Electronic Health Reporter

Connected Nation (CN), through its state program Connected Nation Michigan (CN Michigan), released a study that examines the use and perceptions of telehealth in rural areas with a focus on Michigan counties.

Researchers found, among other things, the highest ratios in the country of patients per doctor, a lower-than-average life expectancy, and a higher-than-average number of preventable hospital stays in rural states with restrictive telehealth policies.

“This study demonstrates why connecting rural America is critical,” said Tom Ferree, chairman & CEO, CN. “Connected Nation has worked for nearly two decades to identify innovative solutions for connecting every community, and in that time, we’ve seen firsthand that having access to high-speed internet impacts everything from the economy to educating our children. Now we have real data that shows it can also impact healthcare—and even life expectancies—among families and individuals in our rural communities and small towns through telehealth applications and programs.”

The more than six-month-long study was done in partnership with AARP and the Michigan Health Endowment Fund. Find the full report at http://bit.ly/2ThWBPX. The study looks at the opportunities and reasons for expanding telehealth as well as the obstacles for rural areas.

“Many older adults in Michigan, especially those who live in rural areas, do not have access to high-speed internet, and that’s a quality-of-life issue for them,” said Paula D. Cunningham, State Director of AARP Michigan. “That means they can’t take advantage of advances in telemedicine that at the very least could save them long trips to the doctor, and at the most could be lifesaving.”

“Our nonprofit has long been focused on connecting more families and communities to high-speed internet,” said Eric Frederick, executive director, CN Michigan. “In recent years, we’ve seen more talk about the ways telehealth could help fill the void in rural areas where there may not be hospitals or doctors for hundreds of miles. But, as we looked around for more detailed information on telehealth in Michigan, we soon learned there were a lot of unanswered questions at the intersection of telehealth and the digital divide that we decided to set out and answer—from how state policies impact the use of technology to whether people or providers even understand the many ways it can be used.”

CN Michigan’s researchers took a three-pronged approach to examine those issues. First, they reviewed the current telehealth policies in all 50 states to identify counties ripe for leveraging the benefits of telehealth. As part of this analysis, CN Michigan compared each county’s access to primary care physicians and health outcomes to determine how big of a role telehealth policies and the Digital Divide play in these metrics.

Second, the team conducted telephone surveys of 2,001 adult heads of households in five rural Michigan counties: Gladwin, Sanilac, Roscommon, Osceola, and Dickinson.

“We chose these five counties because they represent a cross-section of rural portions of the state,” said Chris McGovern, Director, Research Development, Connected Nation (CN). “They were selected due to their differences and representative nature in terms of geography, employment, and the prominence of non-related healthcare provision networks in each county. We focused our questions on current telehealth usage, savings experienced from accessing online healthcare, interest in future use of telehealth services, and barriers that prevent individuals from using the technology.”

The third facet of this study focused on healthcare providers. CN Michigan conducted extended interviews and focus groups with healthcare networks, including doctors, nurses, medical assistants, and others within the five counties identified for telephone surveys. Healthcare networks in these groups ranged from just beginning to experiment with telehealth to those with established and award-winning telehealth programs.

“Although our focus was primarily on the impact in rural Michigan, this data can help inform the development of telehealth services elsewhere and provide a starting point for additional studies in regions across the United States,” said Frederick. “Our hope is to build upon what we’ve learned in this study and help more people in both rural and urban areas save time and money through telehealth applications and expanding broadband access. Most importantly, we hope it will lead to innovations that can improve the quality of life for all Americans—no matter where they live.”

Key findings from the study: 

• Among 1,374 counties in 18 states, counties that are deemed “Care Underserved” (often rural or low-income) have an average ratio of 4,758 residents per primary care physician (PCP), the least favorable rate in the country.
• In the five counties surveyed, telehealth usage represents a savings of nearly $4.7 million per year, just for simple 15-minute visits to general practitioners.
• With studies showing that the average doctor’s visit requires approximately two hours between travel, waiting rooms, and the visits themselves, this represents nearly $1 million ($985,000) in lost productivity per year in these five counties, totaling a savings of $5.7 million per year in these five counties alone.
• Interacting via a website is the most popular way to use telehealth (36%), followed by interacting via email (34%), text messaging (17%), mobile apps (12%), video conferencing (4%), and social media (4%).
• The top barrier to telehealth usage was a concern about the privacy of the information they share. For others, the potential cost, or the potential risk that some costs would not be covered by their insurance or payer, gave them cause for concern.

Six key issues that must be addressed to improve and expand telehealth services in rural Michigan (and likely other rural areas):

• Access to and use of home broadband service is often too low in rural areas.
   
• Rural Michiganders have concerns about the safety of their online information.
   
• Telehealth services are not reimbursed at all or are reimbursed at a lower level than in-person healthcare services.
   
• Healthcare providers need additional funding to support expansion and improvement of telehealth services.
   
• Telehealth technology must become more integrative by adopting and learning how to use new tools and procedures for each telehealth application.
   
• Support for telehealth in Michigan is scattershot and needs to be more organized and targeted.

There are hundreds of key data points, which can be found at http://bit.ly/2ThWBPX.