Maven, the largest telemedicine provider for women’s and family health, announced a new partnership with MassHealth, the Massachusetts, Medicaid and the Children’s Health Insurance Program. MassHealth will provide free telemedicine appointments for members with COVID-19 symptoms with Maven’s network obstetric/gynecologists, maternal fetal medicine specialist, pediatricians, family physicians, and general practitioners for women and families in Massachusetts.
MassHealth members will be connected through an online navigation tool to Maven providers through on-demand chat and video appointments 24 hours a day through the use of any web-enabled device.
“During the COVID-19 emergency, MassHealth has made unprecedented efforts to eliminate barriers to health care access, including expansive coverage of telehealth services,” said Acting Medicaid Director Amanda Cassel Kraft. “We are excited to announce this partnership with Maven ?to provide medical support to our members seeking guidance on COVID-19 symptoms or risk factors.”
In the wake of COVID-19, women and families are dealing with a myriad of health concerns, from managing conditions related to a high risk pregnancy to being discharged from hospitals soon after giving birth to caring for a newborn. Telehealth now plays an essential role in giving these women and families the support and care they need from the safety of their own homes.
“This pandemic has raised serious concerns for millions of women who are pregnant or have just given birth,” said Kate Ryder, founder and CEO of Maven. “We have doctors available around the clock to support MassHealth members and alleviate the burden on the healthcare system during this public health crisis. Massachusetts has long been a leader in healthcare and other states should look to their innovative response to this crisis as a model.”
With the incredible demand for care, trusted clinical data and information, and resources around COVID-19, Maven has developed dedicated COVID-19 resources. This includes:
Ongoing webinar series led by healthcare professionals to provide clinical updates on the rapidly evolving COVID-19 pandemic, answer member questions and address topics including pregnancy, fertility, anxiety and pediatrics. The next webinar will be held on Thursday, April 2 at 1:30 p.m. EST. Please register here.
Covid-19 support section in our member app for those looking to connect with specific providers.
Specific Maven provider in-app resources with the most up-to-date information regarding COVID-19.
The HIPAA waiver issued for telemedicine during COVID-19 is a game-changer for physicians now that CMS says virtual visits are reimbursable.
And now, telehealth is emerging as an effective and sustainable solution for precaution, prevention, and treatment to stem the spread of COVIS-19. But what do the new HIPAA waiver and CMS rule about telemedicine during COVID-19 mean?
According to Dr. Neil Baum, chief medical advisor at Vanguard Communications, professor of Clinical Urology at Tulane Medical School, and in clinical practice for 40+ years, the glass is half full.
“Telemedicine is a great opportunity for us to fill our glass and engage our patients in a way we never have before. We’re still able to practice good medicine without having to be face to face or touching a patient,” says Dr. Baum.
Telehealth is bridging the gap between people, physicians, and health systems, enabling everyone, primarily symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines.
For healthcare professionals, this news means that CMS now allows providers to be reimbursed for the vast majority of virtual visits using telemedicine during the COVID-19 pandemic. (Only a small number qualified for reimbursements as recently as March 14.)
Plus, no special software or extra expense for healthcare-specific hardware and software is needed. The tools are free and easy to use.
Below is a chart of the popular apps approved for telemedicine during COVID-19.
Dr. Baum says telemedicine will go a long way to enhancing a physician’s connection with patients and providing access to care but stresses the importance of documenting virtual visits and video conversations just as you would an in-office appointment.
“If you didn’t document, then you didn’t do it, and then you don’t get paid for it,” says Dr. Baum.
Visiting nurses are valued for their caring and compassionate nature. Their valuable skillset makes a difference in the well-being of their patients and the lives of patients’ families. However, they face unique challenges amid the coronavirus as patients and staff are concerned about receiving in-home care during this time. Bringing healthcare to the home is no easy task.
As NAHC President William A. Dombi stated, “Home care and hospice nurses, therapists, aides, and other providers who choose to use their lives to serve our country’s aged, disabled, and dying. This noble work deserves our recognition and praise.”
Home health agencies are on the front line amid the coronavirus pandemic. A recent Home Care Association of New York State (HCA-NYS) survey found that nearly half of agencies in the survey said they have experienced patients or family members refusing entry of home care personnel. “Different states and regions are at different stages in surveillance and monitoring,” Roger Noyes, director of communications at HCA-NYS, told Home Health Care News.
“This speaks to some very important educational and outreach needs to reassure patients and to ensure that vital care can be delivered,” Noyes said. In addition to patients’ hesitation to let nurses into their homes for in-person visits, many patients are already quarantined, sheltering in place, or social distancing. And, some patients are denying service because they appreciate their nurses so much that they do not want to risk getting their nurse sick in-person. Concurrently, the nurses themselves might also be wary of conducting in-person visits as they might not have sufficient protective gear and/or fear the risk of infection.
