Virginia's Fauquier Clinic Pivots to mHealth to Expand Access to Care

Rural health clinics forced to change their ways by the Coronavirus pandemic are finding that telehealth and mHealth platforms can do a lot of good.

The Fauquier Free Clinic, serving uninsured and underinsured residents of rural northwestern Virginia, had launched a successful telemental health program in 2017. With telemedicine stations in three rooms, the Warrenton-based clinic averaged about 120 sessions a month, connecting patients who couldn’t or wouldn’t find local care with psychologists and counselors across the country.

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“We couldn’t partner with any local brick-and-mortar practices because they just didn’t have the capacity,” says Shannon Raybuck, LPC, Fauquier’s mental health care coordinator. “We’re giving folks who never would have had access to these services any other way access to the care they really need.”

But with the onset of the COVID-19 crisis, the clinic had to shift gears, all but shutting down its in-person service (except for emergencies) and moving to an mHealth platform. Patients were encouraged to use a computer, laptop or smartphone, calling in from their homes or a nearby Wi-Fi hotspot, many of which were set up by communities to facilitate mHealth access.

Raybuck says the new connected health platform hasn’t reduced traffic – in fact, it has helped reduce no-shows and missed appointments.

“All of the patients here have barriers left and right,” she says. Calling or logging in to see a counselor might be a whole lot easier than taking time off from work or school for an appointment, or finding transportation, or even committing to going to the clinic. And clinic staff can call patients who haven’t logged in for an appointment, reminding them or urging them to call in now rather than rescheduling for another time.

“What makes this work is they can (access the service) from wherever they want, and it gives them a safe space to talk,” Raybuck says. “Sometimes they’re dealing with issues that are too overwhelming for a face-to-face visit … and they have a sense of safety in the screen.”

The platform also gives care providers virtual access to the patient’s home environment, allowing them to gain more insight into what are often called the social determinants of health – clues that aren’t always apparent or offered in an office or telemedicine room at the clinic.

Finally, the platform has also given the clinic resources it normally wouldn’t have. Partnering first with American Well and more recently with InSight + Regroup, Fauquier now offers online access to a broad array of specialists not available in rural Virginia.

“We serve a vulnerable patient population with poor social determinants of health,” Raybuck said in a blog published by InSight + Regroup. “Like many rural communities, we have a critical shortage of psychiatric and mental health providers and none of our local psychiatrists speaks Spanish fluently. Therefore, the value of this telepsychiatry program cannot be overstated. Not only does it increase access to behavioral health care in our area, but it also allows the Spanish-speaking residents of our community to have access to these important services. It’s amazing that through this program, our free clinic in rural Virginia is able to provide vulnerable patients access to a Harvard-trained, Spanish-speaking psychiatrist on the other side of the country in California.”

With the COVID-19 crisis pushing most of the clinic onto a connected health platform, Raybuck and her colleagues are exploring new uses and opportunities, including other telehealth services and virtual staff meeting and team-building exercises. They’re also expanding the platform to offer services for staff in need of counseling or support.

Fauquier relies on grant funding to run the telehealth service, and Raybuck is hoping that payers – particularly Medicare and Medicaid programs – understand the value of telehealth being shown during COVID-19 and decide to keep in place rules and policies encouraging telehealth adoption.

She’s not alone. Rural clinics, federally qualified health centers and community health centers across the country are jumping on the telehealth bandwagon now, thanks to relaxed rules that allow them to be reimbursed for their services and funding from the CARES Act and the Federal Communications Commission’s COVID-19 Telehealth Program to help care providers expand their platforms and improve broadband connectivity.

In hopes of keeping this momentum going once the crisis has passed, Raybuck is collecting patient surveys and a great deal of anecdotal evidence.

“This has literally and truly been a life-saver,” she says.