The Boston-based MA FQHC Telehealth Consortium was created for Federally Qualified Health Centers to come together to master telehealth so that their patients could access quality care despite the pandemic.

Before this time, FQHCs generally struggled to get telehealth off the ground because of the expense, lack of reimbursement and issues related to access.

THE PROBLEM

Telehealth expenses such as laptops, webcams and headsets for provider-side enablement are purchases that FQHCs often cannot fit into their budgets. Supporting patient-side enablement and access also is a persistent issue for FQHCs seeking to do more telehealth.

Historically, due to income disparities, patient populations for FQHCs have less access to the necessary equipment, such as phones, tablets or computers with cameras, as well as reliable broadband in order to carry out a successful telehealth appointment.

PROPOSAL

“Pre-COVID-19, most telehealth initiatives were led by very early adopters, were grant-funded, and tended to focus on specialty conditions, like dermatology, and provider-to-provider consultations,” said Matt Mullaney, chief finance and strategy officer of Community Care Cooperative, the lead organization of the MA FQHC Telehealth Consortium. “These initiatives were successful based on their limited aims, but they did not offer the opportunity to transform the clinical model.”

The pandemic has made telehealth crucial for many types of care – especially primary care – and patients and providers now are more open to the idea than ever, Mullaney noted. With that receptivity, the consortium had a new opportunity to support the expansion of telehealth offerings.

"We will be purchasing cell phones and data plans for patients in need in order to support their telehealth visits."

Matt Mullaney, Community Care Cooperative

The MA FQHC Telehealth Consortium needed to get telehealth right, and believed that through the consortium it could leverage collective strengths to increase telehealth training and resources to better serve Massachusetts’ most vulnerable patients and provide them with quality care during the COVID-19 crisis.

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MEETING THE CHALLENGE

The MA FQHC Telehealth Consortium’s approach to technology is guided by the Telehealth Maturity Model developed as a consortium. This model has “technology & tools” as a domain, but sets forth goals for the domain rather than specifying a particular, set solution for all providers and patients to adopt.

“We believe that our focus on ends rather than means is appropriate given the variety of EHRs in use by consortium members; the diversity of patient circumstances; the immaturity of the industry; and the rapidity of the evolution we are undergoing,” Mullaney explained.

“For example, in the four months since the pandemic sharply reduced in-person visits, some health centers that use NextGen have adopted OTTO Health, a telehealth platform acquired by NextGen in December 2019.

“However, others using the same EHR continue to use Zoom or Doxy.me for visits because they were available, rapidly adopted in the first few days of the pandemic and are providing a reasonable technical solution for providers and patients,” he continued.

“We believe most consortium members have found at least a ‘local minimum’ in the telehealth technology equation, a stable condition in which they can conduct telehealth today.”

As better solutions emerge, and a truly integrated clinical model is developed, some members will want to invest the money and energy to move to other, longer-term technology solutions, he added.

“The variety we find in telehealth platform options, and combinations of options, pales in comparison to the Wild West of options available in devices, data plans and remote monitoring,” Mullaney said. “Here, even seemingly simple questions such as 'Which device should I buy for patients who need visits, but lack a phone?' turn out to be complicated.”

Smartphones need data plans, and it is not easy finding the best price for device and data plan, the best terms in case a device is lost or damaged, and the best coverage for patients in a given geography, he noted. The consortium is working with a technology partner that brings experience and expertise to answering these questions, he said.

Beyond these answers, he added, are even more questions, such as: 'Which patients should receive devices? How should success be measured and even ROI with respect to the healthcare objectives? Should the consortium enable other functionality, for example, allow a child in the home to access classes via Zoom?'

“These are all questions that the FCC telehealth award program is helping us to explore, pragmatically and efficiently, and to learn from going forward,” he said.

RESULTS

In mid-March, the MA FQHC Telehealth Consortium set goals for health center services and revenue by service line. These goals were aggressive but pragmatic, intended to hold the organization accountable to ensuring patient access wherever it could and to generating revenue to sustain health center operations during the pandemic.

The goals to achieve by May 1:

• More than 75% of baseline behavioral health services and revenue
• More than 65% of baseline medical services and revenue
• More than 10% of dental services and revenue
• More than 10% of vision services and revenue

“In aggregate, across all consortium members, we did achieve these goals,” Mullaney reported. “In fact, behavioral health services slightly exceeded baseline by May 1 (>100%) and a few health centers were able to restore primary medical services to near 100% as well. This was achieved through rapid deployment of enabling hardware to health center providers suddenly working remotely, and hundreds of hours of IT support, from engineering to help desk.”

USING FCC FUNDS

MA FQHC Telehealth Consortium, made up of 28 community health centers, was awarded $939,627 to maximize the health center providers and patients with access to telehealth via phone calls and videoconferencing, and use connected thermometers and pulse oximeters for remote monitoring of COVID-19 patients, and connected blood pressure monitors for the monitoring of patients with hypertension.

“We will be using a portion of our FCC award funds in order to cover costs of laptops, webcams and headsets purchased for health center staff at the beginning of the pandemic,” Mullaney said. “These initial purchases were key to make telehealth work at a time of deep uncertainty and concern. Providers and other care team members were able to adapt quickly and begin seeing patients via teleconference.

“We also will be using our FCC funds for patient-side enablement for telehealth services and remote monitoring for patients with COVID-19, as well as chronic diseases,” he continued. “We will be purchasing cell phones and data plans for patients in need in order to support their telehealth visits, reducing the need for them to enter the health centers. This is key for both safety and convenience, as they can now take appointments from home.”

The consortium also will be distributing remote-monitoring devices for a subset of vital signs like oxygen saturation and blood pressure. These will be distributed to COVID-19 positive patients for a continuum of care at home and chronic disease patients who would normally need to go into their health center frequently in order to have these vital signs regularly monitored.

“This equipment,” Mullaney concluded, “will have internet connectivity to the health center, facilitating home monitoring, and thereby reducing in-person visits for chronic disease patients and increasing capacity for COVID-19 care.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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