Agencies are implementing telehealth/virtual care to preserve their patients, their staff and their limited supplies. Technology can help agencies’ staff continue what they do – provide compassionate and critical care – and “be present” with their patients as much as possible. With technology, agencies can safely continue the delivery of care during this time and quickly communicate critical updates as needed. The technology helps home healthcare agencies:
Conduct virtual visits with patients to safely ensure continuity of care
Send out critical COVID-19 updates and self-care tips
Send condition-specific messages to improve ongoing adherence
Provide virtual access to their staff which helps nurses address patients’ emerging concerns and also alleviate patients’ loneliness while being socially isolated
With virtual visits, agencies are kept abreast of the realities of the patient’s home environment and their available resources (financial, food, social, etc.). Staff can continue to monitor their patients’ day-to-day situation and individualize the care (and conversation) to the “new normal” for the at-home patient.
Use of telemedicine in the U.S. has been low to date. However, asexpected, it is expected that demand for these services will increase dramatically over the next few months because of the coronavirus (COVID-19) crisis, says GlobalData, a leading data and analytics company.
Telemedicine has been touted as a critical strategy during the COVID-19 emergency to limit the risk of person-to-person transmission of the virus, prevent emergency rooms from being inundated, reduce barriers to screening, and allowing those with moderate symptoms to be treated from home. Teladoc Health, a telehealth provider, announced that patient visit volume had increased by 50% since the previous week and was continuing to rise.
Kathryn Whitney, MSc, director of thematic analysis at GlobalData, said: “Prior to the COVID-19 crisis, telemedicine had never reached its full potential in the US, with several barriers preventing its widespread uptake. These include lack of reimbursement and restrictions affecting access for rural populations, general lack of awareness of these services, and the desire of the sick to see their physician in person.”
Since early March, regulations in the US governing the use of telemedicine have changed regularly, which will expand access to services during the COVID-19 emergency, particularly for Medicare beneficiaries who are deemed at high risk for the virus. In certain states, including California and New York, officials have also announced that payers must offer telehealth services as part of their emergency plans. In Massachusetts, payers must cover the COVID-19 testing and treatment via telehealth, and cannot impose cost sharing via co-pays, deductibles, or coinsurance, and prior authorization is not required to receive treatment via telehealth.
Whitney continues: “Recent changes to regulations by the U.S. government will remove many of the financial barriers to telehealth and drive the use of these services, particularly among older and vulnerable populations. People will also become more aware of these types of services, given amount of information being disseminated by the government, hospitals, healthcare systems and payers.
“As more U.S. cities and states begin to lock down and social distancing becomes the new normal for the foreseeable future, Americans are likely to change their views on telemedicine. With the ongoing risk of virus transmission, people will be eager to avoid hospitals and get screened and receive care from the safety of their own homes.”
We have all heard of the COVID-19 (Coronavirus) which is believed to have originated in the Wuhan province of China. Which it then started spreading across the globe from major outbreaks in countries like Italy, Spain all the way to the United States. We know now there have been a number of countries who have gone in a nationwide lockdown (Italy, Spain, France, Germany).
Here in the United States, many states have been doing everything they can to limit the spread. For example, most restaurants, bars, and other social gathering areas have been closed or limited. Unfortunately, for healthcare workers, you are on the frontlines of this pandemic. Which will mean you may be the best source of information for family friends and clients.
Here are some tips as to what you may want to do. First, let’s start off with yourself. As we mentioned you are one in the thick of this epidemic and you need to make sure you are being safe and keeping yourself healthy and alert.
Of course, you need to follow the usual protocols of keeping your distance from others (when you can), make sure to be washing your hands when you can and, maybe the hardest for many of those working inside hospitals and clinics, make sure to get a good night’s sleep and eat as healthy as you can to keep up your energy.
Being alert will not only be crucial to keeping yourself safe but it can save a patient or coworker from being exposed to the virus. Whenever a new patient or individual comes to your clinic or emergency room take note of any symptoms they may be experiencing. Some of the known indicators of the COVID-19 (Coronavirus) may include some flu-like symptoms such as cough, fever, sweating, shortness of breath, fatigue and muscle pain.
As COVID-19 continues to spread in the United States, health care providers are turning to technology to help treat patients who may be infected and also prevent the spread of the illness.
While there are no known cases of COVID-19 in Alabama, plans to use telehealth technology to fight the spread of the virus are already in place at the University of Alabama at Birmingham.
According to Eric Wallace, M.D., the medical director of UAB eMedicine, UAB is considering using telehealth through three approaches to help care for patients both in Birmingham and around the state.
Keep patients at home
The first approach is to keep as many patients who do not have upper respiratory symptoms at home, especially those who have weakened immune systems. The most common COVID-19 symptoms are fever, runny nose, dry cough, shortness of breath, fatigue and body aches.
