Using Telehealth to Serve Disparate Populations

The following is a guest article by Josh Wilda, CIO at University of Michigan Health-West.

Armando Ruiz is like many who walk through the doors of Exalta Health: an elderly man greeted in his native Spanish by a bilingual marquee outside the small purple clinic on Grand Rapids’ main thoroughfare. He’s also one of many Exalta patients who took advantage of a partnership with a local hospital to receive needed specialty care through a unique hybrid remote/in-person model.

The partnership between Exalta and University of Michigan Health-West serves a variety of business objectives for both providers. As a lesson in the potential for telemedicine to serve disparate populations, the early results of this partnership are promising. Ruiz, an uninsured immigrant from Guatemala, might not have received a proper diagnosis for his combination of chest pains and respiratory problems without seeing a specialist ― an appointment that would ordinarily be unaffordable and take him outside of Exalta’s facility.

Ruiz first met with Laura Kass, a Physician Assistant who treks 7 miles from UMH-West’s campus to Exalta once a week. With help from an on-site interpreter, Kass was able to order tests for Ruiz and refer him to a UMH-West cardiologist. Ruiz’s appointment with the cardiologist was then conducted at Exalta using a remote video call with help from the interpreter.

Given the experience of Ruiz and others, this hybrid care model could be instrumental in addressing the challenge of treatment adherence among uninsured and underinsured patients in the Grand Rapids metropolitan area.

Background

UMH-West is a hospital located approximately 9 miles southeast of downtown Grand Rapids in the suburb of Wyoming, Michigan. When UMH-West moved to its current location in 2007, downtown Grand Rapids was already home to the “Medical Mile,” a cluster of large providers and medical schools. These facilities are close to the metropolitan area’s main highways, easily accessible by car. UMH-West is also easily accessible by highway. However, its location is central to suburban residents who live south of Grand Rapids ― less so for the urban, mostly nonwhite patient base at Exalta.

Exalta describes itself as a “faith-based nonprofit healthcare center that offers accessible, compassionate care for the whole person.” Its primary care physicians and volunteers serve thousands of patients annually. The majority (59 percent) speak one of 18 languages other than English, primarily Spanish. Sixty-four percent of Exalta patients have no insurance. Fourteen percent receive Medicaid benefits.

Geographically, demographically, and economically, there is little overlap between Exalta and UMH-West. This enabled each provider to address a challenge for the other. For UMH-West, Exalta’s patient base represented a subsection of the community they were unlikely to attract through traditional outreach. For Exalta, UMH-West had specialty care providers on staff who could provide follow-up care for patients with two commonly diagnosed heart conditions: hypertension and diabetes.

Connecting Exalta’s patients to UMH-West’s campus posed another challenge.

Embracing Remote Care

Exalta did not utilize telehealth services prior to the COVID-19 pandemic. In 2020, furloughs gutted the clinic’s on-site staff. Remote care became the only non-urgent care option for patients, many of whom are reluctant to embrace video-conferencing technologies like Zoom. A 2020 study on the pre-pandemic use of telehealth by older adults revealed that low-income Spanish speakers were among the demographic groups least prepared to use telehealth services.

Exalta’s reputation among its mostly Spanish-speaking patients allowed it to bridge the technology gap. Forty percent of Exalta’s staff speaks Spanish. If a patient speaks a language other than Spanish or English, and no in-person interpreter is available, Exalta uses Voices for Health, which provides an interpreter over the phone. Some Exalta patients were raised in cultures where institutional medicine is a foreign concept. Others were unable to find a primary care provider who could serve them in their native language. For these groups, establishing trust with a medical provider can pose a challenge.

The limits of Exalta’s basic patient services posed another obstacle. Drop-off was not uncommon when patients were referred to an outside specialist. Through a mutual connection on Exalta’s Board of Directors, UMH-West broached the subject of using telehealth to bridge this gap, matching its specialty care staff to the most pressing needs of Exalta’s patients. Some had already received medical advice over their phone in the early days of the pandemic. Once in-person visits returned, the next step for patients was relatively small.

Beginning in July 2020, UMH-West sent an on-site Physician Assistant, Kass, to Exalta. She used her one shift a week to flag patients seeking treatment for heart-related symptoms. When one was referred to a cardiologist, a doctor at Exalta would schedule an “advance televisit” remotely with UMH-West. TytoCare, a remote patient monitoring platform, connected the UMH-West cardiologist with the Exalta patient for a video exam. The patient sat on-site at Exalta’s clinic while the cardiologist sat at the UMH-West facility. If the physician recommended additional appointments or procedures, he could do so during the exam.

This multi-tiered approach paid immediate dividends. During the first remote appointment, a UMH-W cardiologist was able to diagnose an Exalta patient’s heart murmur.

Cost-Benefit Analysis

Remote patient monitoring (RPM) facilitates appointments between any two points around the globe. Why would a clinic strive to serve its own community remotely, with the doctor and patient only a few miles apart?

For UMH-West, the answer lies in increasing its visibility among patients unlikely to leave the inner city to seek care. Although telehealth itself relies on new technology, the marketing component is old-school, relying on patient word-of-mouth to spread brand awareness among friends and family. The efficacy of this strategy is more difficult to quantify than an email marketing campaign. But the cost to UMH-West is relatively little: a physician assistant for one shift a week, the TytoCare tool, the time out of their cardiologists’ regular schedule. Meanwhile, the short-term benefit to Exalta patients is indisputable.

As hospitals and health systems seek to lower costs, reduce burdens on their staff, and treat more patients efficiently, the need to leverage RPM has never been greater. In the case of UMH-West, that required a closer look at their own community combined with a dash of creativity.

About Josh Wilda

Josh Wilda is the Chief Digital & Information Officer with University of Michigan Health-West. Josh has been with UMH-W for more than 12 years of progressive leadership and strategic responsibilities with a focus on managing and improving the delivery of healthcare through digital innovations.

   

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