Why coronavirus spurred health providers of all sizes to rapidly adopt virtual visits
As the COVID-19 epidemic spread across the Sacramento region in March, telehealth visits rapidly became a crucial avenue for WellSpace Health to reach the region’s most vulnerable populations.
A primary care clinic that primarily serves Medi-Cal, Medicare and uninsured patients, WellSpace began offering video visits with its providers on March 23 and just 20 patients accessed the service that week. Now, WellSpace providers log 2,000 to 3,000 telehealth visits a week.
“Today, telehealth visits make up 40 percent of the comprehensive medical, dental, and behavioral health care we provide,” said Jonathan Porteus, the chief executive officer of WellSpace.
Patient use of telehealth varies depending on the area of care, Porteus said. In adult primary care, half the patient have embraced the technology, but the organization’s pediatricians see just 20 percent of their patients over video chats.
“Behavioral health is quite the opposite,” Porteus said. “Eighty percent of integrated behavioral health visits are now conducted via telehealth, and the no-show rate is just 10 percent, compared to 40 percent for face-to-face visits.”
The global health pandemic has spurred an explosion in the use of telehealth technology, not simply for organizations that care for underserved populations, but for all sorts of health providers. Across the board, they rapidly adjusted to a world where their patients opted to stay home to reduce their risk of getting infected with the new coronavirus, the pathogen that causes COVID-19.
Dignity Health, a unit of CommonSpirit Health, launched its virtual visit technology in mid-March, and two months later, the nonprofit health giant reported that its providers had done nearly 60,000 appointments at its Sacramento, Woodland and Stockton medical group.
iHealth, a company that markets telemedicine software to providers across the nation, reported that telehealth sessions in offices using its technology surpassed clinic visits by almost twice the number of patients by the first week of April.
Also, in a poll done April 8, the California Health Care Foundation found that only 3.8 percent of respondents had seen a provider in person that week while 6 percent had a video or phone consultation.
By June 5, CHCF found that 9.5 percent had seen a doctor in person but an increasing number, 8 percent, had used telemedicine to get care from a provider.
“More than 8 in 10 Californians say they would be ‘very’ or ‘somewhat’ comfortable with a telehealth appointment,” wrote Kristof Stremikis, the director of market insight for CHCF in the latest report. “ Support is strong across all income, racial, and ethnic groups, although Latinos...were less likely than Blacks ... or Asians...to say they would be comfortable with a phone or video appointment. Seventy percent of Californians with low incomes say they would be comfortable.”
The cost of adding are expanding telemedicine services can be a barrier, however, for some companies, and the demand for it came at a time when many hospital providers and medical foundations were experiencing a dramatic drop in revenue. Consequently, insurers, pharmacy companies and other players in the health care space have made investments to ensure patients can get access to their providers with telemedicine.
CVS Health, for instance, has donated $1.35 million to the California’s volunteer-driven free and charitable clinics and the Pacific Business Group on Health to help them launch telehealth services.
Leaders of Anthem Blue Cross have deployed hundreds of digital kiosks in health centers around the Golden State. Not only can patients use the stations for telehealth visits but they also can get real-time language interpretation services to overcome communication barriers.
“We know that expectations have evolved and people today expect a more customized and seamless experience,” said Dr. Barsam Kasravi, president of Anthem Blue Cross. “Technology is helping us close gaps in care and better support the populations we serve.”
Dr. Demetria Malloy, the medical director for Anthem Blue Cross, said, in the case of the kiosks, technology is helping to bridge a critical gap in medical care: “When language barriers exist, the risk of incorrect diagnosis, duplicative testing and inappropriate prescribing increases. Language barriers may make individuals less likely to seek care or build trusting relationships with their doctors and less likely to adhere to treatment programs.”
And, at Health Net, leaders announced in early May that they were awarding $13.4 million to help 138 health providers serving high percentages of Medi-Cal patients, many of them in the Sacramento region, establish or expand telehealth and telephonic services.
“Telehealth has emerged as an effective way for health care providers to care for their patients during this pandemic,” said Brian Ternan, President and CEO of Health Net of California and California Health and Wellness. “As the state’s largest Medi-Cal managed care plan, we know doctors, nurses and clinicians serving our vulnerable patient population are struggling right now. Our goal was to think creatively and support providers funding quickly to help them build their telehealth capacity as soon as possible and care for those most in need.”
Ternan said he had worked with Gov. Gavin Newsom and the California Department of Managed Health Care to redirect funding to this purpose from monies that had been set aside for improving enrollee health outcomes as part of DMHC’s approval of Centene’s 2016 acquisition of Health Net.
Carmela Castellano-Garcia works with the leaders of many clinics that will benefit from the Health Net grants as the chief executive officer of the California Primary Care Association.
“Our clinics are on the frontlines of the COVID-19 pandemic and continue to face increased financial strain that limits their ability to best serve patients—many of whom are Medi-Cal enrollees,” she said. “The funding provided and expedited by Health Net will enable clinics to build out much-needed telehealth capabilities and support those who serve our state’s most vulnerable.”
WellSpace Health, which has more than 20 clinics in Amador, Placer and Sacramento counties, benefited from both the Anthem Blue Cross and the Health Net investments.
Porteus said the majority of WellSpace patients have intermittent access to telephones, making them the primary method of contact. The Health Net grant allowed WellSpace to rapidly expand telemedicine services to meet the need of Sacramento-area residents.
“Our telehealth program gives our community health centers the tools they need to reach the people we serve safely and effectively aid social distancing guidelines,” Porteus said. “WellSpace Health believes that everyone deserves to be seen, and in the age of COVID-19, that means adapting our services to ensure our patient are not forced out of care by quarantine recommendations. This is especially important for people of color, who we already know are more likely to die during COVID-19.”
Medical scholars at the University of California, Los Angeles, joined with Latino policy experts at the college in publishing a report that recommended using telemedicine as a means of offering virtual care to people of color who are increasingly adopting smartphones that connect them to the Internet.
“With the right outreach and training, telehealth can serve as an important bridge to ensure that underserved communities, especially rural and linguistically diverse patients, access the medical attention they need, particularly during the pandemic,” said Sonja Diaz, founding director of UCLA’s Latino Policy and Politics Initiative.
This story was originally published June 18, 2020 at 12:36 PM.
