Safety net medical providers can substantially increase their telehealth services with modest investments in new staff and technology in a move that can help them expand patients' access to specialized medical care, according to a new RAND Corporation study.
But sustaining gains created by expanded telehealth will require more generous reimbursement policies from payers, or ongoing revenue from other sources such as government grants.
While the focus of the study was on the experiences of nine community health centers in California that provided telehealth access to medical specialists from their primary care clinics, the findings have implications about how to sustain the rapid expansion of telehealth that has been prompted by the social distancing efforts triggered by the COVID-19 pandemic.
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There are about 1,400 community health centers across the country that serve 29 million patients who are mostly low-income. The federally supported centers provide comprehensive primary care to medically underserved populations, regardless of their insurance status or ability to pay for services.
RAND examined the experiences of clinics enrolled in the Sustainable Models of Telehealth in the Safety Net, which was funded by the California Health Care Foundation from 2017 to 2020. The project's goal was to help transform participating health centers from low-volume to high-volume telehealth providers that are dedicated to improving access to specialty care through technology.
The nine community health centers in the project operated health clinics mostly in rural areas of California.
WHAT'S THE IMPACT?
On average, the health centers had experienced a slight downward trend in telehealth use prior to the start of the 2017 initiative. But there was a large and significant increase in telehealth volume once the initiative got started, which continued to increase over time. This was attributed to the telehealth technology becoming more viable, according to the study.
The majority of participating health centers contracted with third parties for telehealth services – typically a telehealth vendor or independent group of specialists. In this model, a patient visits the health center where they typically receive primary care and is connected to a remotely located specialist who is employed by another organization.
Two of the health centers primarily used their own clinicians to provide telehealth services. In this model, multisite health centers that employ specialists such as mental health providers connect patients via telehealth to clinics that do not have those specialists.
The community health centers spent between $4,400 and about $250,000 to establish expanded telehealth programs, with most of the money going to new equipment. During the project, telehealth volume at the clinics ranged from fewer than 500 visits per year to more than 7,000 per year.
Nearly half of the telehealth visits were with a behavioral health provider, while another quarter were for eye care. Other common specialists providing telehealth care included endocrinologists, rheumatologists and dermatologists.
Staff from most health centers reported that the telehealth services were likely permanent, but that financial factors would determine the scope of services. Administrators at all of the clinics said that telehealth was a cost center for their organizations, and identified several factors that make it difficult for health centers to break even on the remote care technology.
Barriers that increased costs included a high no-show rate, limited connectivity, restrictions that do not allow some providers to provide telehealth services, telehealth visits taking up space that could be used for more profitable visits and the costs associated with switching telehealth providers.
The RAND evaluation recommended that clinics hire a telehealth coordinator to head their efforts, and that they consider offering such services to patients from their homes.
The home model, which has been widely implemented during the COVID-19 pandemic, allows health centers to serve patients who live farther away. It may be more sustainable because it uses less physical clinic space – and can allow salaried providers employed by a clinic to work at full capacity.
THE LARGER TREND
The volume of telehealth claims lines increased by more than 8,335% between April last year and April of this year, according to data from FAIR Health's Monthly Telehealth Regional Tracker released this month.
The number one diagnosis of telehealth claims in the U.S. was for mental health conditions. This year, they made up about 34% of all telehealth claim lines. Other diagnoses this year included joint and soft tissue diseases, hypertension, acute respiratory diseases and infections, and skin infections.
The data also showed that telehealth was more common in urban areas than in rural areas. In 2020, over 13% of medical claim lines came from urban areas, compared to roughly 8% in rural ones.