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From health care to education to food supply chains, the novel coronavirus pandemic has drastically disrupted Montanans' sense of "normal." Yet in seeking solutions for the short term, business owners, educators, health care professionals and criminal justice workers have developed fixes that may long outlive the virus's first few waves. In the "COVID Solutions" series, reporters investigate avenues of lasting recovery spurred by the pandemic.

Telehealth Appointments On The Rise, Offer Options For Patients And Doctors

Telehealth virutal home screen
Sofia Stuart-Rasi
Telehealth virtual home screen

This story is part of a series that looks at potentially lasting ways Montana adapted during the pandemic. It’s funded in part by the Solutions Journalism Network. 

After the Centers for Disease Control and Prevention began advising against face to face interactions, Montana healthcare providers sought to expand non emergency telehealth appointments. It's a trend that could keep going.

When a place driven by healthcare appointments abruptly shuts down, ideas to go remote have to become reality, fast.

On March 18th, Governor Steve Bullock released a directive to expand access to telehealth services in order to slow the spread of COVID-19.

“We didn’t have weeks or months, you know. We had to stop providing in person services. So, we found a way to do this in days,” Bullock said. 

D’Shane Barnett is the executive director of All Nation’s Health Center, an Urban Indian Health Services center that provides for Natives and non Natives in Missoula and Ravalli County.

When Bullock put Montana in a State of Emergency mid March, All Nations had to completely set up the clinic virtually in three days.

Due in part to having only two exam rooms, Barnett says his clinic has actually been able to provide more for patients since COVID-19.

“I now have the option to hire additional providers from their home and let them provide services via telehealth so that I can actually increase the number of patients I can see and not be constrained by my physical environment,” Barnett says.

Telehealth is an umbrella term for when healthcare providers take care of their patients virtually, by video or phone, and for a large, rural state like Montana, telehealth isn’t novel.

In 2013, Montana joined fewer than half the states with a parity law that requires telehealth services be similarly reimbursed as in person services.

The governor shored that up with another directive in April.

This one allows for expedited registration of licensed out of state providers to practice in Montana. Dr. Michael Temporal is a family medicine physician at the Billings Clinic. He’s been practicing and supporting telehealth for decades.

“If you had to find any gold lining to this pandemic, is that it forces us to get creative and showed proof of concept that there is other ways of conducting health care short of you and me being in the office together,” Temporal says.

Since COVID-19, half of Temporal’s day is spent doing telehealth appointments. He says it expanded in large part because insurers, including Medicaid, took a more relaxed approach to reimbursing this kind of care. That makes sense in Montana, he says.

“You can imagine if having to drive 300 miles for someone to look at a wound and say, ‘oh you’re doing great,’ and then go home. There’s a lot of opportunity to use and continue to use virtual care,” Temporal says.

In order to keep supporting telehealth post pandemic, Temporal says payment systems will need to make their adjustments more permanent; reliable internet connections across the state would also help.

More and more, people are figuring out face to face interactions aren’t always necessary, even if they’re more personal. That’s also true with agencies that do mental health and social work.

Brittany Challinor is a therapist for AWARE inc., a nonprofit for people with disabilities and their families across Montana. Part of her job is working with kids enrolled in the early intervention program, Headstart.

“Today I’m going to read something called Gorilla Thumps and Bear Hugs. This is about something called tapping. It’s a way of calming down and relaxing your body especially when you’re overwhelmed with all sorts of thoughts that are not feeling the greatest,” Challinor says.

Challinor started creating video therapy sessions patients can watch, anytime and anywhere with internet access. It’s proven to be helpful for children with disabilities as they continue learning without being in a classroom.

Trista Vonada is also a counselor at AWARE. She primarily focuses on infant therapy.

Vonada supports and practices telehealth but says it’s not the same as being a room with caregivers and their babies.

“We cannot replicate via telehealth, however, used as a supplement service, I think some really great things can happen,” Vonada says.

The governor’s telehealth directives will end when Montana officially exits a state of emergency.

But U.S. Senators Steve Daines and Jon Tester are among 30 senators who signed a letter June 15 to majority leader Mitch McConnell. In it, they asked that telehealth provisions in the coronavirus related legislation be made permanent.