Hybrid approach to telehealth effective in rural communities

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“A hybrid telehealth approach expands access to specialized care, reduces travel burdens, promotes timely interventions, and enables continuous management of health conditions,” writes Kara Hartl, MD.

This article first appeared on our sister site Medical Economics.

Rural American communities have always faced unique health care challenges. Rural patients tend to be older, have fewer resources, and have more health problems than their urban counterparts. They also have fewer transportation options, making it more difficult to access care when needed.

“When a patient’s condition requires input from multiple providers, the hybrid model lets physicians easily consult with other specialists, share medical records, and collaborate with remote and in-person providers to formulate treatment plans. This set-up also makes it easier for rural residents to get second opinions,” writes Kara Hartl, MD.

“When a patient’s condition requires input from multiple providers, the hybrid model lets physicians easily consult with other specialists, share medical records, and collaborate with remote and in-person providers to formulate treatment plans. This set-up also makes it easier for rural residents to get second opinions,” writes Kara Hartl, MD.

A lack of care providers poses another profound obstacle. Nearly 20% of the US population resides in rural areas, but only around 12% of doctors practice in these communities. The shortage of specialists is particularly dire: Rural areas have approximately one-third of the number of specialists per capita compared to urban areas. America’s ongoing physician shortage will likely increase the severity of this problem in the coming decades, leading to a further decline in the number of on-site physicians available in rural communities.

The COVID-19 pandemic exacerbated many of the problems with delivering high-quality rural health care; however, the widespread expansion and embrace of telehealth proved to be a silver lining. According to a McKinsey & Company study, physicians now see between 50 and 175 times more patients via telehealth than before the pandemic.

In and of itself, telehealth is not a magic bullet, however. The Pew Research Center notes that, as of 2019, 27% of US adults aged 65+ did not use the Internet, and that percentage has not grown significantly since. Even access to the internet in rural communities is a significant problem. Furthermore, a study from the Bipartisan Policy Center and the Center for Outcomes Research and Education found that many rural patients were reluctant to use telemedicine, even when it was readily available. Their primary worry was the quality of the care they would receive.

A hybrid model for telehealth, such as that employed by Troy Medical, is the most promising solution for these dilemmas. This model calls for coordination of three key elements: a small medical clinic in the local community with a dedicated medical assistant physically present to help patients; an administrative staff to manage the logistics of the healthcare system; and a team of specialists delivering expert medical care via telehealth.

This hybrid model successfully addresses the primary obstacles to high-quality care that rural patients and their doctors face and offers three additional benefits beyond those offered by non-hybrid telehealth approach:

1). Better patient engagement.

Medicine is so much more than a doctor telling a patient what's wrong and what to do. Effective medicine, whether in-person, or via telehealth, is rooted in strong physician-patient relationships which, in turn, engender better patient engagement. The trust that grows when a patient feels their doctor is providing personalized care is vital for good outcomes, particularly in complex cases.

A hybrid model encourages robust relational ties between doctors and patients by helping patients feel simultaneously empowered and supported in their health care journeys. Because they can occur more regularly than in-person visits, virtual visits help patients forge better connections with their physicians. This sense of connection means rural patients will be more likely to listen when their doctors offer guidance on lifestyle modifications, self-care practices and other steps which allow them to take a more proactive role in their health and make informed decisions.

Meanwhile, in-person clinic staff can help patients get comfortable using the digital tools available in conjunction with their telehealth care – such as remote monitoring and access to medical records – which can, likewise, prompt those patients to take a more active role in their health care.

2). The right delivery model creates a win-win-win.

The key difference in the hybrid-model of rural healthcare is maximizing the use of local medical care and harnessing technology to deliver high-quality specialty care that is otherwise not available. Because there is a local clinic with a medical assistant, the hurdles of internet connectivity and navigating the electronic health record are completely solved. Furthermore, the medical assistant can be hands on the ground with the patient when an exam is needed as well as a trusted guide to navigate the complex medical system.

This model makes telehealth feel like a regular clinic visit and the quality of healthcare delivery remains at the highest levels. The doctors are able to practice medicine on a long-term basis, giving continuity of care, because they have a team on the ground to help the patient implement their medical plan. And all of the medical billing goes through the patient’s medical insurance, just like any normal medical visit. But, most importantly, doctors are able to practice exceptional medicine and deliver care to patients who desperately need their help and are so grateful for the elevated level of care. This is why we all became doctors.

But let’s not forget that the local community hospital is also a winner with the hybrid-telehealth model. Because the higher-reimbursement outpaint minor procedures, infusions, radiology, and laboratory studies are kept at the local hospital, the struggling rural hospitals benefit tremendously from this delivery system. With the epidemic of rural hospital closures, this novel approach can help maintain our medical infrastructure in rural America.

3). More efficient care.

Because medical facilities and MDs are more scarce in rural locations, patients often must wait many months and travel great distances for an in-person appointment. Physicians working virtually can typically see patients sooner, leading to earlier diagnoses, fewer risks of complications and better continuity of care. Once diagnosed, patients operating within a hybrid care model can then reach out to local clinic staff for help in scheduling necessary tests or interventions.

Even when in-person doctor appointments are available, rural residents tend to have to travel long distances to reach healthcare facilities. Those with limited mobility, chronic conditions or tight budgets may find regular in-person physician visits especially difficult. By offering a telehealth option for routine check-ups, medication management, and certain follow-up visits and consultations, physicians and clinics can reduce their overhead while helping patients avoid the financial and time costs associated with frequent and lengthy travel.

When a patient’s condition requires input from multiple providers, the hybrid model lets physicians easily consult with other specialists, share medical records, and collaborate with remote and in-person providers to formulate treatment plans. This set-up also makes it easier for rural residents to get second opinions. By increasing the efficiency of a multidisciplinary approach, hybrid telehealth can lead to better outcomes, especially for complex medical cases.

A hybrid telehealth approach expands access to specialized care, reduces travel burdens, promotes timely interventions and enables continuous management of health conditions. Together, these improve patient care and health outcomes and bridge the health care gap between rural and urban areas.

Kara Hartl, M.D., is a physician, philanthropist, Harvard graduate and the founder and CEO of Troy Medical, an innovative approach to telemedicine that uses technology to bring high-quality medical specialists to remote and medically underserved communities. After 14 years of living in rural Alaska, Dr. Hartl has seen firsthand the limitations geography can have on access to medical care. She is passionate about creating a new gold standard for telemedicine in underserved America via their groundbreaking hybrid model.

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