“We plan to use telehealth technology to see as many patients in their homes as possible, especially those who are most at risk, such as the elderly and immunosuppressed patients,” Wallace said. “For example, if you have a urinary tract infection, the last thing you should do is go to the doctor’s office and wait in a waiting room when you could have had your UTI treated from home.”
If you have any of the COVID-19 symptoms, you should call your health care provider first before going to the doctor’s office. If you do not have any of the symptoms, but need medical care, Wallace recommends calling your doctor or using UAB’s eMedicine online service. The service allows doctors to diagnose and treat patients for a variety of common conditions online. Furthermore, UAB’s eMedicine online service is now serving as a location to help screen patients with COVID-19 symptoms to determine whether referral for in-person testing is necessary.
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.”
As the technology industry continues to experience continuous, rapid change and advancements, other industries are faced with the challenge of incorporating these new technologies, creating rules and regulations in order to ensure the safety and privacy of consumers and businesses. In 2020, technology will continue to lead to new developments in the healthcare industry, but will also leave room for new threats. In particular, telehealth will grow in popularity for both doctors and their patients, allowing for streamlined communication, more convenient consultations, an increase in treatment accuracy and the ability for patients to receive healthcare anywhere in the world.
As the health industry normalizes digitizing health data and providing telehealth services, we must also prepare for what lies in the year ahead for healthcare and data privacy – specifically as it relates to a rise in cyber threats, increase in regulations and the adoption of blockchain.
Protecting Privacy in the Wake of Cyber Threats
Today, telehealth is segmented, essentially meaning that “walls” exist in the network that protect data and act as a defense against hackers and cyber criminals. However, in the coming year, many networks will be streamlined and optimized into an end-to-end solution, likely under the umbrella of one vendor and cutting out third party applications. This has the potential to minimize costs, resources and time. However, accelerating digital health convergence in this way will open the door for network security vulnerabilities. Ultimately, this will provide hackers new avenues to access private patient data and find ways around pre-existing cyber defense mechanisms.
This increase in cyber threats due to the implementation of end-to-end solutions is something that the healthcare industry cannot be prepared for without proper regulation and a dedication to provider compliance.
Increasing and Reforming Regulations
As telehealth becomes a normalcy in patient-provider communication in 2020, we will see a rapidly evolving regulatory environment in order to combat the increase in cybersecurity threats and data breaches. This will lead to a need for additional regulatory compliance codes and demand for more security compliance assessments for healthcare providers and organizations engaging with personal health data.
The shortage of specialist physicians in the United States continues to receive a great deal of attention as an area of concern. However, a lesser-known compounding factor is the increase in referral rates. In a 2012 study, the National Ambulatory Medical Care Surveys found that between 1999 and 2009, the probability of receiving a specialist referral during an ambulatory patient visit increased from 4.8% to 9.3%, a 92% increase, nearly double. While this study is now several years old, we can surmise that this trend has continued due to the persistence of several factors contributing to the overall disparity between specialist referrals and the number of available specialist physicians.
The clear impact of these compounded problems is substantially increased wait times among patients with a physician referral for specialist appointment. In 15 major metro areas, a recent Merritt Hawkins study covering the medical specialties of cardiology, dermatology, orthopedic surgery, and obstetrics and gynecology, found appointment wait times increased 25% from 2014 to 2017. Wait times averaged 24.1 days across the study, with some extreme cases waiting 165 days for an appointment.
Long wait times impact patient outcomes and healthcare operations
On top of the anguish and emotional impact of waiting for care, diseases and illnesses can progress as patients sit in appointment queues for weeks or even months on end. As NEJM describes, “long waits before appointments, particularly specialist appointments, often contribute to the development of avoidable complications,” which cause more difficult health cases both for the patient and for the physicians caring for them.
There are notable effects on healthcare operations that add to the case for reducing patient wait times as a crucial avenue for improving healthcare overall. For example, long wait times for appointments increase the prevalence of no-shows, indicating that patients are either frustrated enough to not follow through on scheduled appointments or forget appointments altogether because of the long interim period. Sometimes appointments can even be moved around by specialist physicians at the last minute, leaving patients in limbo for even longer.
Additionally, long wait times frequently lead to patients receiving inefficient care. Firstly, extended waits often deter patients from seeking initial care. This shifts the healthcare industry away from proactive to reactive care, which is less effective and more costly for all parties involved. Secondly, the inability to access the care they need and when they need it, leads to patients seeking care within inappropriate settings. These patients are more likely to be admitted to EDs, as the 30-day rate of ED and inpatient usage was 8.7 times higher for patients awaiting a specialist appointment. A study by Truven Health Analytics noted that 71% emergency room visits are unnecessary and avoidable. Each of these issues alone make strong cases for reducing patient wait times; these issues combined suggest reducing patient wait times is a crucial goal that must be prioritized when it comes to streamlining healthcare delivery and improving quality of care.
