Establishing a telehealth alliance to boost rural healthcare access

Rural healthcare provider organizations have a formidable mandate: improve health outcomes of underserved populations with shoestring budgets and limited clinical resources. Though virtual care approaches have proven valuable in expanding care access and outcomes, rural facilities face financial and operational barriers to implementing them. This led one virtual care provider to create a novel solution: an alliance that allows rural hospitals with similar needs to band together to deploy virtual specialty services. 

Research shows that virtual care technologies and programs can positively affect rural healthcare. One report published last year revealed that expanding telehealth access through broadband improvements in 10 Southern counties could save nearly $43 million in healthcare costs. Another study found that telehealth can increase appointment completion rates by about 20 percent among rural residents.

However, telehealth adoption among rural healthcare organizations has historically been lower than non-rural facilities. Compared to metropolitan area hospitals, rural hospitals were 6 percent less likely to adopt any telehealth services, according to an analysis of the 2018 American Hospital Association (AHA) Annual Survey and IT Supplement Survey. 

As the government eased telehealth regulations during the COVID-19 pandemic, including allowing rural health centers to receive Medicare reimbursement for telehealth services, telehealth adoption and use in rural areas grew. Still, implementing telehealth services is a challenging prospect for most rural and low-resourced healthcare facilities.

Enter the Eagle Rural Care Alliance. Launched in February by virtual care provider Eagle Telemedicine, the program enables rural hospitals to pool their needs and offer virtual specialty care services to patients at an affordable price.

HOW THE EAGLE RURAL CARE ALLIANCE WORKS

When Jason Povio, CEO of Eagle Telemedicine, first brought up the idea of the alliance to his team, he cited the example of Sprint’s ‘framily’ plan.

“The commercials were funny to me because it started with friends and family, but then all of a sudden people were trying to get their postman to sign on to their plan…And so that same concept is like, well, hospital A and hospital B are not affiliated; they're not owned by the same company; they don't align to a collaborative or one large group GPO or anything of that nature, but they share the same challenges,” he said in an interview with mHealthIntelligence.

Though the ‘framily’ plan lasted less than a year in 2014, Povio and his team were able to apply the same basic concept to rural hospitals looking to provide specialty care via telehealth.

As part of the Eagle Rural Care Alliance, rural hospitals join together to purchase Eagle Telemedicine’s virtual specialty care services for a minimum number of hours a month. The company has a virtual team of more than 430 physicians across 17-plus specialties.

The minimum hours threshold for any given specialty is calculated based on the cost of operating the virtual care programs in a particular market, including expenses like state licensing and Drug Enforcement Administration fees. For example, Eagle Telemedicine may need a group of hospitals to buy 40 hours of virtual cardiology services monthly to provide the services in a specific market.

“With our first endeavor into the rural care alliance, facilities were only required to buy into four hours of clinic time a month,” said Povio. “I mean, that is really small. And, by doing so, they can keep their financial risk very, very low while also presenting to their community access to a specialty they'd never had. And then we can grow from that point.”

The virtual care company decides which specialty to offer in which market based on need, Povio noted. It uses community-based needs assessments and other research to determine what the most pressing needs are in a market and which services would be beneficial for community health. For instance, if there is a high prevalence of rheumatoid arthritis in an area, hospitals can band together to buy access to Eagle’s virtual rheumatologists.

There are no contractual obligations tying the rural healthcare organizations together, Povio said. The only contracts are between Eagle Telemedicine and the facility.

“For reasons that pertain to them specifically, [hospitals] can buy in more, buy in less, or need to bow out,” he said. “I mean, hospitals close. You never want to have that happen, but if one does, they obviously, by default, need to fall out of this alliance and obviously no longer are contributing to that four-hour buildup to that threshold. And so, we wanted to make this as easy as possible for these facilities in that way.”

In cases where some hospitals have to pull out of the alliance, Eagle would begin conversations with other facilities in the market that have similar specialty care needs.

