One Health, headquartered in Hardin, Montana, is a group of Federally Qualified Medical Centers that provide integrated primary care to rural and border communities in Montana and Wyoming.
It has 12 clinics stretching from the Canadian border to the Montana/North Dakota border to northern Wyoming. The business area (though not continuously) covers an area roughly equivalent to the states of New York, New Jersey and Vermont – combined.
The Rural Health Information Center breaks down different definitions of border designation, but a common definition is six or fewer people per square mile. All but one of One Health’s clinic locations serve communities that meet the border definition.
PROBLEM
“As a testament to the effectiveness of telehealth and its benefits for rural and border communities, Montana is home to two of the oldest telehealth networks in the country – the Eastern Telehealth Network. Montana of the Billings Clinic and the REACH network of the Benefis Health System,” said Sarah Compton, telehealth program manager at One Health.
“Due to billing regulations, FQHC was previously excluded from the ability to bill for services at the remote location and was only eligible to bill for the initial location fee,” she continued. “This historic reimbursement structure is beneficial from a care coordination standpoint, but until COVID, the financial viability of telehealth for FQHCs remains challenging.”
Montana Medicaid was providing telemedicine even before COVID, allowing FQHCs to not only be qualified remote location providers, but also allowing in-person visits to patients. This policy change has enabled One Health to pursue a sustainable telehealth model that provides much-needed access to patient groups that frequently face barriers to accessing services. care service.
“We used the Lean Six Sigma framework to optimize our remote workflow.”
Sarah Compton, One Health
Compton recalls: “In 2019, One Health met with representatives from the TytoCare provider at the ATA conference and was impressed with their solution. “Since then, TytoCare has been a remote partner of One Health, providing software and hardware solutions for our organization.”
SUGGESTIONS
The first use case One Health rolled out in 2016 was a clinic-to-clinic system to help organizations leverage human resources across the health system. This allows providers with open positions in their schedules to be filled at other locations where there is a higher demand for in-person visits.
Compton explains: “We built our remote stroller by mounting an iPad on a wheeled pole and pairing the TytoPro kit with a stethoscope, otoscope, and tongue pressure peripheral accessory for discretionary use. specified by the remote supplier.
“When COVID hit, thankfully we had a telehealth platform in place,” she added. “As our needs rapidly changed, we designed and delivered a direct-to-patient workflow. Video use cases focused on behavioral health and substance use disorder patients. stimulus to immediately benefit from our D2P remote workflow.”
Medical use cases proved to be more complex, and One Health experienced some challenges with device implementation, communication, and usage. There are also some tech and health challenges when it comes to pairing devices with a home WiFi signal. One Health also underestimates the amount of education needed for patients and the training required for staff and service providers.
MARKET
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CHALLENGE MIX ONLY
One Health classifies three different types of telehealth visits and has corresponding workflows to ensure proper documentation. The three types of visits/workflows are clinic-to-clinic, direct-patient, and facilitated. Facilitation visits occur when One Health staff fails to facilitate the initial site visit.
“Over the past few years, we’ve begun to broaden our thinking about how, when and where we can use telehealth,” Compton said. “Our school health clinics rely heavily on telehealth as a program model. In 2021, we participated in a dental distance learning partnership organized by NNOHA and effectively triage, treat, and educate dental patients.
“We continue to talk about how we can better leverage our staff in different locations through telehealth to provide social/motivational determinants of health support for patients through our public health advocates, how we can use telehealth to enhance prenatal and perinatal home visits, and how we can leverage pharmacists to support medication management and adherence,” she continued.
Telehealth technology runs in tandem with One Health’s electronic health records; Healthcare systems are exploring options for integration as they move towards remote patient monitoring to ensure that the right data can be transferred into patient charts.
RESULT
“One Health experienced a similar spike in proven telehealth use in the healthcare sector during the early months of COVID,” Compton reports. “In 2022, we handled 7% of our clinic visits performed virtually across our network, with peak usage continuing to revolve around treatment and counseling on behavioral health and substance use disorders.
“We recently used the Lean Six Sigma framework to optimize our remote workflow,” she added. “After implementing the initial D2P workflow, the process of each clinic location looks a little different based on human resources and comfort with technology. This inconsistency leads to expectations and different experiences for patients and providers.”
Providers often initiate their own telemedicine meetings, which means they are also the ones handling any technical issues that arise with the patient.
“We’ve tapped into our centralized reception team and put more structure in the platform to ensure that our D2P visits are registered with our reception staff,” Compton said. who have had specific training in telehealth and can provide technical support prior to transferring the visit to the provider,” Compton said. “We built the internals of our platform to ensure that patients don’t skip the adoption step of the patient journey.
“Our data analytics team uses the Power BI dashboard, so we can view and track telehealth usage based on clinic, department, and provider,” she continued. “We’re in the process of updating our dashboards to be even more robust to integrating third-party customer satisfaction data for virtual visits, reports TytoCare, in addition to data Our EHR.”
USE FCC AWARD FUNDS
One Health has been awarded $930,000 from the FCC’s telemedicine grant program for remote patient monitoring, mobile devices, cellular data plans, and monitoring platform services to provide healthcare services. remote care and monitoring services for patients.
Compton noted: “We are excited to use our FCC funds for a remote patient monitoring program. “We are starting with hypertensive patients but also look forward to exploring other chronic diseases.
“As an FQHC, our ROI for RPM is not directly related to emissions reductions,” she continued. “We plan to help keep this program going by paying for chronic care management codes and also by helping our patients manage their condition and overall health.”
It will also allow human resources to be used more efficiently by being able to focus on the individual needs of higher-priority patients and focus on individual goals and objectives. their.
“The TytoCare solution will also allow our RPM subscribers to use the platform not just RPM and will be able to access any of our other services that we offer virtually,” she said. conclusion.
Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a publication of HIMSS Media.