In light of these concerning figures and effects, healthcare organization operations are turning their focus toward reducing wait times and improving patient outcomes. This fits well as part of an overall strategy to increase quality and efficiency of healthcare delivery. Below, we will focus on how telehealth platforms, specifically eConsults, combat multiple factors driving specialist appointment wait times, streamlining the physician referral process and thereby reducing patient wait times for happier and healthier patients.
Positive impacts of reducing patient wait times by accessing specialty care from within primary care
Increasingly, healthcare providers are entering into value-based payment arrangements. Telehealth solutions, and specifically eConsults, can support the drive toward more efficient care by increasing access to specialists while better optimizing time and place of care.
eConsults are is an electronic form of peer-to-peer collaboration, providing PCPs with a platform to consult with specialists on specific patient cases. eConsult interaction occurs using a secure, HIPAA-compliant messaging platform, where specialist guidance is received within 24 hours, drastically reducing the interim time between referral and treatment. eConsults can replace more than 70% of routine referrals with immediate, specialist-guided treatment from the PCP, without the wait and additional cost. Keeping lower acuity patients out of the specialist referral queue means faster access to face-to-face visits for the higher acuity patients, expediting care and improving outcomes for all.
One provider (and frequent user of AristaMD eConsults) at a Federally Qualified Healthcare Center describes the challenges of securing specialty care for the patients at her clinic: “Especially with MediCal patients, it usually takes at least four or five months for a patient to complete a referral. Very often, patients end up waiting three to five months, then receive notification their appointment has changed, the specialist has moved, or even that the specialist is no longer taking that patient’s insurance. Some of these patients are then in limbo for more than six to nine months. This is where the benefit of AristaMD’s eConsult platform comes in. AristaMD specialists provide guidance on patient care plans, for example diagnostic or medication recommendations, within 24 hours.”
Several studies have already noted demonstrable decreases in wait times once eConsults were introduced in large health systems. The San Francisco Department of Public Health saw dramatic improvements following the introduction of their eConsult program. The median wait time for a non-urgent appointment with a rheumatology specialist was drastically reduced from 126 days to 29 days. Additionally, patients visiting specialists needed fewer follow-up appointments as a result of a more extensive pre-visit workup made possible by this telehealth platform. Other similar successes have been observed in Los Angeles and the NYC Health + Hospitals System, with the latter finding that median wait times for high-urgency specialist visits decreased from 30 days to 16 days as a result of eConsult implementation.
eConsults are ideal for addressing the growing problem of lengthy patient wait times. They empower PCPs to deliver specialist-guided care to lower acuity patients in a timely manner while freeing up the capacity for in-person specialist visits for the more complex, higher acuity patients who need them most.
Over the past few years, there have been encouraging improvements in the realm of mental health care in the United States. Initiatives to improve mental health outcomes, such as the Affordable Care Act (2010), have been primarily aimed at requiring increased insurance coverage to encompass mental health services at levels comparable with physical medical care.
Despite these improvements, such policies do not address issues caused by access challenges within the referral system, and many of the one in five adults suffering from mental illness in the United States still are not accessing the mental health care they require and need. In particular, there exists a shortage of mental health providers across the country, and these health professionals are likely to be out-of-network for many patients. Further barriers preventing patients from obtaining care include travel, missed work time associated with appointments, and the social stigma of seeking mental health care.
Faced with these challenges, patients with mental health issues are resorting to emergency departments in search of mental health services. Hospital emergency departments lack access to psychiatric services and mental health resources. Further, as patients are improperly treated in urgent care settings, this can lead to reduced access to care for those with acute medical issues, which then results in poorer overall outcomes at the highest cost of care.
To address these multi-faceted challenges, value-based care models have placed particular importance on the role of primary care, as these organizations are uniquely positioned to promote innovation and efficiency through proactive and coordinated care. When it comes to mental health services, primary care providers (PCPs) serve at the front line of care and are positioned to be an excellent means of providing access to mental health care to a patient population in need. However, many PCPs lack adequate resources to treat these often complex and specialized issues.
Telehealth technologies, such as telepsychiatry and eConsults, can support primary care practices by creating networks to provide timely, documented, and standardized access to mental health professionals. This equips PCPs to more effectively manage patients with mental health concerns, reducing wait times and improving mental health outcomes.
AristaMD’s eConsult platform connects PCPs with adult and pediatric psychiatry, addiction medicine, and behavioral health specialists to provide care planning support and treatment recommendations. Ninety-one percent of AristaMD’s mental and behavioral health eConsults have been shown to include medication regimen guidance including initiation of treatments, diagnostic recommendations, and medication dosage adjustment, all of which can be managed within the primary care setting with the support of specialty insight.