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Federally qualified health centers looking to expand their telehealth footprint need to take a closer look at why their patients are having problems accessing healthcare.

Transportation issues, insurance availability, home life and school and work pressures all can play a part in whether someone can or can’t visit the doctor, said Christina Quinlan, director of operations for Islands Community Medical Services on Vinalhaven, an island of some 1,100 people off the Maine coast. And creating a means of identifying those barriers – and using telehealth and mHealth tools to address them – will go a long way toward a value-based care environment.

“Telehealth fills the critical gaps,” she said.

Quinlan, who presented at a recent virtual conference jointly hosted by the Northeast Telehealth Resource Center (NETRC) and the Mid-Atlantic Telehealth Resource Center (MATRC), highlighted the value of using telehealth to identify and address social determinants of health as the nation shifts to a value-based healthcare system.

The situation is particularly important for FQHCs and Rural Health Centers (RHCs), who deal with a large underserved population that is growing larger as the coronavirus pandemic ravages the economy and pushes more people into Medicare and Medicaid or out of insurance altogether. These clinics have been able to take advantage of telehealth freedoms included in emergency mandates and COVID-19 relief bills to expand access, but the future is hazy – and that growing population is and will be there.

That’s why it’s important for FQHCs to understand the people they’re serving, Quinlan said.

“We know that value-based medicine isn’t a matter of if, (but) a matter of when,” she said. Focusing on reducing health disparities will be a huge part of that platform, and “the only way we can do it is through telehealth.”

The best means of identifying barriers to care is through a patient needs survey or questionnaire. This gives providers a window into the patient’s daily life, helping them to get a handle on what care needs aren’t being addressed – such as chronic condition management, behavioral health, health and wellness checkups.

Those needs might not be met because of a lack of transportation, Quinlan said, or perhaps a lack of insurance or other family needs that get in the way of going to the doctor.

Her advice? Take on the no-show rate first, addressing why those visits aren’t being conducted and finding ways to put people in front of providers, either in person or virtually.

This may also mean bundling services together, and using telehealth to access other care providers or specialists or even non-medical services.

This is particularly helpful in a place like Vinalhaven, some 75 miles by boat from the mainland. A family coming in for a wellness checkup or some other medical appointment could also be scheduled at the same time for a behavioral health session, a visit with a social worker, maybe even a substance abuse testing or counseling session or a meeting with a probation or parole officer, education specialist, accountant, lawyer or family therapist.

Integrating social care and other services with clinical care will be “more prevalent as we move towards value-based medicine,” Quinlan says. And a rural or community clinic that can use a telehealth platform to accommodate those services stands a good chance of improving outcomes.

“For the first time, we’re linking medical and non-medical services in ways that can help the provider meet the bottom line,” she said. And “we’re removing the transportation issue” and using the limited space a center might have to accomplish a wide range of services.

The challenge, as always, is sustainability. Federal and state guidelines have eased in the midst of the pandemic to support more connected health access, and private payers have been accommodating in boosting their coverage, but the future beyond COVID-19 is uncertain.

More to the point, Quinlan says an FQHC or RHC needs to address these issues regardless of whether they’ll get paid, because it helps them to establish relationships with patients.

“The reimbursement may not always be there, but the value is,” she said.

The trick may be in understanding what services can lead to coverage. A Medicaid or Medicare program may allow reimbursement for substance abuse therapy delivered via telehealth to the patient’s home or behavioral counseling for obesity, or a private plan might cover health and wellness screenings.

As well, questionnaires and screenings might not be reimbursed, Quinlan said, but “it’s where they lead you to.” These services identify those critical gaps in care that lead to tests, specialist services and follow-up care that will be covered.

And those follow-ups can be handled through telehealth.

Quinlan sees a lot of uncertainty ahead as federal and state regulators move from a fee-for-service platform to value-based care. Social care will be included in alternative payment models, she said, but in many case it will be up to care providers to raise their voices, point out the value of providing certain services, and show that telehealth can and should be used to provide them. There should be some “give and take” in the process, she said.

For distant and disparate community health centers, FQHCs and RHCs that sit on the front lines and serve a growing number of people struggling to access care, “this is the time” to open up about the value of telehealth. “This is a movement for advocacy.”

“Value-based care will require telehealth,” she added. It’s not just a tool in the toolbox, but “the best tool.”  

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