While the virtual care company does offer a proprietary telehealth platform, hospitals that join the alliance do not have to use it. If a hospital has procured its own technology platform through grant funding or another avenue, it can use that platform to access Eagle’s services, Povio stated. However, if a facility does not have an existing platform, Eagle can provide one.

“The challenge we were looking for to solve on the proprietary or the technology side was there's a lot of elephants in the market, and that's great…But not every platform is designed for every problem. And these smaller 10-bed community hospitals need a different solution set that's more fit for [their] purpose,” he said.

WHAT’S IN IT FOR PROVIDERS?

The alliance includes 11 provider organizations in Kansas. One is Goodland Regional Medical Center, a critical access hospital in Sherman County.

“We provide family medicine services through our rural health clinic to a large population of Medicare, commercially insured, and Medicaid patients,” said Amie Powell, RN, BSN, chief operations officer and clinic administrator at Goodland Regional Medical Center and Rawlins County Health Center, in an interview with mHealthIntelligence.

Powell further noted the numerous barriers to specialty care access for patients in rural Kansas, including the long distances, high costs, and potential for missing work to access healthcare services.

While the hospital has an outreach clinic that offers access to 29 specialty care providers on-site and virtually, joining the alliance has allowed it to offer more specialty services, such as rheumatology, nephrology, and endocrinology.

Goodland Regional is bundling services with three or four other hospitals in the area, depending on the specialty. It offers four-hour blocks once a month for the above specialties.

“There would be significant financial limitations if Goodland Regional Medical Center were to provide these services independently from Eagle Telemedicine and collaboration with the other rural hospitals,” Powell said. “When new clinics start, it often takes time for volumes to build, to fill doctors’ schedules, and external providers to refer patients. Due to these factors, it is often difficult to be financially viable due to the high fees for specialist providers within the first year or even two years.”

Not only does being part of the alliance enable Goodland Regional to provide specialty care services to patients, but it also allows hospital physicians to connect with Eagle’s subspecialists.

“Access to healthcare services is crucial for optimal health and well-being of rural residents,” Powell noted. “Telehealth is a valuable solution for addressing these healthcare access challenges in rural areas.”

She added that the hospital is eager to increase the patient care time available for the three specialty care services it currently offers, as well as add other services.

NEXT STEPS

Now that the alliance has been launched, Eagle Telemedicine is focused on increasing the number of hospitals participating in Kansas and expanding the alliance to new states.

“Some lofty goals we have set are we'd like to expand into several states into 2024,” Povio said. “I've kind of thrown a marker out there of five. It's probably being aspirational. If we could get to two or three more states with this specific model, that would be phenomenal.”

As Eagle looks to scale the model, Povio and his team are also discussing health metrics that could be useful track, such as hospital admission and readmission rates. These metrics could provide clinicians with a comprehensive view of the patients seeking specialty care, including those with comorbid conditions or at higher risk of developing complications, and adjust care delivery accordingly. The company also plans to track and analyze how this model affects the total cost of care.

“There is enough data already out there that says if you can get more of the care on the preventative side, that you avoid the big dollars down the road,” Povio noted. “So, some initial conversations are starting in that space.”

Additionally, Eagle Telemedicine is considering tracking patient adoption and satisfaction with virtual specialty care. This data could help inform decisions around the patient care journey.

Keeping rural healthcare organizations in the black is critical as rural hospital closures spike and workforce shortages threaten patient care and safety. According to Povio, novel models like the Eagle Rural Care Alliance can help sustain these hospitals, which are also usually the largest employers in rural areas.

“The ability to be able to contribute to that hospital's economic viability for the community is pretty important,” he said.

One potential hurdle Povio and his team are keeping an eye on as the alliance continues to grow is clinic space. As hospitals add specialties to their roster, they may not be able to grow clinic space accordingly due to a lack of resources. As a result, they may have to operate multiple specialties in one clinic.

However, Povio noted they are “a ways away from that being the problem.”

“So far, we've had really great success with [the alliance],” he said. “I suspect that we'll learn. We will find out over the next year what works well, what hasn't worked well, but we're four months into active programs at this point, and all systems go.”