In Wyoming, COVID-19 Propels Telehealth From a Luxury to a Necessity

Telehealth has long been a luxury in rural America, where primary care is still based on the face-to-face visit in the doctor’s office. But COVID-19 has changed that way of thinking, and is helping to build a wave of support for connected health that could well outlast the virus.

In Wyoming, Lisa Finkelstein is watching – and in many cases leading – that change.

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Just a few months ago, doctors in the nation’s least populous and second most sparsely populated state had two questions about using telehealth: “How am I going to get paid and am I going to get sued?”

“It was like pushing a rock up Mount Moran,” says Finkelstein, a practicing urologist for more than 20 years and former president of the Wyoming Medical Society. “There was very little buy-in. There just wasn’t any interest in trying it.”

But with every state in a near-lockdown and in-person care restricted to the most pressing cases, those doctors are seeing new value in the computer and the telephone.

The pandemic thrust the 12-year-old Wyoming Telehealth Network into the spotlight. The network had been laying the infrastructure for telemedicine and mHealth programs for some time, with support from state government and a cadre of physician champions. The network had averaged a couple dozen new providers per month into this year, then saw almost 1,900 join in the month of March alone.

“Suddenly they were knocking on the door,” Finkelstein says.

A Michigan transplant who moved to Wyoming in 2003, when the number of urologists in the state could be counted on three hands, Finkelstein was an early adopter and champion. For someone who had to drive to remote communities in the mountainous western end of the state multiple times a month, the idea of connecting online or by phone for a routine checkup seemed like a no-brainer.

And her patients “were all in,” she says. “They could see the value.”

Two years ago, she was asked to take over the telehealth program at St. John’s Medical Center in Jackson, and now has that program running smoothly. With that in hand, she and the Wyoming Telehealth Network launched a new telehealth initiative last year, buying 500 HIPAA-compliant licenses from Zoom in an effort to give reluctant providers an easy platform to conduct virtual visits.

Recently, the network asked Zoom for more licenses.

“We’re finally moving forward,” says Finkelstein.

But success won’t come easy.

In a state with less than 600,000 total residents, “we just don’t have enough people to get meaningful data,” she says. That includes readmission rates.

So the proof in the pudding will have to come from payers. The state’s Medicaid program has long been supportive of telehealth, and thanks to the pandemic, Blue Cross Blue Shield – Wyoming’s largest payer – has relaxed its rules a bit, evening expanding the number of originating sites for telehealth coverage.

“If it’s meaningful and it has value to the payers, they are going to pay,” says Finkelstein.

There’s also expansion. The large health systems in Casper and Cheyenne are part of the network, and oncologists in Salt Lake City are finding that it’s much easier to schedule 10-minute follow-up sessions with Wyoming patients online rather than have them make the five-hour drive south. Wyoming was one of the first states to jump on the Interstate Medical Licensure Compact, and is one of the most active states in pushing for universal broadband access.

“In a million years I never thought my best friend would be the broadband manager,” she says.

For her part, Finkelstein is already thinking past the pandemic.

“The paradigm needs to shift to remote monitoring and wellness,” she says, noting she’s tried out the mHealth devices developed by Tyto Care and Eko and is intent on broadening those horizons. “We have to move the conversation to care in the home (and) show people what can be done.”

As the pandemic runs its course and the state and federal government look to roll back emergency measures aimed at broadening telehealth adoption, Finkelstein says she’s prepared to lobby to keep those new rules in place. Her ammunition will be in patient stories, directed at lawmakers and payers who need proof in the value of telehealth.

“The patients and consumers are seeing the value (of telehealth) and saying, ‘I’m not doing this again,’” she says.