk of returning to many of the original restrictions on which kinds of visits are eligible and which kinds of patients can tune in remotely.
And insurers, too, may be more inclined to roll back some of their initial pandemic generosity, which included waiving copays and covering more types of virtual visits. In some cases, doctors were getting paid the same amount for virtual visits as they were for in-person visits—which had previously been a barrier to the adoption of telehealth. SelectHealth, Utah’s largest health plan, is already rethinking benefits, reimbursement rates, and planning for stricter criteria on what qualifies for telehealth.
When it comes to mental health, Utah still has regulatory barriers that will limit virtual appointments. Utah is among many states that still bar out-of-state therapists from providing mental health care to its citizens without going through a cumbersome and expensive licensure process. Yet the state lacks the therapists to meet demand. “It’s a stupid law, and it’s outdated,” says Allred.
Therapists also get paid 20 percent to 30 percent less for virtual visits than they do in-person visits. “There is very little that you can’t do well virtually when it comes to mental health,” Allred says. “You’re not listening to a heartbeat or lungs.”
The Tava Health platform, courtesy of Tava Health
Remote monitoring, virtual reality, and automated visits are coming
Though, the ability to listen to heartbeats and lungs from afar may come to a home near you soon. Intermountain’s ConnectCare is exploring new technologies for remote patient monitoring within its hospital network.
During the height of the pandemic, Intermountain gave newly diagnosed COVID patients mini COVID kits that included pulse oximeters and other technologies so doctors could remotely track their condition at home. The result: a 50 percent reduction in return ER visits. A $200 kit prevented what could have become a three-day, $3,000 hospital stay.
“I spend more time talking about remote monitoring than anything,” says Palakanis. She says the hospital system is exploring at least 20 other conditions where such technology could be useful—mostly in cardiac and lung disease.
Lots of data—heart rate, electrocardiograms, blood pressure, blood oxygen levels, kidney function, and more—can now be measured through remote wearables and used by doctors to manage care offsite. Recognition technologies, too, are being developed to pinpoint voice, emotion, gesture, posture—which could add to a doctor’s evaluation of a patient. And telemedicine could reduce provider workloads, cut the need for hospital or clinic space, and labor-intensive data entry. It could be helpful for post-surgical check-ins, prenatal visits, health education, and medication management.
These new technologies coincide with patients who have gotten very comfortable with virtual doctor visits, according to an October survey by healthcare IT firm DrFirst. Patients reported that during virtual doctor visits, they surfed the web, texted, played video games, sipped “quarantinis,” or drove in the car. Some didn’t even get dressed.
A little patient etiquette might be in order, but most people prefer the comfort of an online waiting room to one inside of a clinic. And that’s good news for startups like Doxy.me, because widespread adoption of the technology presents new opportunities to innovate.
With no outside investors calling the shots at Doxy.me, Welch says he feels more autonomous and free to innovate: “We’re going to create the future of what we think telemedicine should be.”
Palmetto Care Connections (PCC) is the telehealth network for South Carolina that offers telehealth support services to rural and underserved health care providers.
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