Expanded Tele-Health Services Could Continue Post-COVID, Health Professionals Say

Apr 21, 2020


  Community health centers across Montana provide care to people who wouldn’t have access otherwise. While they’ve had to pivot with COVID-19, their expansion of tele-health and new ways of connecting with patients could stick around well after the current pandemic subsides.

Yellowstone Public Radio’s Nicky Ouellet spoke with Rachel Cramer about her reporting.

NO: Montana has 14 Federally Qualified Health Centers, commonly known as community health centers. What niche do they fill in the state’s health care services?

RC: So last year, community health centers across the state served around 120,000 Montanans in places like Missoula, Libby, Billings, Hardin.

They’re located in areas identified by the federal government as not having enough primary care providers, higher than average infant mortality and elevated levels of poverty .

The centers, which have around 90 clinics all together, provide medical, dental and behavioral health services to people regardless of their ability to pay or their insurance status. And some have expanded to meet other community needs, like child abuse evaluations, GED courses and legal services.

NO: So what happened to those services when COVID-19 cases started showing up in Montana mid-March?

RC: Cindy Stergar, CEO of the Montana Primary Care Association, says they had to shift gears.

“We’re on the front lines so in those first two weeks, our clinics pivoted really fast to safeguard their patients and their staff,” Stergar says.

She says in the early stage, like larger hospitals in Montana, community health centers pushed back non critical, in person appointments to prevent staff and patients from potentially spreading the disease. They designated specific clinics or isolated parts of a building to send potential COVID-19 patients to collect nasal swabs for testing. They also cut out non-essential dental services and redeployed staff to help with things like screening patients, answering phones and delivering prescriptions.

Some of the bigger clinics created staff rotations so if one person became infected, the community health center wouldn’t lose all its employees as they went into quarantine.

Stergar says most community health clinics were already offering tele-health services, but they really ramped them up over the last month.

“I would say that first week, we probably lost 80 percent of our visits, but then it’s slowly building back up as people are either coming to the health clinic or doing a tele-health visit," said Pureview Health Center CEO Jill Steeley.

She says half of Pureview patient visits right now are through tele-health.

NO: One of the challenges for providers to use tele-health in the past was ensuring they’d get reimbursed for that service from private insurance, Medicare or Medicaid. But as shelter in place orders went into effect across the country, insurance companies relaxed what services could be provided through phone calls and video chats. How has that played out here in Montana?

RC: I spoke with David Mark, the CEO of the Bighorn Valley Health Center, which has eight clinics across eastern Montana stretching from Miles City to Chinook.

“We have been seeking to develop a system that allows us to get care to people rather than making people come to the care,” Mark says.

Mark says the health center is sending patients these devices that they can plug into smartphones to check their pulse, blood pressure and temperature while talking to their doctor.

He says they planned to roll this out in six months to a year, but got it out the door in a few weeks.

Mark says using tele-health and other types of technology can’t completely replace in person care, but they do offer an opportunity to maintain and expand care that rural Montanans need.

“My suspicion and my hope is that in the post-COVID world, the regulatory landscape will not return to its previous state," Mark says.

This is something I heard from a lot of people.

NO: A few weeks ago you reported that hospitals in Montana were seeing a drastic reduction in revenue with fewer patients, and last week Kalispell Regional Healthcare furloughed 600 employees. How are community health centers in the state doing financially?

RC: As of Apr. 15, Cindy Stergar with the Montana Primary Care Association said none of the community health centers were planning on furloughing staff. The community health leaders I talked to said it’s really difficult recruiting health care professionals so if they cut staff, there’s the risk that those people will find jobs elsewhere.

And in terms of finances, everyone I talked to said they were OK for now.

Federal grants that normally fund community health centers are still coming through, and the more than $9 million allocated to Montana’s community health centers through the CARES Act certainly helped.

Laurie Francis, Executive Director of Partnership Health Center based out of Missoula, says her organization received over $800,000 earlier this month through the federal relief package.

“If it hadn’t come through, we would lose - we think - a million dollars a month,” Francis says.

NO: A million dollars a month?

RC: Yep. She said they’ll know for sure next week when they have better data, but with the reduction in patients and challenges getting reimbursements for tele-health through certain insurers, community health centers are still short on revenue.

And there are still a lot of challenges getting supplies for testing and personal protective equipment like masks, gloves and gowns. The Montana Primary Care Association is working with the Montana Hospital Association and the Department of Public Health and Human Services to coordinate their efforts.

Francis says they’ve been ramping up calls to patients to check-in on them and see how best to ensure their health needs are being met.

“It’s not like 16,000 people stop being sick because this virus came to town. We’re looking at increasingly reaching out to check on people, and that will feel good to all of us,” Francis says.

Francis and the other community health center leaders I talked to mentioned this concept of maintaining physical distance but social connection during the pandemic.

“I do think community health centers view themselves as rising to occasions where there are gaps in services. I’ve heard of some primary care folks closing up shop during this time, and we tend to do the opposite. When there’s a need, we figure it out and I’m really proud to work with the people here and across the state,” Francis says.