Lisa Bard Levine, MD, MBA at CEO
Hacking Health Care Access: Innovations in Telehealth
The COVID-19 pandemic has created further barriers to accessing medical care in the U.S.—especially for the 100+ million individuals who are un- or under-insured. As the economic aftershocks of this crisis continue to drive unemployment, and with it the loss of employer-sponsored health insurance, vulnerable patients will increasingly turn to safety net clinics in their communities for primary care needs. However, as need continues to skyrocket, many clinics are simultaneously being forced to operate at reduced hours and capacity to ensure effective social distancing practices and reduce the risk of infection for patients and providers alike.
To continue supporting patients, traditional in-person health care delivery has pivoted to telehealth—the practice of triaging, diagnosing, and treating patients using communication modalities such as text, email, phone, and video. Virtually overnight, clinics across the country adapted operations and best practices to facilitate the management of patient care via telehealth. Recent reports suggest that providers and patients are adjusting to this new method of care delivery, and a growing percentage prefer it to in-person visits for issues that do not require hands-on assessment.
But telehealth is not a panacea for access, especially as deepening economic and social inequities create more barriers to virtual care. For patients without reliable internet, ample phone data, or video-enabled devices, video visits remain out of reach. And for patients with limited cell phone call and text plans, phone visits and text reminders can rapidly deplete minutes from that month’s plan.
Innovation in Action
Frontline providers working at safety net clinics—often the only point of care for un- and under-insured patients—have been adapting telehealth to ensure that care access is widely available within their communities. By focusing on relationships and personalization, building on established community trust, and creatively adapting operations and technologies, providers and organizations are innovating new ways to expand access for underserved patients and safely provide the right care at the right time during this crisis.
Over the past several months, we have seen tremendous innovation within our network of clinic partners, and are working with them to identify, implement, and spread new best practices for telehealth operations:
Virtually managing chronic conditions: successfully managing diabetes is key to preventing compounding health challenges for patients. Working with a safety net clinic in Washington State, MAVEN Project endocrinology volunteers led a roundtable strategy session with providers to identify effective approaches for managing diabetes via phone and implementing continuous glucose monitoring (CGM). Clinic teams have since secured funding for monitoring devices and are launching a CGM program with phone-based check-ins to continue supporting diabetic patients virtually. There is potential to expand this program to other points of care across the country, as well as use of this model and technology to develop similar initiatives in other disease areas.
Hotspots in parking lots: in-person visits provide vital visual cues to providers, but social distancing means in-person visits must be limited. Video-based visits can provide some visual cues, but patients do not always have access to reliable internet and devices with video capabilities. To circumvent this barrier, clinics are turning parking lots into hotspots. By enhancing clinic internet to reach parking lots and providing video-enabled tablets outside, patients can safely arrive at the clinic and connect with trusted providers via video calls while maintaining social distancing.
Supporting essential workers: frontline health care providers were already at significant risk for burning out prior to the pandemic. But as clinics shifted to virtual operations and reduced clinic staff, isolation and stress further increased this risk. Telehealth programs can offer vital lifelines and peer-to-peer support to providers. For instance, The MAVEN Project developed a virtual mentoring program to connect providers with psychiatry and family medicine volunteers to develop actionable strategies for managing anxiety and uncertainty in clinic staff, patients, and communities.
Contact tracing: contact tracing—a key practice in successfully mitigating the spread of COVID-19—is itself a form of telehealth applied and conducted in the public health space. By training contact tracers to conduct phone and text-based assessments, individuals potentially exposed to COVID-19 can be notified and quarantine to limit further spread. Additionally, contact tracers have the ability to act as community resource connectors by helping patients identify and access essential resources like food, utility support, childcare, and more.
Lisa Bard Levine, MD, MBA AT CEO
Adapting Toward Better Access
As the pandemic continues, telehealth will continue to play a vital role in ensuring care access. By developing innovative telehealth care delivery strategies, providers, clinics, and health care organizations are removing barriers to care and demonstrating that telehealth can be adapted to improve care access in diverse local contexts.
Lisa Bard Levine, MD, MBA is the CEO, and Meghan Guidry is the VP Communications and Donor Engagement of The MAVEN Project, a national nonprofit organization that connects expert volunteer physicians to frontline providers and clinics via telehealth to support patient care and improve community health outcomes.